Presentation by Dr. John Lavis from McMaster University for GREO's Annual Stakeholder Reception held on June 15, 2015.

1. How to Leverage Research Evidence and
KTE to Influence Policy and Practice
Annual Public Meeting
Gambling Research Exchange Ontario
John N. Lavis, MD, PhD
Canada Research Chair in Evidence-Informed Health Systems
Professor, McMaster University
Director, McMaster Health Forum
Co-Director, WHO Collaborating Centre for Evidence-Informed Policy
Adjunct Professor, Harvard School of Public Health

2. Overview
 A high-performing health system is one where
1. Citizens are supported to engage in healthy behaviours, effective
self-management and appropriate care seeking, and to engage in
driving improvements in practice and policy
2. Providers are supported to engage in evidence-based practice
3. Policymakers are supported to engage in evidence-informed
policymaking
 Where are the analogues in GREO’s work?
 No for 1?
 Yes for 2 (where providers are both those engaged in the
prevention and treatment of harmful gambling and the gambling
operators)?
 Yes for 3 (where policymakers are the gambling regulators and
those who oversee prevention and treatment)?
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3. Supporting Citizen Engagement in Healthy
Behaviours, Self-Management & Care-Seeking
 Citizens need access to research evidence
 McMaster Optimal Aging Portal (www.mcmasteroptimalaging.org)
 Decision Aids Database (https://decisionaid.ohri.ca/)
• “Tools that help people become involved in decision making by
making explicit the decision that needs to be made, providing
information about the options and outcomes, and by clarifying
personal values”
 Citizens also need supports to engage in these ways
(www.healthsystemsevidence.org and expand the ‘Implementation
strategy’ topics and, within that, the ‘Consumer-targeted strategy’)
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4. Supporting Citizen Engagement:
McMaster Optimal Aging Portal
 Addresses a number of frustrations among citizens
 There’s too much scientific research coming out every day, it’s often
overhyped and can conflict with existing research, and I can’t
understand most of it
 The Internet is full of free health resources but it’s hard to know which
are worth a closer look
 Scientific research often only partly answers one question among the
many I have
 Newspapers cover lots of stories but the emphasis is usually on
drama (dramatic findings from a new study, dramatic events with no
mention of related scientific research), not substance
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5. Supporting Citizen Engagement:
McMaster Optimal Aging Portal (2)
 Four types of content written specifically for citizens
 Evidence Summaries
• Key messages from scientific research that's ready to be acted on
 Web Resource Ratings
• Evaluations that tell you whether free health resources on the
internet are based on scientific research
 Blog Posts
• Commentaries on what the scientific research on a topic actually
means and on why good science matters
 @Mac_AgingNews
• Tweets about NEWS and related EVIDENCE from the McMaster
Optimal Aging Portal
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6. Supporting Citizen Engagement in Driving
Improvements in Practice and Policy
 Citizens’ informed judgements, and the values and preferences
underpinning them, need to be systematically elicited
 Citizen briefs and panels (www.mcmasterhealthforum.org)
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Evidence-
based
practice
Clinical context
Patient values
& preferences
Research evidence
Evidence-
informed
policy
Institutions
Ideas
(research evidence & values)
Interests
Individual level Policy or organizational level

7. Supporting Citizen Engagement:
Citizen Briefs & Panels
 Citizen briefs describe (based on research evidence) what’s known
about a problem, options for addressing it, and key implementation
considerations
 Citizen panels, comprised of ethnoculturally and socioeconomically
diverse groups of citizens, provide an opportunity to
 Uncover unique understandings of a problem
 Spark insights about viable solutions
 Identify context-specific implementation considerations
 Facilitate and trigger action
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8. Supporting Provider Engagement in
Evidence-based Practice
 Providers need access to research evidence
 ACCESSSS (http://plus.mcmaster.ca/accessss)
• Contains only high-quality studies and reviews about clinical
programs, services and drugs
 Health Evidence (http://www.healthevidence.org)
• Contains quality-appraised reviews about public health programs
 McMaster Optimal Aging Portal (www.mcmasteroptimalaging.org)
• Clinician and public health professional interfaces, not just citizen
 Providers also need supports to engage in evidence-based practice
(www.mcmasterhealthforum.org then Products, Healthcare organization,
and Optimizing clinical practice)
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9. Supporting Provider Engagement in
Evidence-based Practice
 Step 1: Iteratively identify the clinical practice to be optimized based on
data, evidence and guidelines, as well as the causes of the problem
(using meaningful stakeholder engagement)
 Identify the clinical practice based on explicit criteria
 Specify who (i.e., what professional group) needs to do what
differently (i.e., what behaviour change)
 Ascertain the causes of the problem at some or all of five levels
• Motivation at the individual level (e.g., beliefs, emotion)
• Tasks at the individual or team level (e.g., assessments)
• Roles at the professional level (e.g., responsibilities)
• Rules at the organizational level (e.g., authority)
• Strategies at the system level (e.g., system arrangements)
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10. Supporting Provider Engagement in
Evidence-based Practice (2)
 Step 2 - Iteratively select and implement an approach to optimizing
practice based on a good understanding of the issue and context (again
using meaningful stakeholder engagement)
 Select active ingredients (strategies like audit and feedback) based
on a theoretical framework, research evidence, etc.
 Assess the causal mechanism - how the active ingredients are likely
to function) (e.g., increase knowledge, motivate, prompt)
 Consider the mode of delivery - how the active ingredients could be
delivered (e.g., website, personalized email, electronic health record)
 Articulate the intended targets – what the active ingredients aim to
change (e.g. motivation, tasks, roles, rules and strategies)
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11. Supporting Provider Engagement in
Evidence-based Practice (3)
 Step 3 - Monitor, evaluate and review the selected approach to
optimizing practice
 Monitor the extent of implementation of the active ingredients and
their update across different modes of delivery
 (When resources allow) Evaluate the impacts on intended targets
(effectiveness study), its costs and cost-effectiveness, the causal
mechanisms (process evaluation), and the views and experiences of
those involved (acceptability study)
 Review the approach based on monitoring and evaluation data to
decide whether it should be stopped, modified or scaled up
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12. Supporting Policymaker Engagement in
Evidence-Informed Policymaking
 Policymakers also need access to research evidence
 Health Systems Evidence (www.healthsystemsevidence.org)
• Contains quality-appraised reviews about health system
arrangements and implementation strategies, as well as
economic evaluations, reform descriptions, system descriptions,
and many types of policy-relevant documents
 McMaster Optimal Aging Portal (www.mcmasteroptimalaging.org)
• Policymaker interface as well
 Policymakers need to be supported to engage in evidence-informed
policymaking
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13. Supporting Policymaker Engagement in
Evidence-Informed Policymaking
 Evidence-informed policymaking means using the best available data
and research evidence – systematically and transparently – in the time
available in each of
 Prioritizing problems and understanding their causes (agenda
setting)
 Deciding which option to pursue (policy development)
 Ensuring that the chosen option makes an optimal impact at
acceptable cost (policy implementation)
 … alongside the institutional constraints, interest-group pressure,
values and other sources of information (like jurisdictional reviews) on
the policy process
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14. Supporting Policymaker Engagement in
Evidence-Informed Policymaking (2)
 Signal that research evidence is valued as a key input to the policy
process [Climate for research use]
 Produce and synthesize relevant research [Prioritization]
 Make research evidence easy to use [Translation]
 Communicate it effectively [Packaging and push]
 Make it available when policymakers and stakeholders need it
and in a form that they can use [Facilitating pull]
 Prompt policymakers and stakeholders to use it in decision-
making [Pull]
 Convene stakeholder dialogues where health-system challenges
can be discussed with key stakeholders who are informed about
the best available research evidence [Exchange]
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15. Supporting Policymaker Engagement in
Evidence-Informed Policymaking (3)
 McMaster Health Forum is doing many things from the ‘outside’
(www.mcmasterhealthforum.org)
1) Health Systems Evidence (nearly 10,700 registered users
globally, 40% of whom receive a monthly evidence service)
2) Rapid response (in 3, 10 and 30 business days)
3) Stakeholder dialogues, informed by evidence briefs (33 dialogues)
4) Citizen panels, informed by citizen briefs (10 panels and 8 briefs)
5) Health Systems Learning (more than 400 public servants trained
in Ontario alone, as well as more than 100 workshops in more
than 30 countries)
 These programs address prioritization (2-4), packaging and push (1),
facilitating pull (1-5) and exchange (3, 4)
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16. Supporting Policymaker Engagement in
Evidence-Informed Policymaking (4)
 Ontario Ministry of Health is doing many things from the ‘inside’
1) Strong messages from all levels of the ministry
2) Health System Research Fund awards (all of which have to
respond to ministry-articulated priorities, and 25% of budgets
held back for ‘Applied Health Research Questions’)
3) Literature reviews and rapid responses
4) Health technology assessments
5) Research Evidence Tool
6) Capacity-building workshops (delivered by the Forum)
 These efforts address climate (1), prioritization (2), facilitating pull
(2, 3, 4, 6), and pull (5)
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17. Conclusion
 A high-performing health system is one where
 Citizens are supported to engage in healthy behaviours, effective
self-management and appropriate care seeking, and to engage in
driving improvements in practice and policy
 Providers are supported to engage in evidence-based practice
 Policymakers are supported to engage in evidence-informed
policymaking
 There are many evidence-based models and tools (e.g, sources of
pre-appraised research evidence) to help you get us to a high-
performing health system
 Where next for GREO? Citizen-targeted efforts? Targeted practice-
change efforts? Going broader or deeper on policymaker supports?
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18. Acknowledgements
 Key funders of programs
 Government of Ontario, through a Health System Research Fund
grant entitled ‘Harnessing Evidence and Values for Health System
Excellence’ (for support towards evidence briefs/stakeholder
dialogues and citizen briefs/panels)
 McMaster University’s Labarge Optimal Aging Initiative (for the
McMaster Optimal Aging Portal and for several evidence
briefs/stakeholder dialogues and citizen briefs/panels)
 Note that the views expressed in these slides are the views of the
presenter and should not be taken to represent the views of the
funders
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