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Evidence-based policy-making and the ‘art’ of commissio Evidence-based policy-making and the ‘art’ of commissio

Evidence-based policy-making and the ‘art’ of commissio - PowerPoint Presentation

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Evidence-based policy-making and the ‘art’ of commissio - PPT Presentation

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

commissioning commissioners health amp commissioners commissioning amp health research local researchers public external information academic wye bristol providers evidence

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Slide1

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