Homework Summary

1. Homework Summary • Impressive job of identifying policy changes • Thoughtful consideration of comparison groups • Encourage you to step back from policy to ask your question and why policy will address it • To what extent is the policy associated with your predictor but not your outcome except through the policy (instrumental variable) • Don’t stop at predicting predictor - your edge is your clinical connection to policy

2. Lecture 3Positioning Yourself to be Influential in the Policy Arena Andrew Bindman, MD Professor Medicine, Health Policy, Epidemiology & Biostatistics

3. Traditional Model Problem identified with help of research Decision making about actions supported by research on options Policy implemented Monitoring and evaluation through research Research at the core of rational decision making based on consideration of all the options

4. Traditional Model Not So Traditional Real life decision making not linear More iterative process Too complex to consider all the options and insufficient data to do so Rather than finding ideal solution looking for a “good enough” one

5. Incremental Policy “Good enough solutions” lead to small scale changes Research not at the heart of assessing all the options but used in selective ways by competing groups that move in a diffuse way toward consensus

6. Garbage Can Model Policy process is chaotic and unpredictable - irrational Solutions don’t follow from policy analysis and in many cases policy analysis may come after a solution

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

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

17. 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

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

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

20. UNIONS SEIU AFL-CIO UAW ILGWU

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

22. 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

23. 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

24. 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

25. 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

26. Actions Interest Groups Will Take that Other Knowledge Brokers Don’t Encourage introduction of bill Write language of bill Strategize politics of legislation with Congressional leadership Bring members to hearings Liaison with executive branch

27. 9-11 Bill • Became law at end of 2010 • Health care entitlement for responders and community residents related to WTC disaster • Significant lung disease • Insurers deny coverage saying occupational acquired illness

28. 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

29. What else are Congressional Staff Doing with Their Time Organizing hearings Briefing/strategizing with one another Drafting legislation Agenda setting with leadership of chamber Responding to inquiries Preparing public statements for members and the press

30. 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

31. Some University of California State Health Policy Knowledge Brokers California Program on Access to Care (CPAC) California Health Benefits Review Program (CHBRP) California Medicaid Research Institute (CaMRI) Provide opportunities to interface researchers with policymakers, funders and other stakeholders

32. Virtuous Cycle • Goal is to get stakeholders, funders, decision makers focused on your research agenda • Begins with your individual connections but accelerates when they are talking about you when you are out of the room • Inform policymakers, knowledge brokers, interest groups, funders about your issues • Next week’s talk is a case study of this in area of diagnostic radiology safety

33. Homework Assignment Who are the knowledge brokers working in your area and what are they talking about? Which knowledge brokers are your friends and which ones are your adversaries?