Search results

Objective Current government policies simultaneously pursue the development of 'patient‐led' and 'evidence‐based' approaches to healthcare. The objective of this study was to explore how primary care clinicians and Primary Care Trust (PCT) managers balance these potentially competing tensions when considering popular, controversial treatments, like complementary therapies, in consultations (clinicians) or funding decisions (PCT managers).

Background English health-care commissioners from the NHS need information to commission effectively. In the light of new legislation in 2012, new 'external' organisations were created such as commissioning support units (CSUs), public health departments moved into local authorities and 'external' provider organisations such as commercial and not-for-profit agencies and freelance consultants were encouraged. The aim of this research from 2011 to 2014 was to study knowledge exchange between these external providers and health-care commissioners to learn about knowledge acquisition and transformation, the role of external providers and the benefits of contracts between external providers and health-care commissioners. Methods Using a case study design, we collected data from eight cases, where commercial and not-for-profit organisations were contracted. We conducted 92 interviews with external providers (n = 36), their clients (n = 47) and others (n = 9), observed 25 training events and meetings and collected various documentation including meeting minutes, reports and websites. Using constant comparison, data were analysed thematically using a coding framework and summaries of cases. Results In juggling competing agendas, commissioners pragmatically accessed and used information to build a cohesive, persuasive case to plot a course of action, convince others and justify decisions. Local data often trumped national or research-based information. Conversations and stories were fast, flexible and suited to the continually changing commissioning environment. Academic research evidence was occasionally explicitly sought, but usually came predigested via National Institute of Health and Care Excellence guidance, software tools and general practitioner clinical knowledge. Negative research evidence did not trigger discussions of disinvestment opportunities. Every commissioning organisation studied had its own unique blend of three types of commissioning models: clinical commissioning, integrated health and social care and commercial provider. Different types of information were privileged in each model. Commissioners regularly accessed information through five main conduits: (1) interpersonal relationships; (2) people placement (embedded staff); (3) governance (e.g. Department of Health directives); (4) 'copy, adapt and paste' (e.g. best practice elsewhere); and (5) product deployment (e.g. software tools). Interpersonal relationships appeared most crucial in influencing commissioning decisions. In transforming knowledge, commissioners undertook repeated, iterative processes of contextualisation using a local lens and engagement to refine the knowledge and ensure that the 'right people' were on board. Knowledge became transformed, reshaped and repackaged in the act of acquisition and through these processes as commissioners manoeuvred knowledge through the system. External providers were contracted for their skills and expertise in project management, forecast modelling, event management, pathway development and software tool development. Trust and usability influenced clients' views on the usefulness of external providers, for example the motivations of Public Health and CSUs were more trusted, but the usefulness of their output was variable. Among the commercial and not-for-profit agencies in this study, one was not very successful, as the NHS clients thought that the external provider added little of extra value. With another, the benefits were largely still notional and with a third views were largely positive, with some concerns about expense. Analysts often benefited more than those making commissioning decisions. Conclusions External providers who maximised their use of the different conduits and produced something of value beyond what was locally available appeared more successful. The long-standing schism between analysts and commissioners blunted the impact of some contracts on commissioners' decision-making. To capitalise on the expertise of external providers, wherever possible, contracts should include explicit skills development and knowledge transfer components. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Background:The Bristol Knowledge Mobilisation (KM) Team was an unusual collective brokering model, consisting of a multi-professional team of four managers and three academics embedded in both local healthcare policymaking (aka commissioning) and academic primary care.
Aims and objectives:They aimed to encourage 'research-informed commissioning' and 'commissioning-informed research'. This paper covers context, structure, processes, advantages, challenges and impact.
Methods:Data sources from brokers included personal logs, reflective essays, exit interviews and a team workshop. These were analysed inductively using constant comparison. To obtain critical distance, three external evaluations were conducted, using interviews, observations and documentation.
Findings:Stable, solvent organisations; senior involvement with good inter-professional relationships; secure funding; and networks of engaged allies in host organisations supported the brokers. Essential elements were two-way embedding, 'buddying up', team leadership, brokers' interpersonal skills, and two-year, part-time contracts. By working collectively, the brokers fostered cross-community interactions and modelled collaborative behaviour, drawing on each other's 'insider' knowledge, networks and experience. Challenges included too many taskmasters, unrealistic expectations and work overload. However, team-brokering provided a safe space to be vulnerable, share learning, and build confidence. As host organisations benefitted most from embedded brokers, both communities noted changes in attitude, knowledge, skills and confidence. The team were more successful in fostering 'commissioning-informed research' with co-produced research grants than 'research-informed commissioning'.
Discussion and conclusions:Although still difficult, the collective support and comradery of an embedded, two-way, multi-professional team made encouraging interactions, and therefore brokering, easier. A team approach modelled collaborative behaviour and created a critical mass to affect cultural change.

Aim:
Policymaking decisions are often uninformed by research and research is rarely influenced by policymakers. To bridge this 'know-do' gap, a boundary-spanning knowledge mobilisation (KM) team was created by embedding researchers-in-residence and local policymakers into each other's organisations. Through increasing the two-way flow of knowledge via social contact, KM team members fostered collaborations and the sharing of 'mindlines', aiming to generate more relevant research bids and research-informed decision-making. This paper describes the activities of the KM team, types of knowledge and how that knowledge was exchanged to influence mindlines.

Discussion:
KM team activities were classified into: relational, dissemination, transferable skills, evaluation, research and awareness raising. Knowledge available included: profession-specific (for example, research methods, healthcare landscape), insider (for example, relational, organisation and experiential) and KM theory and practice. KM team members brokered relationships through conversations interweaving different types of knowledge, particularly organisational and relational. Academics were interested in policymakers' knowledge of healthcare policy and the commissioning landscape. More than research results, policymakers valued researchers' methodological knowledge. Both groups appreciated each other as 'critical friends'.

Conclusion:
To increase research impact, 'expertise into practice' could be leveraged, specifically researchers' critical thinking and research methodology skills. As policymakers' expertise into practice also bridges the know-do gap, future impact models could focus less on evidence into practice and more on fostering this mutual flow of expertise. Embedded knowledge brokers from the two communities working in teams can influence the mindlines of both. These ambassadors can create improvements in 'inter-cultural competence' to draw academia and policymaking closer.

EPDF and EPUB available Open Access under CC-BY-NC-ND licence. Groups most severely affected by COVID-19 have tended to be those marginalised before the pandemic and are now being largely ignored in developing responses to it. This two-volume set of Rapid Responses explores the urgent need to put co-production and participatory approaches at the heart of responses to the pandemic and demonstrates how policymakers, health and social care practitioners, patients, service users, carers and public contributors can make this happen. The second volume focuses on methods and means of co-producing during a pandemic. It explores a variety of case studies from across the global North and South and addresses the practical considerations of co-producing knowledge both now - at a distance - and in the future when the pandemic is over