Researchers are good at producing and exchanging scientific knowledge but need help in transforming that into practical knowledge.
- We say: How can we get research into policymaking?
- What we mean is: How can researchers influence policymakers?
- What we need to know is: How are policymakers influenced?
What is evidence-based commissioning?
The ‘art of commissioning’ entails juggling competing agendas, priorities, power relationships, demands and personal inclinations to build a persuasive, compelling case. Commissioning involves:
- National and regional performance managers
- Evidence purveyors
- Healthcare providers
- The public
- Internal colleagues
- Service users
- The press
Researchers define evidence as research, while commissioners have a much broader definition of ‘evidence’. Commissioners influence and collaborate with external and internal interested parties to build a cohesive, compelling case for taking a particular course of action.
Where do commissioners get information from?
Commissioners are highly pragmatic – if information is not helpful, they will not use it.
- National Service Framework Guidelines
- NICE guidance
- Government publications (e.g. guidance on the commissioning of cancer services for improving colorectal cancer)
- Clinical guidelines (e.g. choice of ACE inhibitors in the primary care management of adults with symptomatic heart failure)
- Guidance from professional associations e.g. the Royal College of Surgeons
- Secondary sources (e.g. NHS evidence)
- Published cost-effectiveness analyses
- Work commissioned to academic researchers
- General published literature (e.g. journal articles)
Commissioners get practical evidence from:
- Local public health intelligence (e.g. population data, needs analysis, health outcomes, activity and capacity modelling etc.)
- Expert advice either from colleagues or external experts (e.g. from the local authority, Department of Health and Social Care etc.)
- Examples of best practice from other organisations
- Their own personal experience
- Local policies and plans (e.g. the strategic plan, the operating plan, clinical policies, risk registers)
- Benchmarking data with other organisations (e.g. investment levels, outcomes, National Clinical and Health Outcomes Knowledge Base data)
Commissioners tend to seek information from trusted colleagues via conversations. Interpersonal relationships were the most crucial in influencing commissioning decisions. This has been confirmed by systematic reviews:
The most frequently reported facilitators [of the use of research] were collaboration between researchers and policymakers, and improved relationships and skills.
NB Review includes 13 other systematic reviews and studies from outside healthcare field e.g. criminal justice.
Information is modified by organisational pressures and tensions.
What about academic research?
Commissioners are predisposed to using research, but find it difficult to access, understand and apply.
Commissioners rely on public health departments to supply and interpret research. Evidence reviews are difficult to incorporate into decision-making.
Local evaluations more helpful than academic research, because local evaluations include useful contextual information.
NICE guidelines are “crucial” to decision-making, but commissioners only follow the most “doable” as otherwise they would go “bust”.
Academics try to reach policymakers by publishing written material in scientific journals that policymakers do not (or cannot) access from outside policymaking organisations. But policymakers are influenced by regular conversations with trusted colleagues whom they know, usually from within their own organisation.
How can researchers influence policymakers and practitioners?
Researchers can influence policymakers and practitioners through knowledge mobilisation.
Knowledge mobilisation is the process(es) that can lead to the outcome of impact by catalysing change through:
- Engagement & networking
- Educational events
- Embedding procedures & practices
- Science communication
- Social media
- Targeted dissemination
Engaging research users is crucial.
NB Knowledge mobilisation is NOT implementation. Knowledge mobilisation needs to happen for implementation to occur.
Researchers might want to take an outside track or an inside track to knowledge mobilisation.
- Targets large number of individuals
- Uses public messaging and campaigning
- Uses social and traditional media (social, press)
- Involves direct interaction with policymakers through formal negotiations & meetings
- Uses informal face-to-face meetings
- Key finding = 25% men b/t 18-24 presenting at GP surgeries have gambling problems
- Comms officer + PI working together
- Scientific paper + press release + blog + infographic + Twitter
- Coverage in The Times, Guardian, BBC World Service, Pulse, the Conversation
- Top 10 read for 6 months in British Journal of General Practice
- CCG transformation programme of diabetes services
- Researcher in residence + management fellow carried out before & after evaluation of 2 GP practices’ implementation of new intervention
- Presented findings to several CCG committees who continued or changed their plans
- Management fellow learnt evaluation skills later applied in several other projects