18 May 2010

1. 18 May 2010 Supporting the Use of Research Evidence by Health System Managers and Policymakers Moving Palliative and End-of-life Care Forward University of Alberta Edmonton, AB, Canada

2. Outline • Outline of options available to support the use of research evidence • Challenges related to linking research to policy • Strategies to address the challenges (with a focus on systematic reviews and how and why they can be helpful)

3. Increasingly efforts to support linking research to policy 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, high-quality and high-relevance systematic reviews and policy briefs (e.g., one-stop shopping, rapid response units) Options Available to Support the Use of Research Evidence 3

4. Options Available to Support the Use of Research Evidence (2) Research process ► Unlinked asynchronous processes Research process ► Policy- making process Policy- making process ◄ ◄ Fortuitously linked processes Policy- making process Knowledge- translation processes Research process ◄ ► ► Purposefully linked processes 4

5. Such efforts need to recognize that research evidence can play many roles in policymaking Helps to get problems on the agenda (i.e., what challenges should we focus on?) Helps to think about problems and options differently (i.e., how should we begin to approach this challenge?) Helps to solve particular problems at hand (i.e., what type of 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?) Options Available to Support the Use of Research Evidence (3) 5

6. Research competes with many other factors in the policymaking process Research isn’t valued as an information input Research isn’t relevant Research isn’t easy to use Challenges in LinkingResearch to Policy 6

7. 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) Addressing Challenge 1 7

8. 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 evidence by highlighting examples from the past or from other jurisdictions where research made the difference between policy success and policy failure Addressing Challenge 2 8

9. 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 policy briefs, medium-term term requirements for systematic reviews, and long-term requirements for new primary research) Addressing Challenge 3 9

10. 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 policy issue, identify systematic reviews that address different facets of the issue, identify messages arising from the reviews, construct workable options for policymakers to consider, and send the resulting ‘policy brief’ to policymakers Addressing Challenge 4a 10

11. Why systematic reviews? (1) • Systematic reviews offer two advantages over single studies in characterizing the effectiveness (benefits) of a policy option • Reduce the likelihood that policymakers will be misled by research (by being more systematic and transparent in the identification, selection, appraisal and synthesis of studies) • Increase confidence among policymakers about what can be expected from an intervention (by increasing the number of units for study)

12. Why systematic reviews? (2) • Systematic reviews offer two additional advantages over single studies in defining problems or framing options • Allow policymakers to focus on appraising the local applicability of systematic reviews (instead of also having to find and synthesize the available research evidence on their own) and on collecting and synthesizing other types of evidence • Allow stakeholders, including public interest or civil society groups, to constructively contest research evidence because it is laid out for them in a more systematic and transparent way

13. Why systematic reviews? (3) • Systematic reviews can also be conducted for • Administrative database studies and community surveys that help to place problems in comparative perspective • Observational studies that help to characterize an option’s likely harms • Qualitative studies that help to understand the meanings that individuals or groups attach to a problem, how and why options work, and stakeholders’ views about and experiences with particular options

14. Policy briefs Systematic reviews of research Individual studies, articles, and reports Basic, theoretical and methodological innovations Hierarchy of Research Evidence 14

15. 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 One option (among many) for addressing challenge 4b Maintain a policymaker-targeted website that provides “one stop shopping” for optimally packaged high-quality and high-relevance reviews Health Systems Evidence:More than 1200 systematic reviews related to health system governance, financial and delivery arrangements (www.healthsystemsevidence.ca) Addressing Challenge 4b 15

16. 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 framing of policy options to address the problem, and the proposed approach to policy implementation Addressing Challenge 4c 16

17. Challenge 4 Research isn’t easy to use Challenge 4d Policymakers lack fora where policy challenges can be discussed with stakeholders and researchers 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 (e.g., McMaster Health Forum) Addressing Challenge 4d 17

18. Research isn’t valued as an information input [General climate for research use] Research isn’t relevant [Production] Research isn’t easy to use [Translation] Research isn’t communicated effectively [Push] Research isn’t available when policymakers need it and in a form that they can use [Facilitating pull] Policymakers lack mechanisms to prompt them to use research in policymaking [Pull] Policymakers lack fora where policy challenges can be discussed with key stakeholders [Exchange] Addressing Challenges in Linking Research to Policy 18

19. Producers / purveyors of research Users of research Addressing Challenges in Linking Research to Policy (2) User-pull efforts Producers / purveyors of research Users of research Producers / purveyors of research Users of research Producers / purveyors of research One group of users of research Knowledge-translation platforms Push efforts Exchange efforts Integrated efforts 19

20. Thank you to Dr. John Lavis for providing me with the slides for this session Contact information: Email: wilsom2@mcmaster.ca Web: http://www.researchtopolicy.ca/whoweare/mike_wilson.asp Acknowledgements 20