CHSRF Knowledge Transfer: Decision Support: A New Approach to Making the Best Healthcare Management and Policy Choices

here are at least three reasons why distilling the messages from research is becoming a specialized role. First, there has been an enormous growth in the research enterprise and the resulting publications. This makes it impossible for fellow researchers, never mind those working in healthcare, to keep up with what is going on. Second, not all research is created equal, and it requires some skill to sort the wheat from the chaff before making the “summary loaf ” from the best ingredients. Third, there are many spin doctors of research in whose interests it is to do partial summaries that favour their own product or ideology. These can only be countered by those who seek out all the relevant research, favourable or not, and aggregate it into an impartial summary. This approach provides a powerful tool for healthcare managers and policy makers who are searching for ways to improve the system but unsure of where to get or how to assess the deluge of research available. There is no doubt, therefore, of the value of summarizing with integrity the key messages from research, particularly as this improves the chances that the research might get used! Nevertheless, there is debate about how to do it and, therefore, who should be part of this specialist role in healthcare. Much of the debate focuses on where the role of research and researchers stops and where the role of the system and those working in it starts. Is summarizing research for use in the health system a technical exercise reserved for skilled specialists in the research world? Or is it a social change exercise where the world of ideas learns to dance with the world of context and values? The answer to this balance is likely different if the intent is to summarize clinical rather than management or policy relevant research. Medical interventions lend themselves to evaluation in a consistent way with a limited number of methodologies. Summary in this case is more about data aggregation and presentation than about data interpretation. Specialists in describing the data can carry the day. Research to inform management strategy and policy prescription demands more varied approaches and draws on a multitude of methodologies. Careful and context-dependent data interpretation is crucial, and those working in the system are often more skilled at this than those collecting the data. The need is for more collaboration between the data collectors (researchers) and the data interpreters (decision-makers). Hence, the methods used by evidence-based medicine to collect and summarize research are far from the best way to approach summarizing research for managers and policy makers. This is why the Canadian Health Services Research Foundation (CHSRF) collaborated in 2003 with the Service Delivery and Organization (SDO) part of England’s National Health Service (NHS) Research and Development program on the Methods of Synthesis for Managers and Policy Makers project (see www.chsrf.ca/funding_opportunities/commissioned_research/projects/background_e.php). The results of this project informed the new approach recently adopted by CHSRF to summarize research messages and develop recommendations for health system managers and policy makers. Before describing this approach, it is useful to review how we got to where we are today in the science of research summary.