Dia 1

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Levels of evidence

• Scientific evidence, methodologicly tested what
  works, efficacy, effectiveness
• Contextual evidence local and societal
  relevance how does it work, under what
  circumstances
• Not tested supplementary, practical, normative,
  political, traditional, interests, conflicts

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The what works evidencefrom (bio)medical
sciences

• Research evidence, methodologically tested
• Systematic reviews (and meta-analysis) of
  (preferably, double-blind, randomised control)
  evaluations, or the next best thing thats
  available.

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Uncomplicated, unidirectional, linear,
acontextual model of evidence production and
uptake
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The what works evidence

• Could work for instrumentalist knowledge making
  choices e.g national screenings programmes

knowledge packages
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Evidence based medicine (Sackett)

• Integrating individual clinical expertise and the
  best external evidence
• Without clinical expertise, practice risks
  becoming tyrannised by evidence, for even
  excellent external evidence may be inapplicable
  to or inappropriate for an individual patient.
  Without current best evidence, practice risks
  becoming rapidly out of date, to the
  detriment of patients.

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Good health services need broader sense of
social research

• contextual evidence from social (economic)
  sciences
• Organisational research
• Implementation research
• Attitude, behaviour studies
• Scenario studies, models, forecast
• Economic evaluations
• Data on system capacity
• Ethical studies
• Opinion polls and stakeholder consults
• Client and user experience data

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Decision making often constrained with

• ongoing process
• piecemeal no single decision
• values, existing (tacit) knowledge, and
  individual experience
• being socially and contextually situated
• creating conflicting knowledge and/or knowledge
  in incommensurate domains
• knowledge/power intimately co-constructed
• selectively/tactically use of evidence

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Also known as colloquial evidence

• Standards, values
• Political concerns
• Financial constraints
• Lobby, pressure groups
• Practice, tradition
• Professional experience and expertise
• Pragmatism, probability

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When decisions and policy collide with evidence

• No one with the slightest common-sense could
  take seriously suggestions by university
  researchers that a double passport is no hinder
  for integration.

WRR is just babbling
scientific council of government policy
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Sustained interaction
Health providers
Policy makers
Researchers
Service delivery management
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What helps

• to cluster evidence (themes, target groups)
• to contextualise, interpret evidence
• to combine different levels of evidence
• linkage exchange, networking
• to involve decision makers in evidence
  development and research projects
• knowledge brokers and other intermediaries

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7 Research-into-practice policy principles

• Each result deserves its own transfer/translation
• Knowledge transfer and implementation require an
  active approach
• Projects are not the unit of implementation
• National spread of innovations in quality
  programmes
• Capitalizing on results
• The importance of a good network
• Collaboration as a leading principle

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2. KT and implementation require an active
approach

• Organizing linkage and exchange in thematic
  conferences, national implementation congress,
  invitational conferences, expert meetings,
  networks, site visits
• Building knowledge and expertise on KT,
  valorisation and implementation
• Dissemination in meetings, lectures, publications
  
• Brokering people and knowledge between practice,
  private sector, researchers and policy
• Building capacity with training, workshops, advise

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3. Project not the unit of implementation

• Project (grant) useful unit for culture change
  researchers
• User groups more interested in synthesized
  knowledge and context relevant innovations
  (evidence base, workable, what change is needed
  for implementation)

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To improve research uptake organize interactive
processes and a knowledge synthesis
input from research
input from research
contextualised recommendations for policy and
practice
contextualised recommendations for policy and
practice
input from practice
input from practice
input from policy
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4. National spread of innovations in quality
programmes

• 9 national quality collaboratives in all health
  sectors
• commissioned by the Minister of Health
• ZonMw coordinating and directing role
• quality and safety improvements, different levels
  of operation
• teams in departments of institutions
  Breakthrough projects
• institutions internal external spread, HRM,
  leadership, commitment
• sector networks CEOs, CFOs, managers, medical
  and nursing staff participants determine the
  norm for quality, results obligatory for sector
• evaluation of each programme and a comparative
  overall evaluation

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7. Collaboration as a leading principle

• Within projects in specific programmes it is a
  pro or even a criterion for selection
• Specific examples
• The clinical research traineeships
• The academic workplace programmes
• Rehabilitation, Mental Health, Public Health
• Consumer information programme
• National Quality collaboratives
• System Biology programme collaboration between
  genomics, bio-informatics, industry

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The academic workplace programme

• Set up of academic collaborative centres
• Universities and public health departments invest
  in long-term partnership (contractual agreement gt
  5 year)
• Grants for infrastructural investments together
  with RD projects
• Spread of public health themes

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ZonMw experience

• Concerted and sustained (inter)action

Any questions?