Understanding “Research Use” in Health Care Management

1. Understanding “Research Use” in Health Care Management Huw Davies, PhD Centre for Public Policy & Management University of St Andrews

2. Research Unit for Research Utilisation (RURU)Huw Davies, Sandra Nutley, Isabel Walter Jen Morton, Joyce Wilkinson, Tobias Jung many downloadables at: www.st-and.ac.uk/~ruru

3. What IS research use? What IS research impact? How can use/impact be facilitated? CEO

4. not starting with a blank page here! • this is about knowledge, and is concerned with understanding socially situated human action… Nutley SM, Walter I, Davies HTO. Evaluation 2003;9:125-48. From Knowing to Doing: A framework for understanding the evidence-into-practice agenda. “At the core of Evidence-Based Management is the notion that health care managers should incorporate into their decision making the best available research.”

5. SOMETIMES: clearly defined event explicit decisions conscious deliberation defined policies policy fixed at implementation OFTENTIMES: ongoing process piecemeal: no single decision muddling through policies emerge and accrete shaped through implementation Role of Evidence in Management: Engineered : Emergent Managerial decision making

6. Practice & policy change Knowledge & understanding Attitudes, perceptions, ideas Awareness 1. Knowledge 2. Persuasion 3. Decision 4. Implementation 5. Confirmation A research use continuum: CONCEPTUAL USE INSTRUMENTAL Impacts on organisational outcomes? Different strategies for different ends?

7. NOT Evidence-based but Evidence-influenced... or even just Evidence-aware?

8. A map of the terrain Types of knowledge Types of research utilisation EBMan Conceptual Frameworks Models of process Implementation interventions

9. Types of knowledge Types of research utilisation Knowledge content: “What works” (know-what) but also… Know-about (problems) Know-how (to put into practice) Know-who (to involve) Know-why (impetusto action) EBMan Knowledge form: Explicit Knowledge: - research - routine data Tacit Knowledge Conceptual Frameworks Models of process Implementation interventions

10. Types ofknowledge Types of research utilisation EBMan • Instrumental or conceptual? • Underuse, overuse & misuse? • Replication or innovation? Conceptual Frameworks Models of process Implementation interventions

11. Research intomanagement Research inmanagement Types ofknowledge Types of research utilisation EBMan • Research intomanagement (simple): • Emphasis on linearity & logic • ‘Two Communities’ paradigm • Dissemination/KT elements: • Source (e.g. perceived competence) • Content (e.g. fit with existing practice) • Medium (e.g. timeliness, accessibility) • User (e.g. capacity to use information) Conceptual Frameworks Models of process Implementation interventions

12. Research intomanagement Research inmanagement Types ofknowledge Types of research utilisation EBMan • Research intomanagement (complex): • Manager as learner • Emphasis on complex adaptive systems • Implementation as cultural change… Conceptual Frameworks Models of process Implementation interventions

13. Types ofknowledge Types of research utilisation EBMan Research intomanagement • Research inmanagement: • Challengesany neat separation between research and practice • Emphasisesthe social construction of knowledge and the role of power • Analyses the EBEverything discourse Conceptual Frameworks Models of process Research inmanagement Implementation interventions

14. Types ofknowledge Types of research utilisation Diffusion of innovations… Institutional theory… Change management… Knowledge management… Individual learning… Organisational learning… EBMan Conceptual Frameworks Models of process Implementation interventions

15. What works in gettingbetter research use & impact? Types ofknowledge Types of research utilisation • No magic bullets • Even good passive dissemination is not enough • Active interventions are required… • …informed by diagnosis of barriers to change • Multifaceted & multilevel approaches seem best • Some evidence to support partnership working… EBMan Conceptual Frameworks Models of process Implementation interventions

16. Partnership working – no easy ride…

17. Underpants on the outside of trousers... Research-savvy managers? • Understanders of context • Knowledgeable on the research base • Managers of complex relationships • Skilled at information management • Grounded in economics, statistics and social science • Strong project management ability • Presentational and communication skills • Adaptive, continually learning… UK Cabinet Office, 1999

18. Take home messages: • There is scope for improved evidence-informed health care management - especially within modified organisational processes. • For improved impacts: • Develop ‘enlightenment’ impacts • Translate/tailor the evidence • Expect local adaptation and tinkering • Shape the local context • Secure active engagement throughout • Deepen partnership working

19. Evidence based management? Some way to go…