Commentary: Understanding the Underlying Politics of Health Care Policy Decision Making

Blendon, Robert J.; SteelFisher, Gillian K.

doi:10.1111/j.1475-6773.2009.00979.x

Cited by 15 publications

(15 citation statements)

References 14 publications

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“…However, our narrative analysis, which considered the overall conclusions drawn by the authors, showed evidence of change over time. The increasing need for health services research to have impact has led to researchers increasingly choosing to study topics with policy leverage and ‘present them in a manner that policy makers think about these issues’ [ 38 ]. These pressures may influence not only topics for research, but also interpretation and publication.…”

Section: Discussionmentioning

confidence: 99%

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Honeyford

Cecil

et al. 2018

BMC Health Serv Res

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BackgroundThe concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals.MethodsThis is a systematic review and meta-analysis of published studies on the weekend effect in UK hospitals. We used EMBASE, MEDLINE, HMIC, Cochrane, Web of Science and Scopus to search for relevant papers. We included systematic reviews, randomised controlled trials and observational studies) on patients admitted to hospital in the UK and published after 2001. Our outcome was death; studies reporting mortality were included. Reviewers identified studies, extracted data and assessed the quality of the evidence, independently and in duplicate. Discrepancy in assessment was considered by a third reviewer. All meta-analyses were performed using a random-effects meta-regression to incorporate the heterogeneity into the weighting.ResultsForty five articles were included in the qualitative synthesis. 53% of the articles concluded that outcomes for patients either undergoing surgery or admitted at the weekend were worse. We included 39 in the meta-analysis which contributed 50 separate analyses. We found an overall effect of 1.07 [odds ratio (OR)] (95%CI:1.03–1.12), suggesting that patients admitted at the weekend had higher odds of mortality than those admitted during the week. Sub-group analyses suggest that the weekend effect remained when measures of case mix severity were included in the models (OR:1.06 95%CI:1.02–1.10), but that the weekend effect was not significant when clinical registry data was used (OR:1.03 95%CI: 0.98–1.09). Heterogeneity was high, which may affect generalisability.ConclusionsDespite high levels of heterogeneity, we found evidence of a weekend effect in the UK, even after accounting for severity of disease. Further work is required to examine other potential explanations for the “weekend effect” such as staffing levels and other organisational factors.Trial registrationPROSPERO International Prospective Register of Systematic Reviews -registration number: CRD42016041225.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3688-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Honeyford

Cecil

et al. 2018

BMC Health Serv Res

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“…2008; Stone 1997). This interplay of political and rhetorical imperatives with technical and rational aspirations is no less evident in health services policy, which, due to its association with biomedicine, places greater emphasis on evidence‐based policy tropes (Blendon and SteelFisher 2009; Shaw and Greenhalgh 2008).…”

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confidence: 99%

Galvanizers, Guides, Champions, and Shields: The Many Ways That Policymakers Use Public Health Researchers

et al. 2011

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Context:Public health researchers make a limited but important contribution to policy development. Some engage with policy directly through committees, advisory boards, advocacy coalitions, ministerial briefings, intervention design consultation, and research partnerships with government, as well as by championing research-informed policy in the media. Nevertheless, the research utilization literature has paid little attention to these diverse roles and the ways that policymakers use them. This article describes how policymakers use researchers in policymaking and examines how these activities relate to models of research utilization. It also explores the extent to which policymakers' accounts of using researchers concur with the experiences of "policy-engaged" public health researchers. Methods:We conducted semi-structured interviews with thirty-two Australian civil servants, parliamentary ministers, and ministerial advisers identified as "research-engaged" by public health researchers. We used structured and inductive coding to generate categories that we then compared with some of the major research utilization models.Findings: Policymakers were sophisticated and multifaceted users of researchers for purposes that we describe as Galvanizing Ideas, Clarification and Advice, Persuasion, and Defense. These categories overlapped but did not wholly fit with research utilization models. Despite the negative connotation, "being used" was Address correspondence to: Abby S. Haynes, The Sax Institute, PO Box K617, Haymarket, NSW 1240 Australia (email: abby.haynes@saxinstitute.org.au). The Milbank Quarterly, Vol. 89, No. 4, 2011 (pp. 564-598) reported as reciprocal and uncompromising, although researchers and policymakers were likely to categorize these uses differently. Policymakers countered views expressed by some researchers. That is, they sought robust dialogue and creative thinking rather than compliance, and they valued expert opinion when research was insufficient for decision making. The technical/political character of policy development shaped the ways in which researchers were used. Conclusions:Elucidating the diverse roles that public health researchers play in policymaking, and the multiple ways that policymakers use these roles, provides researchers and policymakers with a framework for negotiating and reflecting on activities that may advance the public health goals shared by both.

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“…In her work examining how policy makers use health service research, Marsha Gold revealed that healthcare policy makers' decisions to implement research programs are influenced by “underlying politics” (Gold 2009). To influence policy decisions, researchers must develop a deeper understanding of the context in which these decisions are made (Blendon and SteelFisher 2009). This includes being aware of existing healthcare policies, how evidence-informed public policy is developed, and which research topics have policy leverage, and presenting these factors in a way that engages policy makers' interests.…”

Section: Discussionmentioning

confidence: 99%

Using an Integrated Knowledge Translation (IKT) Approach to Enable Policy Change for Electronic Consultations in Canada

Liddy¹,

Moroz²,

Joschko³

et al. 2018

hcpol

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This paper explores our efforts to support the expansion of a regional electronic consultation (eConsult) service on a national level by addressing potential policy barriers. We used an integrated knowledge translation (IKT) strategy based on five key activities leading to a National eConsult Policy Think Tank meeting: (1) identifying potential policy enablers and barriers; (2) engaging national and provincial/territorial partners; (3) including patient voices; (4) undertaking co-design and planning; and (5) adopting a solution-based approach. We successfully leveraged a diverse set of stakeholders in strategic discussions, culminating in actionable suggestions for next steps, which will serve to inform a national implementation strategy.

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Commentary: Understanding the Underlying Politics of Health Care Policy Decision Making

Cited by 15 publications

References 14 publications

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Galvanizers, Guides, Champions, and Shields: The Many Ways That Policymakers Use Public Health Researchers

Using an Integrated Knowledge Translation (IKT) Approach to Enable Policy Change for Electronic Consultations in Canada

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