The value of evidence informed decision and policy making: how to introduce and sustain it

1. 36th World Hospital Congress
Parallel Session
Don Juzwishin Ph.D. MHSA
Reiner Banken M.D. M.Sc.
November 11, 2009
Rio de Janeiro, Brazil
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2. Themes
 Describe the importance of scientific evidence on
decision making systems in healthcare practice and
policy
 Describe the impact of scientific evidence on cost
reduction and improving the quality of care to the
patient
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3. Improving Health by Improving Decision-Making
Governance
Health Impact
Reduced Cost
Improved Quality
Decisions
Appropriate
Intervention
High Quality Scientific
Evidence

4. Evidence for Informing Decision-Making
Technological, Ethical,
Legislative
Conditions
Political, Social,
Economic
Intuitive
Conditions
Decision-making

5. Evidence …
The process of evidence
generation and use may be
more important than the
evidence itself.

6. Layers of Questions & Layers of Evidence
High Quality Scientific Evidence
How should we do it
here?
Implementation
Should we do it
here? Appropriateness
Can it work Effectiveness
here?
Efficacy
Regulation
Can it work? Technical
Performance

7. Context is essential for evidence-
informed decision making
There are decisions that…
take good in context
… and use it well
evidence …
poor evidence … … and use it poorly
without context
Adapted from Shaxson, L 2004: Evidence-based policy making: if it exists
what makes it robust? Available at http://bit.ly/hIsNC

8. Canadian Society for International Health
Approach to Health System Strengthening
Vision: Equity and Accountability
Stewardship and Leadership
“
“Health in all policies”
Health Framework
Social Determinants of
Health Human Health Financing and
Resource Allocation
Resources
Research for Development
(Evidence-Based planning and
policy-making)
Health Information
Systems
Data for Decision-
Evidence-Based
making
Decision-Making
(Clinical and
Service delivery Community
Community-based)
- treatments interventions
and programs and health
Strong and vibrant Civil Society
promotion
Transparent and Accountable Public/Private Sector

9. Scientific Evidence for long term Health System
Strengthening
Vision: Equity and Accountability
Stewardship and Leadership
“Health in all policies”
Social Determinants of
Health Human Health Financing and
Resource Allocation
Health Framework
Resources
Research for Development
(Evidence-Based planning and
policy-making)
Health Information
Systems
Data for Decision-
Evidence-Based
making
Decision-Making
(Clinical and
Service delivery Community
Community-based)
- treatments interventions
Strong and vibrant and health
and programs Civil Society
promotion
Transparent and Accountable Public/Private Sector

10. Professional Policy-Making for the
Twenty-First Century
• Forward looking • Joined-up
• Outward looking • Evaluates
• Innovative and • Reviews
creative • Reviews
• Using evidence • Learns lessons
• Inclusive • UK Cabinet Office 1999,
Professional Policy-Making for
the Twenty-First Century,
<http://www.civilservant.org.uk
/profpolicymaking.pdf>
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11. Levels of resource decisions in
Health Systems
Health Professionals Provider institutions
Out-of-pocket
Services payments
Pooling of Public payers:
Patients resources National, regional
Taxes
Population Health Insurance Private payers
Adapted from Harrison and Moran p 494 in Handbook of Social Studies in Health and Medicine. Sage 1999

12. How to develop evidence-
based decision-making ?
Linked to Appropriate level of decision
governance making to be informed by HTA
Linking evidence Strong support by senior
to decision- decision-makers
making
Well trained human resources
with high analytic capacity
Scientific
Institutional arrangements for
credibility
guaranteeing scientific
independency
Social
Processes to include context
credibility
information from stakeholders

13. Concluding remarks
 What foundation
would you like to stand
on?
 Political expediency
 Opinion
 Beliefs
 Scientific evidence
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14. References
 Canadian Society for International Health
 www.csih.org
 D. Fradon, 1977, New Yorker Magazine
 U.K. Cabinet Office
 http://www.civilservant.org.uk/profpolicymaking.pdf
 Contemporary Government Challenges
of evidence-based policy-making
 Australian Public Service Commission
 Shaxson, L. 2004, http://bit.ly/hIsNC
 Harrison and Moran in Handbook of Social Studies in
Health and Medicine, 1999
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