Collaboration Between Researchers and State Policymakers AHRQ Annual Meeting September 16, 2009 Robert F. St. Peter, M.D. President & CEO Kansas Health Institute

Communicating with Policy Makers Research competes for the attention of policy makers on two levels Subject – health vs. all other public policy issues demanding attention Influence – objective information is only one voice among many affecting decisions by public policy makers

Audience Identification & Research Message Development Tactics Strategic Communication 101

Kansas Legislature Citizen legislature In session ~90 days every year Five “health” committees  Senate Public Health and Welfare  Senate Financial Institutions and Insurance  House Health and Human Services  House Insurance  Health Policy Oversight Committee Two budget committees Leadership committee

Kansas Legislature (cont.) Limited support staff  Legislative Research Department (staff of 36, including clerical)  Committee staff (primarily clerical)  Personal staff (clerical, shared)  Agency testimony It’s not Washington, DC out there!  OMB, GAO, CRS, AHRQ, think tanks, etc.

Survey of Kansas Policy Makers (2003) State legislators  70% response rate (116/165) County commissioners  80% response rate (268/334) CATI-administered telephone survey Questions focused on  sources and methods of receiving information  perceived information needs

Sources of Health Policy Information: KS Legislators

Information Sources for State Policy Makers, U.S. (scale from 1 to 5)Rating Legislative staff4.3 State agencies4.1 Constituents3.8 Non-profit organizations3.5 Legislators3.5 Advocates/lobbyists3.3 Sorian & Baugh, 2002

(scale from 1 to 10)KS Legislators KS Commissioners Talking one-on-one w/ informed ind Reading brief summary material Receiving testimony at hearing Forums/seminars lasting 1-3 hours News media articles/reports Reading in-depth articles or reports Watching videotapes Conferences lasting 1 day or longer Listening to audio tapes Preferred Ways to Receive Information

Length of Written Information “Ideal length of written materials you read to help you make policy decisions” (KS Legislators)

Adequacy of Available Information “In making policy decisions, would you say you have enough reliable information on public health never, sometimes, usually, or always?” (KS Legislators)

Framework for Knowledge Transfer What should be transferred to decision makers (the message)? To whom should research knowledge be transferred (the target audience)? By whom should it be transferred (the messenger)? How should it be transferred (communications infrastructure)? With what effect should it be transferred (evaluation)? Lavis, et. al., 2003

What Should Be Transferred? Transfer actionable messages from a body of research knowledge, not simply a single research report or findings from a single study Research in the form of “ideas,” not “data,” is most influential Decision makers rarely use a regression coefficient to solve a particular problem Over long periods of time, “ideas” enlighten decision makers about a particular issue and how to handle it Lavis, et. al., 2003

Focus on “interactive engagement”  Interpersonal  Exchange of ideas  Iterative “The research literature on which processes are best at transferring knowledge suggest that passive processes are ineffective and that interactive engagement may be most effective…. The hall mark of these interventions is interaction: interaction between the [subject] and an ‘expert’ … or interaction between the [subject] and someone to whom he or she routinely turns for guidance.” Lavis et al., 2003 How Should It Be Transferred?

How Should It Be Transferred? (cont.) Focus on process not events  Long-term  Continuous  Outcome oriented “ Over long periods of time, two-way ‘exchange’ processes that give equal importance to what researchers can learn from decision makers and what decision makers can learn from researchers can produce cultural shifts. Such cultural shifts can facilitate the ongoing use of research knowledge in decision making, not just one-off uses.” Lavis, et al., 2003

Evolution of KHI Communication Activities Briefs and reports Legislative testimony Legislative brown bags and forums Study groups for legislature KHI News Service Legislative Health Caucus Legislative Health Academy

Kansas Legislative Health Academy Launch in Fall legislators  Selected with input from legislative leadership Substantial commitment of time  3-day retreat, three 2-day sessions  At least one year Payment of per diem and expenses Support from legislative leadership Certificate upon completion Curriculum integrates  System dynamics  Values framework  Leadership skills

Considerations with Active Engagement Restrictions based on tax status Governmental ethics/open meetings Comfort with shared control Potential for introduction of bias Maintaining credibility while in mix Resources to sustain engagement Determining effectiveness

Information for policy makers. Health for Kansans. Kansas Health Institute