H ow commissioners access use and transform academic research in real life decision making a qualitative study Lesley Wye Emer Brangan Ailsa Cameron University of Bristol John ID: 243227
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Evidence-based policy-making and the ‘art’ of commissioning How commissioners access, use and transform academic research in ‘real life’ decision making: a qualitative study
Lesley Wye,
Emer
Brangan
, Ailsa Cameron
(University of Bristol)
John
Gabbay
, Jonathan Klein, Catherine Pope
(University of Southampton)
HSRN conference 1-2 July 2015Slide2
Department of Health Disclaimer:
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR
programme
, NIHR, NHS or the Department of Health.Slide3
Why do this study?Commissioners from Clinical Commissioning Groups (CCGs) plan services with an annual budget of about £95 billion Academic research not informing local commissioning decisions muchResearchers need to know more about commissioning and how commissioners access and use information to better influence themSlide4
The approach8 case studies of contracts between commissioners and external providers4 CCGs + 3 external providers (2 commercial 1 NFP)92 interviews
36 external consultants
47 clients
Commissioners, analysts, public health
9 other people
24 observations of commissioning meetings & training events
Hundreds of documents (e.g. board papers, minutes)
Thematic coding, summaries, constant comparisonSlide5
The ‘art’ of commissioningSlide6
What is evidence-based commissioning?Researchers define evidence as research while commissioners have a much broader
definition of ‘evidence’
Influence
and collaborate with external and internal interested parties to build a
cohesive,
compelling
case for taking a particular course of
action
Commissioners highly pragmatic – if info not helpful they will not use itSlide7
Sources of informationWho?Local clinicians, commissioning managers, analysts, patients & the public, freelance consultantsWhat organisations?
Department of Health, NICE, NHS Improving Quality, Public Health (England & local), CSU, Think tanks e.g. King’s Fund, Royal Colleges, local healthcare providers, other CCGs/CSUs/ providers, commercial & not-for-profits Slide8
Sources of information (2)What info sought/ received?Best practice guidance, Department of Health commissioning guidance, service & population data, improvement tools, ‘horizon scanning’, clinical guidelines, how services operate, ‘whole picture view’, hospital/ primary/ community data, condition specific expertise, contracting, procurement, finance, budgets, benchmarkingSlide9
Commissioners tend to seek information from trusted colleagues via conversationsSlide10
Interpersonal relationships were the most crucial in influencing commissioning decisionsSlide11
InterpersonalRelationships
People
Placement
Governance
Copy, Adapt
and Paste
Product
Deployment
Engagement & Contextualisation
Organisational Pressures
and Tensions
Conduits
of informationSlide12
Pressures, tensions, demands & implications to
be negotiated before
A
influences the decision about
B
Organisational
Processes
A much modified
A
may influence
decision
about
B
A influences
the decision about
BSlide13
Role of academic researchCommissioners predisposed to using research but found it difficult to access, understand & applyCommissioners rely on public health departments to supply & interpret research Evidence reviews difficult to incorporate into decision-making
Local
evaluations more helpful than academic research because evaluations include useful contextual informationSlide14
Negative research findings did not inform disinvestment plansI’ve had conversations [with colleagues] about, “Well, we shouldn’t be putting that down to say it will make savings because there’s no evidence that it will,” versus me saying, “But actually we’ve still got a statutory responsibility to deliver a balanced plan, and if I take those savings out they need to come from somewhere else.” (Carla, NHS commissioning manager
)
Role of academic research (2)Slide15
What can researchers do?We need to change our ways of reaching commissioners
Start talking & rely on
written
communication less (F2F)
Produce what they want
Focus more on context
Tell stories
Employ people placement strategies e.g. researchers seconded into commissioning organisations (co-location)
Learn about your local CCG to find out areas of commonality
attend public governing body meetings
look at their website to identify commissioners in your area
Carry out local evaluations to build relationships & demonstrate that researchers have something worthwhile to offer
Develop relationships with your local public health departmentSlide16
Practising what we preach in BristolLW NIHR Knowledge Mobilisation Fellowship Knowledge mobilisation team set up Sept 20132 researchers
in residence
embedded in Bristol CCG + 2 NHS commissioners at University of Bristol + 1 communications manager
Development of interpersonal relationships through
Embedding
KM team facilitating introductions
Embedded researchers attached to CCG sub-committees
Co-production of service evaluations
More studies including interactive dissemination activitiesSlide17
Publications Wye L, Brangan E, Cameron A, Gabbay J, Klein J, Pope C. Knowledge exchange in health-care commissioning
: case studies of the use of commercial, not-for-profit and public sector agencies,
2011–14. Health
Serv
Deliv
Res 2015;3(19
).
Wye, L, Brangan E, Cameron A,
Gabbay
J, Klein J,
Anthwal
R, Pope C. What do external consultants from private and not-for-profit companies offer healthcare commissioners? A qualitative study of knowledge exchange. BMJ Open 2015: 5: e006558Slide18
AcknowledgmentsNIHR HS&DR for fundingAll participants especially the 3 external providers and 4 CCGsAdvisory commissioners : Maya Bimson
, Michael Bainbridge, Tim Wye, Jude Carey,
Adwoa
Webber, Neil Riley, James Rooney, William House
Andrée
le May
for conceptual help
FFI: lesley.wye@bristol.ac.uk