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

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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


Values

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


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

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


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

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

CRS, CBO, GAO

Congressional Commissions

Medpac, MACPAC

Institute of Medicine

Foundations

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

ADVAMED


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

Heritage

Cato

Urban Institute

New America Foundation

Brookings Institute


Unions

UNIONS

SEIU

AFL-CIO

UAW

ILGWU


Other major stakeholders

Other Major Stakeholders

AARP

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


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