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Uncovering the processes of knowledge transformation: the example of local evidence-informed policy-making in United Kingdom healthcare

Uncovering the processes of knowledge transformation: the example of local evidence-informed policy-making in United Kingdom healthcare
Uncovering the processes of knowledge transformation: the example of local evidence-informed policy-making in United Kingdom healthcare

Background: healthcare policy-makers are expected to develop 'evidence-based' policies. Yet, studies have consistently shown that, like clinical practitioners, they need to combine many varied kinds of evidence and information derived from divergent sources. Working in the complex environment of healthcare decision-making, they have to rely on forms of (practical, contextual) knowledge quite different from that produced by researchers. It is therefore important to understand how and why they transform research-based evidence into the knowledge they ultimately use.

Methods: we purposively selected four healthcare-commissioning organisations working with external agencies that provided research-based evidence to assist with commissioning; we interviewed a total of 52 people involved in that work. This entailed 92 interviews in total, each lasting 20-60 minutes, including 47 with policy-making commissioners, 36 with staff of external agencies, and 9 with freelance specialists, lay representatives and local-authority professionals. We observed 25 meetings (14 within the commissioning organisations) and reviewed relevant documents. We analysed the data thematically using a constant comparison method with a coding framework and developed structured summaries consisting of 20-50 pages for each case-study site. We iteratively discussed and refined emerging findings, including cross-case analyses, in regular research team meetings with facilitated analysis. Further details of the study and other results have been described elsewhere.

Results: the commissioners' role was to assess the available care provision options, develop justifiable arguments for the preferred alternatives, and navigate them through a tortuous decision-making system with often-conflicting internal and external opinion. In a multi-transactional environment characterised by interactive, pressurised, under-determined decisions, this required repeated, contested sensemaking through negotiation of many sources of evidence. Commissioners therefore had to subject research-based knowledge to multiple 'knowledge behaviours'/manipulations as they repeatedly re-interpreted and recrafted the available evidence while carrying out their many roles. Two key 'incorporative processes' underpinned these activities, namely contextualisation of evidence and engagement of stakeholders. We describe five Active Channels of Knowledge Transformation - Interpersonal Relationships, People Placement, Product Deployment, Copy, Adapt and Paste, and Governance and Procedure - that provided the organisational spaces and the mechanisms for commissioners to constantly reshape research-based knowledge while incorporating it into the eventual policies that configured local health services.

Conclusions: our new insights into the ways in which policy-makers and practitioners inevitably transform research-based knowledge, rather than simply translate it, could foster more realistic and productive expectations for the conduct and evaluation of research-informed healthcare provision.

Evidence-based healthcare policy, healthcare commissioning, knowledge mobilisation, knowledge transformation, research implementation, research-based evidence
1478-4505
Gabbay, John
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Le May, Andrée
d31b0269-60f6-47cd-a844-f0bc522662ab
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Brangan, Emer
7f159972-1519-4d36-82ad-5df8edb097d0
Cameron, Ailsa
d669618a-bc3e-4cb2-84b1-64c91d9e33c1
Klein, Jonathan H.
639e04f0-059a-4566-9361-a4edda0dba7d
Wye, Lesley
106916f3-2dd2-4960-80be-73e317fa8275
Gabbay, John
92f028e9-3ef8-495d-8fe8-df6d967b690b
Le May, Andrée
d31b0269-60f6-47cd-a844-f0bc522662ab
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Brangan, Emer
7f159972-1519-4d36-82ad-5df8edb097d0
Cameron, Ailsa
d669618a-bc3e-4cb2-84b1-64c91d9e33c1
Klein, Jonathan H.
639e04f0-059a-4566-9361-a4edda0dba7d
Wye, Lesley
106916f3-2dd2-4960-80be-73e317fa8275

Gabbay, John, Le May, Andrée, Pope, Catherine, Brangan, Emer, Cameron, Ailsa, Klein, Jonathan H. and Wye, Lesley (2020) Uncovering the processes of knowledge transformation: the example of local evidence-informed policy-making in United Kingdom healthcare. Health Research Policy and Systems, 18 (1), [110]. (doi:10.1186/s12961-020-00587-9).

Record type: Article

Abstract

Background: healthcare policy-makers are expected to develop 'evidence-based' policies. Yet, studies have consistently shown that, like clinical practitioners, they need to combine many varied kinds of evidence and information derived from divergent sources. Working in the complex environment of healthcare decision-making, they have to rely on forms of (practical, contextual) knowledge quite different from that produced by researchers. It is therefore important to understand how and why they transform research-based evidence into the knowledge they ultimately use.

Methods: we purposively selected four healthcare-commissioning organisations working with external agencies that provided research-based evidence to assist with commissioning; we interviewed a total of 52 people involved in that work. This entailed 92 interviews in total, each lasting 20-60 minutes, including 47 with policy-making commissioners, 36 with staff of external agencies, and 9 with freelance specialists, lay representatives and local-authority professionals. We observed 25 meetings (14 within the commissioning organisations) and reviewed relevant documents. We analysed the data thematically using a constant comparison method with a coding framework and developed structured summaries consisting of 20-50 pages for each case-study site. We iteratively discussed and refined emerging findings, including cross-case analyses, in regular research team meetings with facilitated analysis. Further details of the study and other results have been described elsewhere.

Results: the commissioners' role was to assess the available care provision options, develop justifiable arguments for the preferred alternatives, and navigate them through a tortuous decision-making system with often-conflicting internal and external opinion. In a multi-transactional environment characterised by interactive, pressurised, under-determined decisions, this required repeated, contested sensemaking through negotiation of many sources of evidence. Commissioners therefore had to subject research-based knowledge to multiple 'knowledge behaviours'/manipulations as they repeatedly re-interpreted and recrafted the available evidence while carrying out their many roles. Two key 'incorporative processes' underpinned these activities, namely contextualisation of evidence and engagement of stakeholders. We describe five Active Channels of Knowledge Transformation - Interpersonal Relationships, People Placement, Product Deployment, Copy, Adapt and Paste, and Governance and Procedure - that provided the organisational spaces and the mechanisms for commissioners to constantly reshape research-based knowledge while incorporating it into the eventual policies that configured local health services.

Conclusions: our new insights into the ways in which policy-makers and practitioners inevitably transform research-based knowledge, rather than simply translate it, could foster more realistic and productive expectations for the conduct and evaluation of research-informed healthcare provision.

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Accepted/In Press date: 7 June 2020
e-pub ahead of print date: 25 September 2020
Published date: 25 September 2020
Keywords: Evidence-based healthcare policy, healthcare commissioning, knowledge mobilisation, knowledge transformation, research implementation, research-based evidence

Identifiers

Local EPrints ID: 445300
URI: http://eprints.soton.ac.uk/id/eprint/445300
ISSN: 1478-4505
PURE UUID: e6981028-d421-424d-be24-0290d7fad6e9
ORCID for Catherine Pope: ORCID iD orcid.org/0000-0002-8935-6702
ORCID for Jonathan H. Klein: ORCID iD orcid.org/0000-0002-5495-8738

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Date deposited: 02 Dec 2020 17:30
Last modified: 28 Apr 2022 04:55

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Contributors

Author: John Gabbay
Author: Andrée Le May
Author: Catherine Pope ORCID iD
Author: Emer Brangan
Author: Ailsa Cameron
Author: Lesley Wye

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