crossing the policy chasm how to connect health services research with decision making
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Crossing the Policy Chasm: How to Connect Health Services Research with Decision-Making. Andrew Bindman, MD Professor Medicine, Health Policy, Epidemiology & Biostatistics University of California San Francisco. Traditional Research to Policy Model. Problem identified with help of research

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crossing the policy chasm how to connect health services research with decision making

Crossing the Policy Chasm:How to Connect Health Services Research with Decision-Making

Andrew Bindman, MD

Professor Medicine, Health Policy, Epidemiology & Biostatistics

University of California San Francisco

traditional research to policy model
Traditional Research to Policy 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

traditional model not so traditional
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

incremental policy
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

two communities
Two Communities

Research and policy worlds culturally distinct

Distinct language, timing, and values



Publish or Perish

A Mile Deep

Peer Review




Endowed Chair


The Hill

The Power of the Press

A Mile Wide

Public opinion

Meet and Greet


Committees (A/B)

Committee Chair



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


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 on back order, and comes from last year’s fashion line

knowledge brokering
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

attributes of knowledge brokers
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

who are knowledge brokers in federal health policy
Who Are Knowledge Brokers in Federal Health Policy

Congressional think tanks


Congressional Commissions

Medpac, MACPAC

Institute of Medicine


Universities and other research organizations

others who seek to fill the knowledge void
Others Who Seek to Fill the Knowledge Void

Washington think tanks

Interest groups

voluntary health associations
Voluntary Health Associations

American Heart Association

American Cancer Society

American Diabetes Association

Paralyzed Veterans of America

National Alliance Mentally Ill

March of Dimes

trade associations
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


professional societies
Professional Societies

American Medical Association

National Medical Association

American Nurses Association

American Pharmacists Association

American Trial Lawyers Association

think tanks
Think Tanks

Center for American Progress



Urban Institute

New America Foundation

Brookings Institute






other major stakeholders
Other Major Stakeholders


Families USA

National Governors Association

National Conference of State Legislators

knowledge broker communication
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

what are they talking about
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

interest groups will go beyond information and promote action
Interest Groups Will Go Beyond Information and Promote Action

Encourage introduction of bill

Write language of bill

Strategize politics of legislation with Congressional leadership

Bring members to hearings

Liaison with executive branch

why do policy makers staff want to meet with knowledge brokers
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

limitations of knowledge broker model for researchers
Limitations of Knowledge Broker Model for Researchers

Time demanding to be an available resource for decision-makers

Value of objective research evidence can be diminished in a sea of competing messages from biased knowledge brokers

Promotes style over substance

where does research end and advocacy begin
Where Does Research End and Advocacy Begin
  • Some researchers never cross the policy chasm
  • Others engage policymakers without engaging the communities affected by the policies
  • Increasingly researchers are working in a collaborative and interactive way throughout the research process with stakeholders to influence policy
community based participatory research
Community Based Participatory Research
  • “Research subjects become more than research objects. They give more than informed consent; they give their knowledge and experience to the formulation of research questions and methods applied…they become active partners in identifying key problems and in using the research findings to advocate policies and programs and in program development, monitoring and evaluation.”
  • Green and Mercer, AJPH, 2001
who is the community in participatory research
Who is the Community in Participatory Research
  • Those affected by issue being studied
    • Individuals living in a geographic area
    • Community based organizations
    • Government agencies that provide/manage resources targeting at- risk individuals/communities
traditional research vs cbpr formative stage
Traditional Approach

Researchers plan project

Form team

CBPR Approach

Policymakers and academic partners form team

Develop shared mission and decision-making structure

Traditional Research vs CBPRFormative Stage
traditional research vs cbpr study selection
Traditional Approach

Researchers choose topic and design based on scientific theory, academic interest, data, feasibility

CBPR Approach

Policymakers and academic partners also incorporate community priorities insights and assets; scientific rigor and community feasibility

Traditional Research vs CBPRStudy Selection
traditional research vs cbpr funding
Traditional Approach

Grant written by researcher

Funds go to researchers

CBPR Approach

Policymakers and academic partners co-develop grant with equitable distribution of funds based on contributions

Traditional Research vs CBPRFunding
traditional research vs cbpr implementation analysis
Traditional Approach

Researchers solely responsible for conducting study and analyzing data

CBPR Approach

Policymakers and academic partners collaborate on all efforts; traditional analysis informed by policy driven questions

Traditional Research vs CBPRImplementation/Analysis
traditional research vs cbpr disseminate findings
Traditional Approach

Disseminate to academic audiences

CBPR Approach

Policymakers and academic partners are co-authors and co-presenters; disseminating to academics, research participants, involved communities and policy makers

Traditional Research vs CBPRDisseminate Findings
traditional research vs cbpr translate research in policy
Traditional Approach

Research often ends with publishing of results

CBPR Approach

Policymakers and academic partners mobilize the community to use findings to advocate for policy change

Traditional Research vs CBPRTranslate Research in Policy
traditional research vs cbpr sustain team
Traditional Approach

When grant ends, researchers often move to new project

CBPR Approach

Sustainability built into work from inception; partners honor initial commitment to continue partnership and work beyond funding cycles

Traditional Research vs CBPRSustain Team
community based participatory research cbpr
Community Based Participatory Research (CBPR)
  • Benefits
    • Direct and indirect funding potential
    • Enhanced access to data
    • Greater understanding of policy questions
    • Opportunity to participate in applied work that could have direct impact on policy
cbpr with policymakers
CBPR with Policymakers
  • Challenges
    • Relationships take time
    • Sharing power, resources, decision-making
    • Service versus research objectives
    • Academic independence and desire to learn from data versus a shared mission-driven set of beliefs
community based participatory research with policymakers
Community Based Participatory Research with Policymakers
  • Additional Challenges
    • If too aligned with one political party could be labeled and isolated by the other
    • Political environment can challenge ability of policymakers to be consistent partners
    • Policy versus academic response times
navigating a university and state government partnership
Navigating a University and State Government Partnership
  • California Medicaid Research Institute (CaMRI)
    • University of California multi-campus research program
    • Master agreement between UC and state that specifies expectations and responsibilities for choosing projects, data sharing and publishing
    • Cultivating relationship over time and deep into organizations - not just with leadership
    • Pursue direct as well as independent funding
camri medicaid waiver evaluation process with state
CaMRI Medicaid Waiver Evaluation Process with State
  • Formulate questions together
  • Agree on methodological approach
  • Approach funders together
  • Dissemination plan includes scientific community as well as Medicaid stakeholders (counties, patients and providers)
closing thoughts
Closing Thoughts
  • Research can inform public policy and be a powerful tool for social change
  • To enhance your effectiveness you need to be scientifically rigorous and sophisticated in how you disseminate your results
  • Connecting with and forming linkages among knowledge brokers is critical for influencing the policy process
  • Community based participatory research may be a highly effective way to align the research process with the policy decision-making process