Getting research into the hands of policy makers at the right time, on the right topic, and in an accessible format is fraught with challenges, including research timelines that don’t align with policy making; researchers’ lack of training in, and lack of incentives for, translating findings into simpler language; and the multitude of voices and priorities that compete for policy makers’ time and attention.
For nearly thirty years, staff at the Robert Wood Johnson Foundation’s (RWJF’s) program called Changes in Health Care Financing and Organization worked to overcome these challenges as they sought to generate and disseminate rigorous research to inform and strengthen health policy, a goal shared by AcademyHealth, the program’s long-time national program office. The sunset of this program, commonly known as HCFO, at the end of 2016 provides an opportunity to reflect on the effectiveness of the HCFO program’s knowledge-brokering activities and provides useful insights for similar efforts aimed at strengthening the relevance and use of evidence in health policy making.
Here are some lessons we’ve learned over the years.
1. For research to be policy relevant, you get out of it what you put into it.
Early on, we recognized that connecting applicants and their ideas with policy makers and their priorities was a crucial step in generating useful research. HCFO staff played an important role in brokering this communication—beginning with the initial grant application. Proposals underwent review by both methodological experts and people with policy expertise, with funding contingent in part on the reviewers’ assessments of projects’ timeliness, relevance, and potential contribution to actionable policy or practice change. Successful applicants were encouraged to incorporate policy maker feedback—provided in the form of blinded reviews—into their projects, with the end result that many HCFO-funded studies were informed by policy makers before the work even began!
We continued to “bridge” researchers and policy makers throughout the research cycle. For example, when grantee and law professor Mark Hall of Wake Forest University launched a study in 2012 to understand why employer use of the Massachusetts Connector for the small-group market lagged behind expectations, HCFO staff, at the outset and midpoint of his study, connected Hall with state policy makers who helped him refine his survey instrument and ensure the study would be useful to states implementing health insurance exchanges under the Affordable Care Act.
2. Know and respect the audiences you seek to inform.
In addition to connecting researchers and policy makers at the start of a research project, HCFO staff undertook several types of knowledge-brokering activities once projects concluded. Each of these activities was structured to reflect the information needs, time constraints, and other characteristics of intended research users—primarily policy makers working in state and federal government. For example, recognizing that policy makers have limited time available to read a full research article, HCFO staff frequently prepared concise written summaries of HCFO-funded research that highlighted its important implications for policy.
Additionally, we periodically convened researchers and policy makers for full-day meetings that sought to summarize the state of the evidence on a policy-relevant topic (for example, managed care, risk adjustment) and identify outstanding questions in need of further exploration. Such was the case when HCFO convened approximately thirty researchers and policy makers for a 2013 meeting on the Medicare Hospital Readmissions Reduction Program, which followed an agenda designed by participating policy makers.
In addition, HCFO frequently organized in-person briefings between individual grantees and small groups of relevant policy makers. These briefings often featured presentation of prepublication study findings by the grantee, serving the dual purpose of providing policy makers with early insights into forthcoming research, while also eliciting from them constructive feedback for the grantee to consider when drafting and refining manuscripts for peer-reviewed publication. Across these and other knowledge-brokering activities—including the production of accessible research summaries, HCFO staff sought to disseminate grantees’ findings in a way that acknowledged and respected the priorities and pressures facing the intended research users.
3. Research investments are as much about the people as the product.
In its knowledge-brokering role, the HCFO program had a broader goal beyond the targeted dissemination of study findings. We aimed to facilitate continued knowledge exchange and relationship building between the research and policy communities. For example, after grantee R. Adams Dudley of the University of California, San Francisco, presented findings from his study on virtual medical care to staff from the Federal Trade Commission (FTC) and the Office of the National Coordinator for Health Information Technology (ONC) in 2014, he was asked to contribute to an ONC white paper on telemedicine and to serve as a panelist at an FTC/Department of Justice workshop on evolving provider payment models.
This example exemplifies a larger and perhaps less tangible effect of HCFO’s activities: its support of new knowledge brokers—its grantees. Indeed, some of today’s most prominent voices for the fields of health services and policy research are former HCFO grantees who have become important knowledge brokers in their own right. Their continuing efforts to bring evidence to bear on far-reaching policy decisions underscore the impact a funder can have beyond a single research study.
4. Tracking impact: Don’t let the perfect be the enemy of the good.
Despite the many successes of HCFO’s knowledge-brokering efforts, the program was not without its challenges. Chief among them was the persistent challenge of measuring the impact of our activities, including the use of study findings by policy makers. As many research organizations know all too well, it is often difficult to pinpoint the impact of a meeting, briefing, single study, or researcher on a specific policy or policy change. Many HCFO-funded studies and activities contributed to an accruing body of evidence from HCFO and others, making it difficult to attribute policy impact to a single study or discussion.
Over the years, we implemented and honed a process that involved regular communication with grantees and policy makers to track policy impact. While an imperfect system, this process helped inform AcademyHealth’s growing interest and work in the area of research impact assessment, including a current project supported by the RWJF that seeks to test tools and processes for more systematically tracking the impact of research-related investments.
Foundations that hope to generate evidence to inform policy have an important role to play as knowledge brokers between the research and policy communities. As we reflect on the successes and challenges of the HCFO program in this regard, we have identified several key junctures where knowledge brokering is particularly important and effective: in the production of research, in the dissemination of study findings, and in the development of human capital—or future knowledge brokers. And we are making progress in understanding how to measure the effectiveness of these activities.
As we move forward in the health reform era, research that can inform policies to pay for and deliver better value in health care will be paramount. We hope the next generation of grantmakers may build on HCFO’s lessons learned in bridging the research and policy communities to ensure that research is useful and used.
For examples of HCFO research published in Health Affairs, please go to the journal’s search engine and search under “Changes in Health Care Financing and Organization.”