December 1, 2006
Karen Adams, Tanya Alteras, Jack Meyer
J. A. Meyer, T. T. Alteras, and K. B. Adams, Toward More Effective Use of Research in State Policymaking, The Commonwealth Fund, December 2006
Health services research can be used to inform policymakers about pressing issues; provide them with data and resources needed to develop new programs or reform existing ones; guide the implementation process; and evaluate programs or policies to determine whether they are meeting their goals. Yet, putting new and innovative research to work in the policymaking process takes tenacity and understanding on the part of both researchers and policymakers. Effective partnerships between researchers and policymakers are grounded in sustainable relationships and mutual trust.
This report sets out a conceptual framework to support effective use of research in health policymaking and improve communications between researchers and state policymakers and program administrators. States are essential players in disseminating evidence-based practices and policies that can lead to better care. Strengthening channels of communications between researchers and policymakers at the state level is a practical way to accelerate health system improvement.
The framework includes the following four stages:
- Understanding the scope and extent of the problem. Policymakers or program administrators and their staff become aware of problems in the health system and scan existing research to learn about the issue.
- Developing options. As they develop policies or programs, they look to already existing research and/or interpret research results or commission new research to guide possible solutions.
- Implementing a program/policy. Policy and/or program staff consult with researchers on strategies for implementing new programs or reforming existing programs.
- Evaluating the program/policy. Researchers examine the effects of changes in program and policy to inform policymakers of positive and negative outcomes.
This report includes practical lessons and communication strategies gleaned from interviews with researchers working on state issues and state health policymakers. To illustrate the four stages, it also includes a case study of the creation and launch of Massachusetts' health care reform act, which requires all state residents to have health insurance and creates policies and programs to achieve this goal.
Key Lessons for Stage 1: Understanding the Scope and Extent of the Problem
- Before a crisis hits, build and maintain relationships with researchers in order to be better informed on key policy issues relevant to your state.
- Assign each staff person a portfolio of key issues to track and monitor and identify researchers who are experts in these fields.
- Develop relationships with the administrative and legislative staff responsible for "your" issues. This is the point at which influencing the policy process begins. Build your audience before you need it.
- Identify which issues are most important to policymakers in your state, and develop strategies for helping them address those issues.
Key Lessons for Stage 2: Developing Options
- While developing policy options, remain open-minded—allow the research findings to guide decision-making.
- Recognize that there are often limitations to the data that researchers have available to them, and that this may diminish their ability to address certain policy options.
- Ideally, engage the community, relevant stakeholder groups, and potential end-users in the process of developing policy options.
- Recognize that databases may be limited, particularly when it comes to identifying gaps in services, programs, and unmet needs.
- Become familiar with proxy data sets for studying salient state issues, as often "ideal" state data may not be readily available.
- Be flexible about finding useful data and developing workable research models.
- Be ready and willing to modifying policy options as stakeholder feedback emerges.
Key Lessons for Stage 3: Implementing a Policy
- Be aware that researchers need to have a different set of skills for the implementation stage than for the policy options development stage.
- Generally, researcher involvement at the implementation stage is limited. A government agency typically takes over, often with the assistance of consultants. Still, researchers can help analyze the potential effects of choices made during implementation.
- Recognize the unique set of skills needed for the implementation stage.
- Since trial and error are the norm during this phase, researchers can prove useful by explaining early results as they occur.
Key Lessons for Stage 4: Evaluating the Program/Policy
- To avoid the perception of bias, seek an outside, nonpartisan research team to evaluate a program.
- Build into prospective legislation a comprehensive evaluation plan, including the collection of baseline data before program implementation.
- Commit to an ongoing assessment of the program to promote a culture of continuous quality improvement.
- Communicate clearly to researchers how you want findings from the evaluation to be packaged and presented to ensure the findings are understandable and meaningful to your targeted audiences.
- Call upon the relationships developed during stage one to build a case for conducting an evaluation. Relationships will also be crucial to secure necessary data and, ultimately, to get the evaluation results acted upon.
- Be willing to use a mix of qualitative and quantitative research methods. Take advantage of statistical methods developed to control for confounding variables in order to help identify the independent effect of the new policy.
- Concise executive summaries of lengthy reports can be helpful. In addition, one-page issue briefs, graphs, charts, or PowerPoint presentations can be easily digested—key to having research findings read and remembered.
- Identify conduits for moving your research findings up the bureaucratic ladder.