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Who influences policy and why?. Understanding strategies to influence the policy process. Kathryn Oliver [email protected] @oliver_kathryn. Outline. Knowledge brokerage as the ‘answer’ to the EBP ‘problem’ Approaches to studying KB Activities of policy actors as a lens

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Who influences policy and why
Who influences policy and why?

  • Understanding strategies to influence the policy process

Kathryn Oliver

[email protected] @oliver_kathryn


Outline
Outline

  • Knowledge brokerage as the ‘answer’ to the EBP ‘problem’

  • Approaches to studying KB

  • Activities of policy actors as a lens

  • Who are KBs?

  • How do they influence policy?


Evidence based policy research
Evidence-based policy research

  • Explicitly aims to

  • increase amount of research used in policy

  • to ‘upskill’ policy makers

  • to present joint narratives of how evidence is used in the ‘black box’ of policy

Oxman et al. Health Research Policy and Systems 2009 7(Suppl 1):S15


Evidence based policy research1
Evidence-based policy research

i.e. the research Is framed as a “problem” that evidence is not used in research

What effect does this framing have?

Oxman et al. Health Research Policy and Systems 2009 7(Suppl 1):S15


Solutions offered by researchers...

Social relations known to affect use of evidence, finding of information, decision-making and many other aspects of policy making



Knowledge brokerage is
Knowledge brokerage is...

A intervention (set of actions) carried out by academic/research-based individuals in an attempt to influence policy processes

Policy-makers

Academia

KB


Stumbling block
Stumbling block…

Policy process models unverified, unvalidated, unhelpful

If we don’t understand the policy process, how can we influence it?

Oxman et al. Health Research Policy and Systems 2009 7(Suppl 1):S15


Questions remain
Questions remain….

WHO influences policy?

HOW do they influence policy?

&

Can we compare [KB] with [strategies used to influence policy] as two sets of activities?


NHS North West

Regional Director of Public Health (Emma)

Heywood, Rochdale & Middleton PCT

Bury PCT

Manchester PCT

Salford PCT

Bolton PCT

Oldham PCT

Directors of Public Health

Chair: Alistair

Trafford PCY

Stockport PCT

Ashton Leigh and WIgan

Data

Chief executive

Chairman of board

Directors (Finance, Medical, Nursing, HR, Public Health)

Non-executive board members



Influential policy makers
Influential policy makers

225 network members


Data

42 interviews (formal and informal) with academics, policy actors, public health professionals

18 hours observations of public and private meetings

Generating accounts of evidence use, policy processes and policy networks


Data

From these accounts, KB activities identified – and who used them


Who are the knowledge brokers
Who are the knowledge brokers?

  • Within transcripts, identify where

  • Respondent describes themselves as using one or more KB activities

  • Describes someone else as using KB activities

  • Use these data to generate a network


Kb results
KB results

NHS

Council

Public health

Universities

Size ∝ number of nominations

Darkness of line ∝ strength of tie


Kb results strong ties only
KB results: strong ties only

NHS

Council

Public health

Universities

Size ∝ number of nominations


What does this show us
What does this show us?

  • People already within policy community act as knowledge brokers

  • Main KBs appear to be NHS and council managers

  • Self-nominations common


Does the concept help us to understand the policy process
Does the concept help us to understand the policy process?

  • Roles not played by academics or researchers

  • Exchange or brokering of knowledge part of policy process

  • Focusing just on this aspect risks ignoring

    • Wider strategies used to influence policy

    • Policy makers’ conceptual understanding of policy process



Creating and managing key organisations

[The Commissioning Programme Board] manages business on behalf of the Chief Execs...everybody knows how business is done....But I would say that because I invented it. NHS manager_10

If my job is just to make stuff happen and get the correct outcome from meetings..., you know, collate the evidence, you have the discussions outside the meeting, you see who's with you, you think about how to present the case, you... it's one of those things of “never going into a meeting with a proposal without knowing exactly how it's going to come out of the meeting”….. That sounds terribly manipulative but to me it's about momentum

NHS manager_9


Deciding the topic and detail of the policy

Me and Alistair, we were trying to get sentences into [a key economic document] for about a year. Basically what would happen would be the document as would be written would occasionally manage to get to my desk at which I would put in various sentences which would ... some would get pruned out some would get in. Or you’d be constantly writing to Alistair about the arguments so he felt that he had sufficient strength behind him to be able to say “This is it, this is the case”. Public health intelligence_1


[Alistair] would exercise a certain degree of leeway in interpreting ...those instructions [from the DPH], but nonetheless in general...he wouldn't want, to substitute their own professional judgment because he isn't himself a public health professional... he's a doer and an implementer. ...So when he's got that policy, erm that lead he, the he kind of really takes it on and runs with it

DPH_10

....Alistair’s almost the acceptable face of mad DPHs, isn't he really. Managerial translation, I'll have a chat with him behind the scenes

Council officer _6

NHS manager_10 = Alistair

Managing other people


Me, Alistair and Evan, we’re running this place, in the core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs. Council Officer_6

We can’t just sit in an office and dream things up... I think a lot of people forget that that’s how things work in the real world, is through relationships and it does take time to build relationships, to build trust, and so you know, reorganisations that lose lots of people mean you just have to start all over again because that is how it, that is how the world works, that’s how you get things done. DPH_8

[Alistair’s] connectedness is indisput...you know his capacity to take, the information that he gets from the DPHs to influence... right across the AGMA structures...and that sort of work and relationship with a very wide range of officers where he keeps his fingers on the pulse that’s... is very very powerful. DPH_10

Using relationships


Example alcohol mup
Example: alcohol MUP core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

  • Creation of GM Health Commission

  • Had to take action on alcohol as key priority area

  • Alistair managed papers for meeting

  • Alistair, Evan and Sam (policy managers) identified MUP as a possible policy

  • Identified experts to attach to policy

  • Drew up policy papers

  • Identified executives to present and champion policy

  • Persuaded local and regional senior figures to endorse the policy

  • Policy considered successful because GM now much more visible

  • Individuals involved had greater credibility

  • Bargaining position with Westminster strengthened.


Knowledge evidence
Knowledge core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs. ≠ evidence

Evidence is used as part of a negotiated political strategy

I'll get a confident view from the DPH when she's in her own space, that it's an evidence-based intervention, that it's adding value... [Then] other senior views coming through around “[is this] giving bang for the buck” and so forth so then the confidence of the DPH not coming through in the same way ...in fact knowing which side her bread's buttered and shutting up. And then in the end the person who made the decision ...was the leader of the council who came up with his own elegant solution, which was “we'll continue to give it to the under-16s because that's a political winner, we'll do a little bit of targeted stuff for means-tested” ...after all the heat and noise from the evidence-based experts.. Council officer_6


Understanding and using relationships vital
Understanding and using relationships vital core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

Even within acadaemia, if you said... oh I searched the evidence and so on, if you want the answer to something, usually what you do is you email somebody you know, and say “What about this?” and they’ll connect back to you with people…You could argue it's a way of quickly getting to the evidence cos all you're trying to do is use your contacts to try and find someone who knows about the issue that you're interested in

(Clinical academic)


Message or messenger
Message or messenger? core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

Individuals’ characteristics (credibility, likeability, trustworthiness) influenced how messages were received

[The individual] with the responsibility for this piece of work erm is somebody who erm has had a very very longstanding interest in [the area] but at the same time, [their] manner can antagonise some people. So there was that, I think, something about the messenger.....The messenger kind of clouded the message...

(Board member, NHS)


Insiders and outsiders qualitative descriptions
Insiders and outsiders: qualitative descriptions core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

  • Core group of actors involved in all stages of policy

  • Some actors were not influential - did not want to be, did not have skills, had wrong characteristics

  • Key characteristics included: being ‘sensible’, ‘credible’, being ‘on message’ i.e. endorsed by other influential people

  • Being able to identify, create, maintain & finally exploit relationships as a strategy to influence policy


Revisiting the kb concept
Revisiting the KB concept core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

Academia

Policy-makers

KB


Revisiting the kb concept1
Revisiting the KB concept core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.


Conclusions
Conclusions core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

  • KB activities can and do influence policy...

  • ...but only when used by the right people as part of a wider ‘toolkit’ of strategies

  • Very difficult to do effectively if not embedded in policy community

  • “Message” content is not as important as “messenger” characteristics

  • Current approaches to ‘tackling’ EBP are likely to fail unless actor- and relational factors are taken into account

  • Effective leadership and mobilisation of the policy machinery is dependent on an ability to make and exploit relationships beyond those associated with knowledge production and translation


Implications
Implications core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

Proposing the ‘solution’ of KB to the ‘problem’ of EBP risks ignoring (the importance of) day-to-day activities of policy makers

While important to help policy makers find and use evidence, literature does not acknowledge the fact that there are already individuals using KB activities

Identifying these actors and describing their strategies / activities used to influence policy illuminates components of the policy process itself

Focus on empirical descriptions sheds new light on the policy process and questions utility of current research foci in EBP

Implies that to be influential, researchers should consider adopting a pro-active approach to make & exploit links with influential actors, using practical targeted messages


So what
So what? core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

  • Assumptions that policy makers do not use evidence & require help from generalist researchers are challenged

  • Should we continue to focus on knowledge brokerage and transfer as a means of researchers influencing policy?… or

  • Does the policy entrepreneurship framework of activities offer a new way of understanding policy processes?

  • Does this imply that researchers who wish to influence policy need to create their own relationships and ties with relevant actors?


  • Funded by DG Research, European Commission core group... we know where power centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll make her look good in AGMA Chief Execs.

  • Thanks to Frank de Vocht, Annemarie Money & Martin Everett

http://www.ccsr.ac.uk/mitchell/

Mitchell Centre for Social Network Analysis

Oliver K, de Vocht F, Money M, Everett M (2013) Who runs public health? A mixed-methods study combining network and qualitative analyses. Journal of Public Health (epub 5th April)

Oliver K, Everett M, Verma A, de Vocht F (2012) The human factor: reorganisations in health policy. Health Policy 106:6

Oliver K, Lorenc T, Innvaer S (under review) New Directions in Evidence-Based Policy Research. Public Administration

Oliver K, Money A, Everett M, de Vocht F. (under review) How to make friends and influence policy. Social Science and Medicine


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