Lecture 4 Communicating with Policymakers

1. Lecture 4Communicating with Policymakers Andrew Bindman, MD Professor Medicine, Health Policy, Epidemiology & Biostatistics

2. Two Communities Research and policy worlds culturally distinct Distinct language, timing, thought processes and values

3. Thought Processes Scientific Problem Statement Literature Search Methods Data Analysis Results Limitations Summary and Conclusions Political The issue Current Law Positions The member The party Relevant Stakeholders -Budget Impact and Distribution -Staff recommendation

4. Values Academic Publish or Perish A Mile Deep Peer Review Teaching Research/Grants Department Endowed Chair Tenure The Hill The Power of the Press A Mile Wide Public opinion Meet and Greet Fundraising Committees (A/B) Committee Chair Reelection

5. Researchers tend to see decision making as an event-they deliver their edicts to the impenetrable cardinals’ retreat and await the puff of smoke that signals decision while grumbling about irrationality within the conclave

6. Decision makers tend to see research as a product they can purchase from the local knowledge store, but too often it is the wrong size needs some assembly, is o back order, and comes from last year’s fashion line

7. Knowledge Brokering • Conduit for two way communication between researchers and decision-makers • Informing decisions is as much social as it is technical • Requires re-formulated communication and social interaction to bridge

8. Attributes of Knowledge Brokers Understands cultures of research and decision making environments Able to find and assess relevant research in a variety of formats Facilitates, mediates, negotiates Trusted and credible Clear communicator

9. Who Are Knowledge Brokers in Federal Health Policy Congressional think tanks CRS, CBO, GAO Congressional Commissions Medpac, MACPAC Institute of Medicine Foundations Universities and other research organizations

10. Others Who Seek to Fill the Knowledge Void • Washington think tanks • Interest groups

11. Voluntary Health Associations American Heart Association American Cancer Society American Diabetes Association Paralyzed Veterans of America National Alliance Mentally Ill March of Dimes

12. Trade Associations America’s Health Insurance Plans American Hospital Association Association of American Medical Colleges Federation of American Health Systems Pharmaceutical Research and Manufacturers Association ADVAMED

13. Professional Societies American Medical Association National Medical Association American Nurses Association American Pharmacists Association American Trial Lawyers Association

14. Think Tanks Center for American Progress Heritage Cato Urban Institute New America Foundation Brookings Institute

15. UNIONS SEIU AFL-CIO UAW ILGWU

16. Other Major Stakeholders AARP Families USA National Governors Association National Conference of State Legislators

17. Interest Groups Often form in the wake of legislation Source of expert but self-interested opinion Protect the turf and further membership’s agenda and special marketplace position

18. Interest Group Relationship with Research • Groups vary in their commitment to evidence based decision making • Increasingly play a role in funding • Convince 3rd party to fund • Directly support • Dissemination of research findings often selective based on whether they support policy agenda

19. Knowledge Broker Communication Shopping ideas to sympathetic staff in Congress, White House and Agencies Cultivating specific relationships Talking to other knowledge brokers Communicating back to leadership of organization

20. What are They Talking About Updates about what new things they have learned since last conversation Information about membership concerns Updates about where things are in legislation cycle Updates on how other decision makers view action items

21. Why Do Policy Makers/Staff Want to Meet with Knowledge Brokers To hear about the latest research findings To learn about stakeholder positions and priorities To learn what knowledge brokers have learned from other decision makers To test ideas for solutions To activate political pressure

22. Can an Individual Researcher be a Knowledge Broker Yes but … It generally takes an ability to be consistently visible Working with a “professional” knowledge broker is akin to having an agent A knowledge broker can position you to maximize your use in cameo roles

23. Opportunities to Speak with Policymakers Legislative (hill) visits Executive branch visits Legislative hearings Judicial testimony Work on government commissions

24. Why Should You Interact with Policymakers • To advance your agenda • Don’t squander this on over describing yourself or your organization • This is a strategic opportunity

25. Legislative Visits Typically initiated by you or an organization you work with Specified appointment (30-60 min) More likely with staff than member

26. Who Are You Representing Generally not yourself unless it is a personal story Your university? Your professional organization? A community based organization? A coalition of groups?

27. Don’t Be a Loose Cannon • Be explicit with all parties about who you are representing • If you want to suggest you are representing an organization make sure the organization has explicitly approved your doing so • UCSF government affairs office • Most organizations including the University will send along their lobbyists

28. Consider Making It a Party • Many visits work better as a group particularly if you can represent a unified position among stakeholders • Choreograph ahead of time how group members will participate in presentation

29. Anticipating Your Audience Legal - what’s the current law for your issue Technical - what are the operational barriers to change Political - what’s the relevant voting record of the member on the topic Jurisdictional-how does the issue relate to members geographic/committee jurisdiction Personal - What’s the member’s personal commitment to the issue

30. Resources • Websites • Legal - www.thomas.loc.gov;www.gpoaccess.gov/fr/ • Foundations and other knowledge brokers • RWJ Foundation, Commonwealth Fund, Kaiser Family Foundation • Members of Congress own sites • Direct communication with government affairs personnel working for knowledge brokers can quickly get you up to speed

31. Dress Formally and Be On Time Government is a formal place Business suits are the norm The pace is brisk Members and staff will act casual about time but they aren’t Be on time but not too early Stay on time

32. Setting the Stage to Deliver Your Message Acknowledge constructive efforts the member has made in your area of interest Briefly introduce yourself, what your organization does, and who it serves To the degree possible make a connection between your issue and how it affects those who the representative serves

33. Boiling Down Your Message You’ve got somewhere between 30 seconds and 3 minutes to tell your story Prepare both and know when to use each State why your issue is important and illustrate with examples Describe how your work/your work with an organization provides a solution. Avoid jargon/technical terms

34. Storytelling A critical way to build a bond with a policymaker around an issue A pointed story that the lawmaker might repeat to others Focus on a person or a family and include a few special details to help make it real Ideal if affected party from member’s district/state

35. The Ask Don’t just describe an issue, propose a solution Politicians dislike problems they can’t solve as much as doctors dislike diagnoses they can’t treat Members like to help and want to say yes- tell them what you want them to do

36. Some Things You Can Ask of a Policymaker • Provide a letter of support • Attend a meeting • Help navigate a regulatory issue • Organize a hearing • Request an investigation • Support pending legislation • Introduce legislation

37. The Follow Up Plan Figure out who is doing what next Make it clear how you think you can help move an issue forward Plan for the next interaction

38. What to Leave Behind A business card A one-pager Possibly a research summary No gifts

39. The One Pager A brief synopsis of your issue, your solution and your ask Simply phrased bullet points with lots of white space on paper Include pointed examples that make it relevant for a particular representative Include contact information or attach your card

40. Executive Branch Visits • Similar format for meeting • Less need to emphasize district/state specific details • Ask relates to flexibility agency has in setting regulations within limits of law

41. Hearings • Support a legislative committee’s role in oversight of executive branch • Testifying is more formal than a visit but follows the same format of rapidly framing an issue, illustrating with examples and ending with an ask (recommendations) • One usually testifies as a part of a panel and legislators will often ask questions • You are either a majority or minority witness

42. Government Commissions • Structured to be bi-partisan • Often include representation of key stakeholders and may sometimes include current or former politicians • Intended to provide technical expertise and to formalize expert advice of stakeholders • Researchers often prepare background/summary papers and testify • Obtain guidance from Commission staff / follow format of legislative hearings

43. Be Strategic • In every interaction think about how you can use it to further your agenda • All talk is for a purpose; use it wisely to try to make a difference • In the context of interacting with policymakers and their staff you are always on- watch the jokes and “off the record” comments

44. One-Pager Homework Assignment • Your chance to practice boiling down your message to 1 page • Use bullet points • What is your policy issue • How does your research support a particular policy approach • What is your ask of the policymaker • Be prepared to share it in class next week