1. Knowledge transfer to policy makers (with apologies to John Lavis!)
Jeremy Grimshaw MD, PhD
Clinical Epidemiology Program, OHRI
Department of Medicine, University of Ottawa
Canada Research Chair in Health Knowledge Transfer and Uptake

2. Overview Evidence to support management and policy making
Effects of KT strategies targeting managers and policy makers
Current KT models targeting managers and policy makers

3. Background
What is the place for research evidence in management and policymaking?
Helps to get problems on the agenda (i.e., what issue should I focus on?)
Helps to think about problems and solutions differently (i.e., how should I begin to approach this issue?)
Helps to solve particular problems at hand (i.e., what program or policy should I support?)
Helps to justify a decision made for other reasons (i.e., how can I sell the position I’ve taken?)

4. Background (2) Systematic reviews of research evidence
Reduce the likelihood that managers & policymakers will be misled by research (by being more systematic and transparent in the identification, selection, appraisal and synthesis of studies)
Increase confidence among managers & policymakers about what can be expected from an intervention (by increasing number of units for study)

5. Background (3) Systematic reviews of research evidence (2)
Allow managers, civil servants and political staff to focus on appraising the local applicability of systematic reviews and on collecting and synthesizing other types of evidence, such as evidence about political acceptability and feasibility – i.e., allow them to focus on the apex of the research knowledge pyramid while doing the rest of their jobs
Allow for more constructive contestation of research evidence by stakeholders

6. Background (4) Actionable messages Systematic reviews of research
Individual studies, articles, and reports
Basic, theoretical and methodological innovations

7. Adapting Reviews
Two types of adaptations would enhance the usefulness of the global stock of systematic reviews
Changing the types of information profiled in a systematic review
Developing “friendly front ends” for reviews that would allow rapid scanning for relevance and then graded entry to highly relevant reviews

8. Adapting Reviews (2)
Changing the types of information profiled in a systematic review
Provide ‘bread and butter’ information
Harms (or risks) and costs of interventions (not just the benefits)
Uncertainty associated with estimates
Differential effects by sub-group

9. Adapting Reviews (3)
Changing the types of information profiled in a systematic review (2)
Provide information about the contextual factors that may influence a review’s local applicability
Highlight key features
Review’s relative importance to health problem
Relevance of outcome measures
Practicality of the intervention
Appropriateness of the intervention
Cost-effectiveness of the intervention

10. Adapting Reviews (4)
Changing the types of information profiled in a systematic review (3)
Provide information about the contextual factors that may influence a review’s local applicability (2)
Prompt managers & policymakers to ask the right questions
Could it work in my jurisdiction?
Will it work?
What would it take to make it work?
Is it worth it?

11. Adapting Reviews (5) Developing “friendly front ends” for reviews
For example, one page of take-home messages and a three-page executive summary
Facilitates rapid assessments of the relevance of a review and, when the review is deemed highly relevant, more graded entry into the full details of the review

12. Implications
For health system managers and policymakers who are interested in systematic reviews
Develop the skills to acquire, assess, adapt and apply systematic reviews
Become involved in the review process or at least push for the profiling of decision-relevant information in reviews

13. Effects of KT strategies targeting policy makers and managers
Health policy-makers perceptions of their use of evidence: a systematic review
24 studies involving 2014 interviews with health policy makers
Most studies focused on hypothetical scenarios or retrospective perception of the use of evidence in relation to specific cases.
Innvaer, Vist, Trummald, Oxman (2002). Journal of Health Services Research and Policy

14. Effects of KT strategies targeting policy makers and managers
Facilitators
Personal contact (13/24)
Timely relevance (13/24)
Inclusion of summaries with policy recommendations (11/24)
Barriers
Absence of personal contact (11/24)
Lack of timeliness or relevance of research (9/24)
Mutual mistrust (8/24)
Power and budget struggles (7/24)
Innvaer, Vist, Trummald, Oxman (2002). Journal of Health Services Research and Policy

15. Knowledge translation models
Push
Pull
Linkage and exchange
Knowledge brokers

16. Push models (1) Improving dissemination by researchers
Five key questions
What should be transferred?
To whom should research knowledge be transferred?
By whom should research knowledge be transferred?
How should research knowledge be transferred?
With what effect should research knowledge be transferred?
Lavis JN, Robertson D, Woodside JN, Mcleod CB, Abelson J (2003) Milbank Quarterly

17. Push models (2)
Multiple approaches targeting different stakeholder groups
Peer reviewed papers
Policy briefings (1, 3, 25)
Toolkits

18. Pull models Increase demand from decision makers
Enhancing receptor capacity
Critical appraisal skills
EXTRA training program
Policy maker secondments

19. Linkage and exchange
Creating new relationships between researchers and policy makers to enhance mutual understanding and develop partnerships for framing and conducting research.
Policy makers as partners as in grant applications: matching funds to demonstrate commitment

20. Knowledge brokers
Using knowledge brokers to build and nurture relationships between those involved in joint knowledge production (researchers and policy makers)

21. Knowledge brokers Understanding of both the research and decision
making environments
Ability to find and assess relevant research
Entrepreneurial skills (networking, problem solving
skills, innovative solutions, etc)
Mediation and negotiation
Understanding of the principles of adult learning
Communication skills
Credibility…

22. Summary
Systematic reviews and syntheses are valuable for managers and policy makers
Managers and policy makers need to consider likely applicability of systematic reviews to their context
Other factors influence management and policy maker decisions
Limited evidence base on how to do KT to policy makers
Emergence of new models that need evaluation