Critical%20Issues%20in%20Knowledge%20Utilization%20and%20Health%20Policy-Making

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Critical Issues in Knowledge Utilization and
Health Policy-Making

• Robert F. Rich, Ph.D.
• University of Illinois at Urbana-Champaign

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Donald Schon Beyond the Stable State

• A social system learns whenever it acquires
  new capacity for behavior but government as a
  learning system carries with it the idea of
  public learning a special way of acquiring new
  capacity for behavior, in which government learns
  for society as a whole. In public learning,
  government undertakes a continuing, directed
  inquiry into the nature, causes and resolution of
  our problems.
• continued

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Donald Schon Beyond the Stable State
(continuation)

• If government is to solve new public
  problems, it must also learn to create the
  systems for doing so and to discard the structure
  and mechanisms grown up around old problems.
• Because many sorts of social systems have
  governments, the requirements of public learning
  may not be limited to traditional political
  units the concept of public learning applies as
  well to institutions such as the church, labor
  unions, schools, welfare agencies, and business
  firms.

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Donald Schon Beyond the Stable State

• Because many sorts of social systems have
  governments, the requirements of public learning
  may not be limited to traditional political
  units the concept of public learning applies as
  well to institutions such as the church, labor
  unions, schools, welfare agencies, and business
  firms.

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John W. Gardner

• A society that is capable of continuous
  renewal will have effective internal
  communication among its diverse elements. We do
  not have that today. We are drowning in a torrent
  of talk, but most of it serves only to raise the
  noise level. Communication in a healthy society
  must be more than a flow of messages it must be
  a means of conflict resolution, a means of
  cutting through the rigidities that divide and
  paralyze a community.

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Knowledge utilization, the social contract, and
the role of public learning (1)

• What is the social contract? (This is a legal,
  political, economic, and social concept.)
• The social contract (as it relates to the
  relationship between science and government)
  evokes the voluntary but mutual responsibilities
  between government and science, the production of
  the public good of basic research, and the
  investment in the future prosperity that is
  research. (Guston, 2000)
• There has traditionally been an uneasy
  partnership between scienceespecially basic
  researchand government.

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Knowledge utilization, the social contract, and
the role of public learning (2)

• Scientists believe that it is in societys best
  interest to incorporate scientific knowledge into
  decision-making.
• Policy-makers have posed a critical set of
  questions
• What is the return on our investment?
• What is the utility of the research that is being
  financed out of public funds?
• How are these publicly financed research studies
  going to be used?

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Knowledge utilization, the social contract, and
the role of public learning (2)

• Is it science serving the needs of society or
  society serving the needs of science?
• The adaptation of scientific knowledge to meet
  with needs of society is recurring in Western
  thought.
• How does the social contract apply to knowledge
  inquiry systems in a knowledge society?
• How has this changed over time? What is the
  relationship to public learning?

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Examples of Public Learning

• Public learning is a process by which citizens
  become engaged in the search for valid responses
  to a problematic issue or situation.
• Such learning is a social phenomenainteracting
  with government agencies and other
  stakeholdersto frame the problem and then to
  become engaged in the process of formulating what
  to do about it.
• Public learning involves changing attitudes and
  beliefs, which may lead to action indeed to
  behavior changes in society.

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Focus of Knowledge Utilization

• The knowledge inquiry systemWhat is the basic
  model?
• The acquisition, distribution, utilization, and
  impact of knowledge on decision-making /
  policy-making
• Decision-making can be made by individuals,
  organizations, (in the public and private sector)
  governments, and society.
• The role of information / knowledge in the
  formulation of beliefs and attitudes and in
  motivating or driving actions.

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Basic Assumptions

• Information is collected for a variety of reasons
  and not necessarily for purposes of use
  information may be collected simply for building
  inventory or building capacity.
• There may be negative, unintended consequences of
  using information.
• It may be fully rational to ignore available
  information or to actively reject it.
• Intended non-utilization is different from
  mis-utilization of information.

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Different Types of Knowledge

• Practical knowledge
• Intellectual knowledge
• Small talk or past-time knowledge
• Spiritual knowledge
• Unwanted knowledge
• All of these types have implications for the
  operations of a knowledge inquiry system
• The distinction between data, information, and
  knowledge

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Common Myths

• Acquiring information will automatically lead to
  its distribution and use.
• Using basic research is a rational act.
• The problem with policy-making or
  decision-making is that there isnt enough
  scientific information being used.
• If we can bridge the gap between the two
  cultures, we will have solved the primary problem
  of translating research into action.
• Use is use is use !
• Use for decision-making is the same as
  organizational learning or public learning.

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Special Issues in Health Care (1)

• The growing complexity of technology and medicine
  
• This technology has an ever growing influence on
  every-day life
• Evidence-based medicine and health care
  decision-making is of growing importance
• The general model of decision-making in health
  care is fundamentally different from
  decision-making in politics

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Special Issues in Health Care (2)

• Health policy more than many other areas relies
  on science and is, in many ways, guided by
  science
• Telemedicine
• Biotechnology
• Molecular biology
• Genetic screening and the development of
  diagnostic procedures
• The human genome project
• Therapeutic technology
• Health economics

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Special Issues in Health Care (3)

• Is there some reason to believe that decisions
  that involve a heavy scientific or technical
  dimension should be handled differently than
  those that do not?
• Legally the answer is no
• Is there a differencethe answer is yes
• Why is this the case?
• What are the consequences?

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Key Findings from Research (1)

• Learning involves introspection and
  self-reflection, and the demands of the public
  sector usually do not encourage this type of
  behavior.
• Public and private organizations tend to reward
  people for knowing and winning, and not for
  admitting they dont know. (Implications of
  this)
• Knowledge is power to the bureaucrat does this
  conflict with the system of scientific
  publication?
• The use of knowledge produces effects and not in
  a single effect.

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Key Findings from Research (2)

• The realities of the political policy-making
  process reinforce feelings of distrust and
  suspicion between the two communities.
• To a great extent, bureaucrats credibility,
  prestige, and legitimacy are related to the
  reliance of their superiors on the information
  they provide. This has implications for the
  system used to produce and collect information.
• Who provides the information (the source) is at
  least as important as the content of the
  information provided.

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Key Findings from Research (3)

• In health care, voting records on traditionally
  controversial issues like needle exchange
  programs directly oppose research demonstrating
  their public health value.
• Government sponsored studies have concluded that
  needle exchange programs decrease HIV
  transmission and drug use yet, lawmakers have
  continued to ban federal funding for such
  programs. What is the basis for this seeming
  contradiction?
• Use is not the same as dissemination or impact.

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Key Questions (1)

• What types of information are preferred over
  others?
• To what extent do decision-makers take research
  into account?
• To what extent does research influence or change
  a position the decision-maker is already
  predisposed to? (This has particular implications
  for health policy-making)
• What are the characteristics of basic science
  that make it useful for decision-making?
• How do lawmakers define their needs? Where does
  scientific knowledge fit in with these needs?

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Theoretical and Empirical Issues

• Developing an appropriate theoretical or
  conceptual framework
• The theoretical frameworks which have been used
  are ALL problematic
• Rational Actor
• Two Communities
• Communications Model
• Bureaucratic Actor model

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Measurement issues

• There are also a key set of measurement issues
• The input-output model
• Linear models
• Specifying the dependent variable
• Defining what is meant by use
• The problem with causality
• The use of interviews
• The use of citation analysis

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Promising Areas for Research and Practice (1)

• Organizational learningorganizations can also be
  thought of as having learning disabilities
• Public learning
• The role of e-government and d-government
• The knowledge inquiry system and the use of
  technology ( i.e., e-mail, the internet,
  decision-support systems, artificial intelligence)

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Promising Areas for Research and Practice (2)

• Management of information
• Processing errors and biases
• The use and abuse of information by individuals
  and by organizations
• Symmetries and asymmetries of information (this
  may be particularly relevant in the area of
  health care)

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Conclusions and Implications (1)

• In health care, understanding the use of
  scientific and technical knowledge continues to
  be a real challenge
• Researchers and practitioners will not be able to
  advance much further if they continue to rely on
  the Two-Cultures metaphor or the rational actor
  model.

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Conclusions and Implications (2)

• Advances in technology have underscored the
  importance of
• Channels for transmitting information
• Increasing the speed and efficiency with which
  information can reach our desk
• Resisting the temptation to allow the
  availability of technology to define the decision
  to be made
• The utilization process is directly and
  measurably affected by the type of information
  that is available for purposes of potential
  utilization AND the area in which the information
  is being applied.