One of the most fulfilling aspects of our research is its ability to impact policy. Yet getting on the radar of decision-makers can often be a challenge. According to Les Levin, with Health Quality Ontario, the track record for traction between evidence and policy is weak. We can also see that the relationship between evidence and policy is fluid, and subject to change based on politics, governments, public opinion and a host of other factors. How do we as researchers and subject experts, get our research and our voices heard by the right people?
The National Institute for Health and Clinical Excellence (NICE) in the U.K. was established to provide evidence for the UK National Health Service (NHS). A recent article discusses how NICE recognizes that decisions are informed by many factors and how NICE tries to influence decisions beyond a straight-forward presentation of the evidence. Evidence about effectiveness and, to a lesser extent cost-effectiveness, are ones that we are most interested in as researchers, but often the values of policy-makers play an important (if not the most important) role in decision-making. Some of the ways that NICE sees values influencing decision-making is in judgements about suitability of outcome measures, weighting of aspects of health, public v. private expenditures (and in Canada 30% of health expenditures are private so we shouldn’t ignore private spending), the acceptability of processes of care delivery and the affordability of different treatment options (both for individuals and for the state).
One of the ways that NICE attempts to resolve issues that arise from differences in values and value judgments is through a deliberative decision-making process which includes a Citizen’s Council as a form of direct democracy. This is not a foreign concept to BCers, many of which will remember the Citizen’s Assembly on electoral reform.
Deliberative dialogues are also used by the McMaster Health Forum, which convenes a broad cross-section of policy-makers, stakeholders and researchers that work through a specific health issue. According to Michael Wilson, assistant director at McMaster Health Forum, these deliberative dialogues can be uniquely supportive of evidence-informed decision-making by bringing together the data and research evidence with the knowledge, views and experiences of those who will be affected by the specific health issue.
While a full blown Citizen’s Council or Assembly is clearly beyond the scope of most researchers (including ourselves), the concept of a process of deliberative dialogue between researchers and academics and policy- and decision-makers is a useful one to consider for knowledge translation. How do we get decision-makers engaged in our research? Not only can we tell them about the evidence uncovered by our research, but we can also engage in discussions around values and value judgements. Learning what values are important to decision-makers will allow us to tailor our message and presentation of our evidence in a way that is more likely to resonate with them.
This post is based on ideas inspired by the Healthcare Quarterly volume 15 special issue “Toward Performance and Quality,” December 2012