Forging Ahead: Evidence to Innovation Saint Elizabeth Health Care Conference Evidence: Impacting Eff

1
Forging Ahead Evidence to InnovationSaint
Elizabeth Health Care Conference Evidence
Impacting Effective PolicyPolitics,
Evidence,Connectionsand Luck

• Sandra MacDonald-Rencz
• Office of Nursing Policy, HC
• March 7 2008

2
The Office of Nursing Policy BACKGROUND

• Mandate
• Contribute to policy development by bringing
  knowledge, evidence and perspectives of nursing
  community to government and
• Facilitate liaison of government with nursing,
  nationally and internationally, and broader
  health community

Office of Nursing Policy
Health Canada
3
Evidence as the foundation of policy

• as the pressure on resources increases,
  decisions will have to be made explicitly and
  publicly, those who take decisions will need to
  be able to produce and describe the evidence on
  which each decision is based
• Gray, 1997, p. 1

Office of Nursing Policy

Health Canada
4
Evidence in Policy

• Policy levers that can be
• used
• 1. robust research evidence
• 2. effective research-policy linkages
• 3. understanding of change management
• 4. understanding of policy cycle
• 5. political acumen
• (Shamian et al, 2003)

Office of Nursing Policy
Health Canada
5
Evidence in Policy

• Robust Research Evidence
• instrumental use - changing a policy based on the
  findings of a study (uncommon)
• conceptual use - new ways of approaching and
  interpreting evidence - changing ways of thinking
• symbolic use - strategic use to defend or justify
  a preferred position

Office of Nursing Policy
Health Canada
6
Evidence in Policy

• 2. Effective Research-Policy Linkages
• Two Communities theory - cultures of researchers
  and policy-makers prohibit successful
  communication need to overcome
• Social Interaction Model - research utilization
  influenced by non-linear relationship between
  researchers and policy-makers
• Improved through increased interaction at all
  stages of research production, dissemination,
  utilization

Office of Nursing Policy
Health Canada
7
Evidence in Policy

• 3. Understanding change management
• Diffusion of Innovation model (Rogers, 1995)
• innovation-decision process - first knowledge of
  an innovation - forming an attitude - decision to
  adopt or reject - implementation - confirmation
  of the decision
• factors in adoption characteristics of the
  innovation, the organization, the environment and
  the individual

Office of Nursing Policy
Health Canada
8
4. Understanding the Policy Cycle
Getting to Policy Agenda
Values Beliefs
Problem or Issue Emerges
Regulation, Experience Revision
Knowledge Development Research
Public Policy Deliberation Adoption
Public Awareness
Interest Group Activation
Moving into Action
Political Engagement
Adapted from Tarlov, 1999
9
Evidence in Policy

• 5. Political acumen
• policy-making less a rational act than a process
  of social influence
• policy windows open infrequently and do not stay
  open long (Kingdon, 1995)
• important to understand which policy options have
  the greatest potential for adoption and when
  small incremental changes are the preferred option

Office of Nursing Policy
Health Canada
10
The ONPs Journey of Science and Policy

• The research
• emerging body of evidence which demonstrates
  significant and dramatic relationships between
  nurse and patient outcomes and
• nurse-to-patient staffing ratios
• the skill mix and experience of nursing staff
• existing nursing shortages

Office of Nursing Policy
Health Canada
11
The ONPs Journey of Science and Policy

• The Research
• more favorable staffing ratios and higher
  proportions of regulated staff have been
  associated with
• lower mortality rates in neonates and adults
  lower re-admission rates
• shorter lengths of stay, lower rates of GI bleeds
  and shock in medical patients
• lower fall rates, improved pain management, and
  higher levels of patient satisfaction

Office of Nursing Policy
Health Canada
12
The ONPs Journey of Science and Policy

• The Research
• Startling evidence relating to the worklife of
  nurses
• nurses suffer the highest stress of all HC
  workers
• absenteeism rate is 80 higher than for 47 other
  occupational groups - translates into 9,000
  FTEs/year
• overtime - a quarter of a million hours/week -
  translates into 7,000 FTEs/year
• estimated cost of overtime, absentee wages and
  replacement for RN absentees is between 962 M
  and 1.5 B/year

Office of Nursing Policy
Health Canada
13
The ONPs Journey of Science and Policy

• Policy changes to improve work environments slow
  despite the evidence which point to both patient
  and nurse impacts
• Relevant research and its dissemination are
  necessary but insufficient to ensure utilization

Office of Nursing Policy
Health Canada
14
K N O W L E D G E
KNO WLEDGE
PPolicy Cycle Policy Cycle
Transfer
Healthy Nurses, Healthy Workplaces
Expand
Create
2002
2004
2006
2008
2000
ONPTrajectories
Describe Issues
Awareness Mobilize
Disseminate Information
Generate Solutions
Monitor Evaluate
15
The ONPs Journey of Science and Policy

• Healthy Workplace Initiative
• CCHSE Quality of Worklife Indicators Project
• National Health of Nurses Survey
• Healthy Workplace Guidelines
• QWQHC collaborative
• working with provincial and territorial
  colleagues and key stakeholders

Office of Nursing Policy
Health Canada
16
Potential contribution of research to policy

• In the world of research, completing the study
  is just the first stepmaking the research come
  alive and using it to build capacity for future
  science and scientists and to tell stories that
  capture policy-makers attention and ultimately
  lead to policy changes, are what it is all about
• OBrien-Pallas, 2003

Office of Nursing Policy
Health Canada
17
Evidence must underline policy but leadership is
the key to making policy changes a reality
Office of Nursing Policy
Health Canada