Translating research into policy and practice
NICS Knowledge Translation Workshop
14 March 2008, Melbourne
Eleanor Jackson-Bowers, PHC RIS
The National Institute of Clinical Studies recently hosted a workshop on knowledge translation (KT) featuring presentations by visiting speakers, Jeremy Grimshaw from the University of Ottawa and Nick Mays from the London School of Hygiene and Tropical Medicine.
The theme of the workshop was how to promote evidence use in policy making and in practice and we heard about many activities which are happening in this area.
We were fortunate in hearing many perspectives on evidence based policy making including Adam Chapman from the Victorian Department of Human Services who spoke about his experience of using evidence in policy making in the context of other considerations.
We heard about a large study by the Australasian Cochrane Centre of evidence use in Local Government policy making which is underway. One to watch as results emerge.
Jeremy Grimshaw examined the evidence for methods of KT by researchers to policy makers, which is scant and shows little effectiveness. He argued for systems to encourage policy makers to be explicit about their use of evidence and for improved procedures and resources to facilitate evidence based policy making.
One promising model, described by Sally Green, is the Evidence Based Policy Network, facilitated by the Australian Cochrane Centre, which provides a community of practice for DoHA policy makers interested in evidence based policy, a liaison officer, and access to summarised Cochrane reviews.
One strong outcome of the day was the argument that syntheses provide more reliable evidence and should be used in preference to individual studies in policy making and this was strongly endorsed by several speakers.
Nick Mays spoke about methods for research synthesis. Look out for his new book: Pope, Mays and Popay: Synthesising Quantitative and Qualitative Health Evidence published by Open University Press.
The presentations from the workshop can be found here: www.epoc.nhmrc.gov.au/asp/index.asp?
Turnaround in UK health organisations - lessons from research
3rd HARC Forum: Capitalising on Opportunities for Hospital Reform
1 April 2008, Sydney
Attended by Libby Kalucy, PHC RIS
Why do organisations decline and fail? Can we predict or prevent decline? When failures occur, how are they best managed? Professor Kieran Walshe, Centre for Public Policy and Management, Manchester Business School and new Director of the Institute of Health Sciences at Manchester , has been researching these topics in the UK . He has plenty of studies of failure to examine, starting with events at Bristol Royal Infirmary. He discussed his research in Sydney on 1 April at the 3 rd Forum of the Hospital Alliance for Research Collaboration which was auspiced jointly by the Sax Institute and the Clinical Excellence Commission.
The primary causes of failure are organisational culture and attitude; introspection, arrogance, myopia and trauma; and failure to learn, adapt and change appropriately. While hard and soft data about these causes are available, they are not necessarily looked at or used.
A crisis or declaration of failure occurs through external assessment by key stakeholders, a disaster or major failure, a change of perspective such as a new CEO or team, and new governance. When failures occur, the self regulation response can work if the organisation recognises the situation, is willing to respond and has the capacity to respond. Otherwise intervention for instance by a ‘turnaround team' in the UK , becomes important. A common response is to replace, retrench and renew. The turnaround sometimes works, but it takes longer than twelve months to renew an organisation's culture. It is necessary to find a way to avoid return of failure after the intervention.
Prof Walshe stated that the learning capacity of organisations is at the heart of failure and turnaround. Organisations need absorptive capacity, to acquire and apply knowledge to improve performance. Public sector failures are important in the political narrative, functionally and symbolically.
The presentation is available on the Sax Institute website, which is well worth browsing.
Linking evidence policy and practice
National Health Care Reform Conference 2008
12-13 March 2008, Sydney
Attended by Libby Kalucy & Ann-Louise Hordacre PHC RIS
Health care reform is needed because the health system is not meeting needs, and costs to government and individuals continue to climb. There is not enough prevention, health promotion and early detection of chronic illness; a lack of access, integration and coordination; and reducing satisfaction for consumers and providers. Dr Kirsty Douglas, Acting Director of APHCRI, outlined succinctly in the opening plenary that reform was needed to meet the needs and expectations for users, providers and government. This was especially salient for patients with chronic and complex conditions, Aboriginal and Torres Strait Islanders, people with low socio economic status or from rural and remote areas, who found services hard to access and bore the greatest burden of ill health with the poorest outcomes; practitioners who are so overwhelmed by acute demands that health promotion and advocacy drop in priority; and governments responsible for the well being of the population who are spending more dollars on a system which is not working.
This was an opportune time to discuss reform, when primary care is in the spotlight through the National Hospital and Health Reform Commission, the National Primary Care Strategy, the National Prevention Taskforce, and other initiatives. Phillip Davies, Deputy Secretary of the Australian Government Department of Health and Ageing identified the hotspots as access, affordability and effectiveness. He suggested that multidisciplinary teams are the key to each of these. The concept of the ‘medical home' was raised as a possible way ahead - a goal worth shooting for. The Department is looking for creativity, replicability, and the best way to organise and manage structures and businesses in primary care.
It was gratifying to see that the PHCRED Strategy was the foundation for many of the presentations in this excellent conference. APHCRI systematic reviews provided valuable and relevant evidence, PHCRED research fellows presented their results, and PHC RIS data were prominent.
For presentations see www.cyberwisecomputing.com/yrd-nhcr/nhcr.htm
Investing in Australia's health and wellbeing
National Prevention Summit
9 April 2008, Melbourne
Attended by Libby Kalucy, PHC RIS
About 100 leaders from many fields of prevention attended the National Prevention Summit in Melbourne . This key consultative event which was organised by the Australian Institute of Health Policy Studies (AIHPS) and VicHealth, took place at a most opportune time two weeks before the 2020 Summit. High level commitment to prevention was shown by the presence of both the Federal Minister of Health, Nicola Roxon and the Victorian Minister for Health, Daniel Andrews. Minister Roxon announced the members of the National Prevention Taskforce who will drive national debate on prevention, have an input to the Australian Health Care Agreements, and will develop a blue print for priorities.
Much of the emphasis of the summit was on tackling chronic disease and its causes. Minister Roxon referred to 500,000 preventable hospital admissions each year, and the high costs of drug use. These drive the need to invest in prevention, to deliver savings for the community and improve participation and productivity.
Beyond chronic disease and its risk factors, the broader scope of prevention encompasses ‘what it takes to lead a flourishing life' in the words of one delegate. This requires a whole of government approach to address the health impact of policies outside the health sector.
Many speakers recognised reorienting the system towards prevention requires significant cultural change in the community at grass roots, policy and service delivery level. The task is neither simple nor quick. Partnerships will be essential between all jurisdictions of government, NGOs, the private sector, and the community. Indigenous health is the most pressing challenge.
Results from discussions and workshops at the National Prevention Summit were presented to Minister Roxon in time for the 2020 Summit, and will contribute to the work of the Prevention Taskforce and the National Hospital and Health Reform Commission.
For further details, see AIHPS at www.aihps.org
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