You Can't Get There from Here: Building Bridges across Research and Practice Communities
Dwyer, Judith, Leggat, Sandra G., Australian Health Review
IN THIS ISSUE, Ried and Fuller (page 6) describe an approach taken by the Primary Health Care Research Evaluation and Development (PHCRED) program in South Australia to support novice authors. This paper reminds us of the acute need to support developing researchers, given the low levels of support for health services research in Australia.1 But where is the accompanying paper that focuses our attention on developing the research insight of managers, leaders, policymakers and practitioners? There has been much talk of the critical need to link the disparate research and decision-making communities, but little action.
Consistently we find evidence that evidence is not available or is not used. In a study of economic evaluations only 27% were thought to have influenced either health care decision makers or policy2 Review of purchasing decisions by NHS districts found that only 42% had evidence to support the decision made.3 In Australia there is a dearth of health services research focusing on major system or broad policy issues.1
As a mechanism to disseminate research findings, we often expect Australian Health Review (AHR) to be controversial, especially as it is positioned across the boundaries of the research and practice 'communities'. We wonder whether these communities are growing further apart in their understanding and expectations of research, in the light of feedback we have received from some authors. More than one has feared, or occasionally experienced, unexpected adverse reactions to the publication of research stories from the field, coming from policymakers, health care staff or community members.
Some other jurisdictions have recognised and attempted to bridge this gap. For example, the Canadian Health Services Research Foundation EXTRA program is designed to provide nurse, doctor and other health executives with better skills in research utilisation,4 and the step-by-step guide, "How to be a good research partner", assists in defining the roles and responsibilities necessary for collaborative research.5 In 2000, three-hundred organisations came together to form the Alliance for Health Policy and Systems Research, with the aims of capacity building for, and the dissemination and use of, policy research.6 In Australia and New Zealand, the National Health and Medical Research Council, the Australian and New Zealand Society for Health Services Research, and many others, are thinking about and pursuing better linkages between researchers and practitioners.
Research that speaks to practitioners and policymakers
This issue of the Journal offers a collection of practice- and policy-relevant papers, including several which yield important learnings from problems or failure of new interventions and current health care practice. Manning and Jackson (page 61) document the risk of hypoglycaemia for diabetic patients of a subacute unit. Basic and Conforti (page 51) report on the failure of an intervention in the emergency department to reduce admissions or lengths of stay. Ting and Humphrey (page 37) present evidence that a lot of the time of after-hours ward medical officers is taken up with routine work, at least some of which might better be done inhours or by other means.
For health care providers, frank public discussion of such problems is both difficult and uncomfortable, even when we're working towards an open approach to safety and quality improvement. Frank evaluative discussions can also be difficult for those who make policy decisions. Health authorities and other regulators - those who work at a higher level of abstraction than providers and researchers - are sometimes required by the nature of their tasks to use 'murky means aimed at ambiguous ends'. On the other hand, objective assessment of effectiveness requires clear focussed research methods.
Examples of research that highlights policy ambiguities are provided by four of the papers in this issue. Leggat, Bartram and Stanton (page 17), surveyed the use of performance indicators by Chief Executives in the Victorian health system and found little movement from the old standards of finance and volume reporting, suggesting a need to review both policy and practice in performance monitoring. …