Program in Policy Decision-Making
McMaster University
8 January 2009
Supporting Research Use by
Health System Managers and Policymakers
Knowledge Translation (KT) Canada Lecture Series Videoconference
Toronto, ON, Canada
John N. Lavis, MD, PhD
Associate Professor and
Canada Research Chair in Knowledge Transfer and Exchange
McMaster University
Learning Objectives
1. What do we know about supporting research use by
health system managers and policymakers?
2. What are the challenges that such efforts are striving
to overcome?
3. What are some innovative strategies that are being
developed and evaluated?
2
Supporting Research Use by Health
System Managers & Policymakers
Increasingly efforts to support research use strive to
address the two factors that emerged with some
consistency in a systematic review of the factors that
increased the prospects for research use
• Interactions between researchers and policymakers
- Engage policymakers in priority-setting, research
(including reviews), and deliberative dialogues
• Timing / timeliness
- Facilitate retrieval of optimally packaged, topical
systematic reviews and review-derived products
(e.g., one-stop shopping, training workshops,
rapid response units)
3
Supporting Research Use by Health
System Managers & Policymakers (2)
Research
process
Policymaking
process
Research
process
►
◄
►
►
◄
Fortuitously linked processes
Unlinked asynchronous processes
Research
process
Policymaking
process
Knowledgetranslation
processes
Policymaking
process
►
◄
Purposefully linked processes
4
Supporting Research Use by Health
System Managers & Policymakers (3)
Such efforts need to recognize that research evidence
can play many roles in management and policymaking
• Helps to get problems on the agenda (i.e., what
challenges should we focus on?)
• Helps to think about problems and solutions
differently (i.e., how should we begin to approach this
challenge?)
• Helps to solve particular problems at hand (i.e., what
policy or action should we support?)
• Helps to justify a decision made for other reasons
(i.e., how can we ‘sell’ the position we’ve taken?)
5
Challenges in Linking
Research to Policy
1. Research competes with many other factors in the
policymaking process
2. Research isn’t valued as an information input
3. Research isn’t relevant
4. Research isn’t easy to use
6
Addressing Challenge 1
Challenge 1
• Research competes with many other factors in the
policymaking process
- Institutional constraints (e.g., constitutional rules)
- Interest group pressure
- Citizens’ values
- Other types of information (e.g., experience)
One option (among many) for addressing challenge 1
• Improve democratic processes (but this is beyond the
scope of most of us) or create “routine” processes
(as many countries have done for new technologies)
7
Addressing Challenge 2
Challenge 2
• Research isn’t valued as an information input
One option (among many) for addressing challenge 2
• Convince policymakers to place value on the use of
research by highlighting examples from the past or
from other jurisdictions where research made the
difference between policy success and policy failure
8
Addressing Challenge 3
Challenge 3
• Research isn’t relevant
One option (among many) for addressing challenge 3
• Engage policymakers periodically in priority-setting
processes and communicate the priorities to
researchers (including short-term requirements for
evidence briefs, medium-term term requirements for
systematic reviews, and long-term requirements for
new primary research)
9
Addressing Challenge 4a
Challenge 4
• Research isn’t easy to use
Challenge 4a
• Research isn’t communicated effectively (i.e.,
policymakers hear noise instead of music)
One option (among many) for addressing challenge 4a
• Identify a high-priority issue, identify systematic
reviews that address different facets of the issue,
identify messages arising from the reviews, construct
workable options for consideration, and send the
resulting ‘evidence brief’ to policymakers - e.g., 27
reviews (1/6/6/14) re ACT to treat malaria
10
Reviewderived products
(e.g., evidence briefs)
Systematic reviews of research
Applied research studies, articles, and reports
Basic, theoretical and methodological innovations
11
Addressing Challenge 4b
Challenge 4
• Research isn’t easy to use
Challenge 4b
• Research isn’t available when policymakers need it
and in a form that they can use
Two options (among many) for addressing challenge 4b
• Maintain a policymaker-targeted website that provides
“one stop shopping” for optimally packaged, topical
reviews (e.g., PPD/CCNC database)
• Provide policymaker training workshops that provide
the knowledge and skills needed to find and use
research evidence efficiently
12
PPD/CCNC database contains >800 systematic reviews
about health system arrangements, plus review-derived
products (www.researchtopolicy.ca/search/reviews.aspx)
• Summaries of systematic reviews (for more than half)
•
- E.g., SUPPORT summaries that grade the evidence
and highlight local applicability, equity and scaling up
considerations
Overviews of systematic reviews
•
- E.g., Lancet articles on human resources for health
and on primary healthcare (see reference list)
Policy (or evidence) briefs
- E.g., HEN/Observatory briefs for European ministers
13
Policymaker training workshops address: 1) defining
and framing problems, 2) identifying and characterizing
policy and programmatic options, 3) identifying
implementation challenges and characterizing
implementation strategies (and soon will address
characterizing performance monitoring, reporting and
management strategies)
• Five-day version available through EXTRA
• Two-day version offered in a number of settings in
Africa and Latin America
• One-day version offered at the Ontario Ministry of
Health and Long-Term Care and at PAHO
14
Addressing Challenge 4c
Challenge 4
• Research isn’t easy to use
Challenge 4c
• Policymakers lack mechanisms to prompt them to
use research in policymaking
One option (among many) for addressing challenge 4c
• Propose changes to cabinet submissions and
program plans to prompt policy analysts to
summarize whether and how research informed the
definition of a policy problem, the characterization of
policy/programmatic options to address the problem,
and the proposed approach to implementation
15
Addressing Challenge 4d
Challenge 4
• Research isn’t easy to use
Challenge 4d
• Policymakers lack fora where policy challenges can
be discussed with researchers and stakeholders
One option (among many) for addressing challenge 4d
• Plan deliberative dialogues at which pre-circulated
evidence summaries serve as the starting point for
off-the-record deliberations involving policymakers,
stakeholders, researchers and others
16
Addressing Challenges in
Supporting Research Use
1. Research isn’t valued as an information input
[General climate for research use]
2. Research isn’t relevant [Production]
3. Research isn’t easy to use [Translation]
a. Research isn’t communicated effectively [Push]
b. Research isn’t available when policymakers need it
and in a form that they can use [Facilitating pull]
c. Policymakers lack mechanisms to prompt them to
use research in policymaking [Pull]
d. Policymakers lack fora where policy challenges can
be worked through with key stakeholders
[Exchange]
17
Some Innovative Strategies that are
Being Developed and Evaluated
Producers
/
purveyors
of
research
Users of
research
Push efforts
Producers /
purveyors of
research
Producers /
purveyors
of research
Users of
research
User-pull efforts
One group
of users of
research
Exchange efforts
Producers /
purveyors
of research
Users of
research
Knowledge
-translation
platforms
Integrated efforts
18
Some Innovative Strategies that are
Being Developed and Evaluated (2)
Push efforts
• Literature service drawing on the PPD/CCNC
database (Canada, Brazil)*
• Evidence briefs (HEN/Observatory, EVIPNet Africa,
EVIPNet Asia/ Asia-Pacific Observatory, Canada)
Efforts to facilitate user-pull
• PPD/CCNC database
• Training workshops
Exchange efforts
• Deliberative dialogues (EVIPNet, Canada)*
Integrated efforts
• Knowledge-translation platforms (EVIPNet)*
19
References
• Lavis JN, Davies HTO, Oxman A, Denis J-L,
Golden-Biddle K, Ferlie E. Towards systematic
reviews that inform healthcare management and
policymaking. Journal of Health Services
Research and Policy 2005; 10 (supplement 1): 3548 [contains the systematic review]
• Lavis JN, Lomas J, Hamid M, Sewankambo N.
Assessing country-level efforts to link research to
action. Bulletin of the World Health Organization
2006; 84(8):620-628 [contains the framework]
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References (2)
• Lewin S, Lavis JN, Oxman AD, Bastias G, Chopra
M, Ciapponi A, Flottorp S, Garcia Marti S, Pantoja
T, Rada G, Souza N, Treweek S, Wiysonge CS,
Haines A. Supporting the delivery of costeffective interventions in primary health-care
systems in low-income and middle-income
countries: An overview of systematic reviews.
The Lancet 2008; 372: 928-939. [An example of an
overview that draws on the typology and contents
of the PPD/CCNC database]
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