Knowledge transfer, and evidence informed health policy-minster's meeting

Knowledge Transfer, and Evidence-Informed Health PolicyUndersecretary Meeting, Feb. 26, 2009

Ghaiath M.A. HusseinMBBS, MHSc. (Bioethics)

Research DirectorateFederal Ministry of Health

Acknowledgement

•Many the slides used in this presentation are used with permission from presentations by:

•Dr. Fadi El-Jardali (AUB)•Dr. Abdul Ghaffar (RPC Advisor,

WHO/EMRO)•Dr. Noha Dashash (PHC Directorate,

Jeddah, KSA)

Outline of the presentation

•Background•The ‘Knowledge Cycle’•The Knowledge Transfer•Evidence-Based Healthcare•Where are we?•What we need to do?•Conclusion and Discussion

خريطة توضح حجم دول العالم من حيث اإلنفاق على البحوث والتنمية وأكثر واقل عشر دول إنفاقا على البحوث في العالم )بالدوالر لكل مواطن www.worldmapper.orgلكل عام(. المصدر:

من مليون لكل المنشورة العلمية المقاالت عدد يوضح وجدول المنشورة، العلمية المقاالت عدد حيث من العالم دول حجم توضح خريطةلعام www.worldmapper.orgالمصدر: م. 2001السكان

The ‘Classical’ Knowledge Cycle

Researchers

Policy makers

What is KT?

•…a process by which relevant research information is made available and accessible for practice, planning, and policy-making through interactive engagement with audiences.

•Other terms include: research transfer, knowledge exchange, knowledge translation, knowledge mobilization, research uptake, research/knowledge utilization, and dissemination. Although these terms are similar and are sometimes used interchangeably

What’s Evidence-Based Healthcare?

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Evidence-based healthcare (EBH) is the integration of best research evidence with clinical/policy expertise and patient/population values.

Why do we need to be evidence-based?•Lack of resources: we need to be sure

this is the best way to spend them -Cost-containment

•Quality improvement: Are we providing the best service?

•Accountability (for political leadership and served population)

Components of EBM/H

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EBHC

EBHC

Individual Clinical /PolicyExpertise

Best External Evidence

Patient/Population’s Values & Expectations Modified from

Huneborg, 2000

Steps of evidence based medicine

•1)Ask a question•2)Acquire relevant articles•3)Appraise the evidence•4)Apply the findings•5)Assess our performance

What is worse than having no evidenceis to have bad evidence!

Hierarchy of Evidence

Systematic Reviews and Meta-analysis

Randomized controlled trials with definitive results

RCTs with non-definitive results

Cohort studies

Case Control studies

Cross-sectional surveys

Case reports / opinions

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Evidence Pyramid

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Potential contribution of evidence to policy• Exposure to a wider range of validated policy

options• Evaluation of the success and failure of previous

policies• Ability to identify relationships between

seemingly• independent factors (e.g.. Health care reform

and health outcomes)• Capacity to legitimize some policies while

casting doubt on others (Hanney et al, 2003)• Promote evidence based management practices

Science Decision-Making

Where am I?

You’re 30 metres

above the ground in a balloon

You must be a

researcher

Yes. How did you

know?

Because what you told me is absolutely correct but completely

useless

You must be a

policy maker

Yes, how did you

know?Because you don’t know

where you are, you don’t know where you’re

going, and now you’re blaming

me

The problem

17/30

A research institution is a "knowledge" factoryInput: information

Output: information

Processing

Knowledge

The policy and execution grinding mill

Information

Policy and communication

Processing

Knowledge

Analyses of threats and

benefits Impact

Testing Evaluation

Many “Leaks” from research & practice

Aware Accept Target Doable Recall Agree Done

ValidResearch

If 80% achieved at each stage then0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21

Need a ‘new look’?

“In the world of research, completing the study is just the first step…making the research come alive and using it to build capacity for future science and scientists and to tell stories that capture policy-maker’s attention and ultimately lead to policy changes, are what it is all about”

(O’Brien-Pallas, 2003)

Research

• Generation of new knowledge• Synthesis of available information• Sharing good practices• Translation of knowledge (for

improved policy and management decisions)

Diagnosis, treatment• Trained health

workers• Clinical diagnostics• Treatment/medicines• Hospital services• Information

Health promotion, disease prevention

• Information• Products• Services

Access to

• Health products and services• Information• Conditions to gain/maintain good

health

environment

work social conditions

economic conditions

Biomedical researchHealth policy and systems

researchSocial sciences and

behavioural researchOperational

research

Basic research:physical and biological

sciences, includingchemistry, pharmacology,

toxicology, genetics, etc.

Research onpolicy formulation, relationship

to evidence,prioritization, etc.

Research and development for

medicines, vaccines, diagnostics, appliances,

etc.

Research onhealth systems management,

functions, efficiency, effectiveness, system factors

affecting access,scale-up, monitoring and

evaluation, etc.

Research onsocial and behavioral

factors influencing health and their relation

to equity, access, lifestyle and health-seeking behaviours,

etc.

Research onfactors affecting functioning of programmes,

effectiveness of targeting, impact

on behaviour, disease burdens

and public health,

etc.

Understanding the biological nature of diseasesCreating products to prevent or treat disease states

Understanding how to test, scale-up and follow through on the introduction of interventions to optimise their benefits

Impact24

The spectrum of research for development

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Types of research

Potential stakeholders

Basic Clinical Health services

Population health

Patients +++ +++ Professionals +++ +++

Local administration + +++ +++ National policy-

makers +++ +++ +++

Regulatory bodies +++ +++ ++ ++ Industry +++ +++ ++ +

Research funders +++ +++ +++ +++ Researchers +++ +++ +++ +++

Source: Institute of Health Economics, Alberta, Canada, 2008.

Stakeholders for different types of research

Researchers and Policy-makers: From mutual understanding to mutual work

Matter of Fact!

•“There is nothing a government hates more than to be well informed; for it makes the process of arriving at decisions much more complicated and difficult”

John Maynard Keynes

Another Set of Facts!

•A substantial knowledge base exists, albeit under-utilized, to improve the health of populations

•Research is biased in favour of biomedical sciences and public health interventions with significant (disease-based) implications

•Researchers and policy-makers are two different groups with different backgrounds, different incentives and with different roles and responsibilities

Researchers and Policy makers are twoseparate communities?

“Researchers search for truth by using a rational model…policy makers search for a compromise, by using an intuitive model”

Choi et al (2005)

Feature distinguishing (academic) research and policy-makers

Researchers Policy-makers

Overall goal To advance science To improve the performance of health systems

Specific objectives

Tenure track positions Publications

To gain popular and political support

Output Detailed reports, based on science Press release s

Desired outcome Respect of peers

Perception more important than what happens in reality

Time factor Some studies can take years Demand results in the short term

Accountable to

Peers and editors of medical journals

Cabinet and constituents

How to Bridge the gaps?

Science Decision-MakingKnowledge

Brokers

Reza Majdzadeh

What we do now as Research Directorate?

Train, Review, curricula

SeminarsWebsiteDatabase

Steps Forward• Update the research priorities collectively• Develop a Knowledge Transfer & Evidence

Synthesis Unit• Establish a Decision Support Unit• Develop and activate the Policy Forum• Policy makers need to be able to:• Identify situations where research can help• Articulate research questions for topics of

policy relevant research; and• Access evidence and incorporate them in

decision making

Key Messages

•Policy makers need to be research-oriented

•Researchers should be action-oriented•Each partner need to understand and

cope with other partners•Always remember that our common and

ultimate goal as researchers & policy makers if the health of our people!