Who influences policy and why? Understanding strategies to influence the policy process Kathryn...

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Who influences policy and why?

Understanding strategies to influence the policy process

Kathryn Oliver

kathryn.oliver@manchester.ac.uk @oliver_kathryn

Outline

•Knowledge brokerage as the ‘answer’ to the EBP ‘problem’

•Approaches to studying KB

•Activities of policy actors as a lens

•Who are KBs?

•How do they influence policy?

Evidence-based policy research

Oxman et al. Health Research Policy and Systems 2009 7(Suppl 1):S15

Explicitly aims to

(a) increase amount of research used in policy

(b) to ‘upskill’ policy makers

(c) to present joint narratives of how evidence is used in the ‘black box’ of policy

Evidence-based policy research

i.e. the research Is framed as a “problem” that evidence is not used in research

What effect does this framing have?

Solutions offered by researchers...

Social relations known to affect use of evidence, finding of information, decision-making and many

other aspects of policy making

KB activitiesKnowledge brokerage strategies Supporting literature

Being an expert (Haas, 2009; Johnson, 1994)

Keeping up to date with recent research (Dobbins et al., 2009a; West et al., 1999)

Providing information (Dobbins et al., 2009a; Green et al., 2009; West et al., 1999)

Managing and filing information (Denis & Lomas, 2003; Dobbins et al., 2009a; Green et al., 2009; Van Kammen et al., 2006)

Writing and disseminating tailored messages (Green et al., 2009; West et al., 1999; Denis & Lomas, 2003; Dobbins et al., 2009a)

Setting agenda, framing discussions, controlling debates

(Burt, 2004; Johnson, 1994; Scott, 2001; Ward et al., 2009a)

Building Capacity Michaels 2009

Engaging, matchmaking, collaborating, linking with policy makers

Michaels 2009Ward 2009

Knowledge brokerage is...

A intervention (set of actions) carried out by academic/research-based individuals in an attempt to influence policy processes

Academia Policy-makers

Stumbling block…

If we don’t understand the policy process,

how can we influence it?

Policy process models

unverified, unvalidated,

unhelpful

Questions remain….

WHO influences policy?

HOW do they influence policy?

Can we compare [KB] with [strategies used to influence policy]

as two sets of activities?

DataNHS North West

Regional Director of Public Health (Emma)

Bury PCT Stockport PCT

Trafford PCY

Ashton Leigh and WIgan

Heywood,

Rochdale &

Middleton PCT

Salford PCTOldham PCT

Manchester PCT

Bolton PCT

Directors of Public Health

Chair: Alistair

Chief executive

Chairman of board

Directors (Finance, Medical, Nursing, HR, Public Health)

Non-executive board members

Influential policy makers

225 network members

Data42 interviews (formal and

informal) with academics, policy actors, public health professionals

18 hours observations of public and private meetings

Generating accounts of evidence use, policy processes and policy

networks

From these accounts, KB activities identified – and who

used them

KB activities Summary of themes from interviews

Being an expert Includes professional and managerial knowledge. Expertise confers credibility on evidence, but is dependent on context

Keeping up to date with recent research Not described

Providing information Widely described. Information exchanged usually not research (included tacit knowledge, politics) and highly dependent on interpersonal relations

Managing and filing information Not described

Writing and disseminating tailored messages Understanding audience in terms of content, format, their perception of credibility and who would be best to front something out

From providing meeting papers, setting long-term work priorities, gathering evidence, attaching champions and providing policy content,

NHS an council managers set the agenda

Building Capacity Rarely happens. Noted that there was a transactional cost which is usually ignored.

Bridging across multiple organisations, providing peer support, managing both up and down, identifying and maintaining relationships were

essential skills.

New themes from interviews

Appraising evidence Criteria for assessment related to public credibility rather than research methodology

Interpreting evidence Explaining what was important for a particular decision, or interpreting methods

Commissioning and co-ordinating analysis Responsive analysis available to policy makers to answer specific questions

Challenging debates Challenging the status quo, using professional authority

PresentingBeing a figure head

Providing policy content Being a creative policy agent, spotting windows of opportunity and coming up with ideas

Gatekeeping experts and champions Controlling access to and representing experts, decision makers, and peers

Showing leadership and championing Convincing others and being an authority

Who are the knowledge brokers?

Within transcripts, identify where

(a)Respondent describes themselves as using one or more KB activities

(b)Describes someone else as using KB activities

(c)Use these data to generate a network

KB results NHSCouncil

Public healthUniversities

Size ∝ number of nominations

Darkness of line ∝ strength of tie

KB results: strong ties only

NHSCouncil

Public healthUniversities

Size ∝ number of nominations

What does this show us?

1. People already within policy community act as knowledge brokers

2. Main KBs appear to be NHS and council managers

3. Self-nominations common

KB activities Summary of themes from interviews

Being an expert Includes professional and managerial knowledge. Expertise confers credibility on evidence, but is dependent on context

Keeping up to date with recent research Not described

Providing information Widely described. Information exchanged usually not research (included tacit knowledge, politics) and highly dependent on interpersonal relations

Managing and filing information Not described

Writing and disseminating tailored messages Understanding audience in terms of content, format, their perception of credibility and who would be best to front something out

From providing meeting papers, setting long-term work priorities, gathering evidence, attaching champions and providing policy content,

NHS an council managers set the agenda

Building Capacity Rarely happens. Noted that there was a transactional cost which is usually ignored.

Bridging across multiple organisations, providing peer support, managing both up and down, identifying and maintaining relationships were

essential skills.

New themes from interviews

Appraising evidence Criteria for assessment related to public credibility rather than research methodology

Interpreting evidence Explaining what was important for a particular decision, or interpreting methods

Commissioning and co-ordinating analysis Responsive analysis available to policy makers to answer specific questions

Challenging debates Challenging the status quo, using professional authority

Presenting Being a figure head

Providing policy content Being a creative policy agent, spotting windows of opportunity and coming up with ideas

Gatekeeping experts and champions Controlling access to and representing experts, decision makers, and peers

Showing leadership and championing Convincing others and being an authority

Does the concept help us to understand the policy

process?

• Roles not played by academics or researchers

• Exchange or brokering of knowledge part of policy process

• Focusing just on this aspect risks ignoring

(a) Wider strategies used to influence policy

(b) Policy makers’ conceptual understanding of policy process

Knowledge brokerage roles

Being an expert

Keeping up to date with recent research

Evaluating evidence

Production of information

Providing and disseminating information and

advice

Managing and filing information

Writing and disseminating tailored messages

Setting agenda, framing discussions,

controlling debates

Writing policy reports / reports for policy /

policy content

KB as part of policy entrepreneurship framework

[The Commissioning Programme Board] manages business on behalf

of the Chief Execs...everybody knows how business is done....But I would say that because I invented

it. NHS manager_10

If my job is just to make stuff happen and get the correct outcome from meetings..., you know, collate the

evidence, you have the discussions outside the meeting, you see who's with you, you think about how to present the

case, you... it's one of those things of “never going into a meeting with a

proposal without knowing exactly how it's going to come out of the

meeting”….. That sounds terribly manipulative but to me it's about

momentumNHS manager_9

Creating and managing key organisations

Me and Alistair, we were trying to get sentences into [a key economic document] for

about a year. Basically what would happen would be the document as would be written

would occasionally manage to get to my desk at which I would put in various sentences

which would ... some would get pruned out some would get in. Or you’d be constantly

writing to Alistair about the arguments so he felt that he had sufficient strength behind him to be able to say “This is it, this is the case”.

Public health intelligence_1

Deciding the topic and detail of the policy

Managing other people

[Alistair] would exercise a certain degree of leeway in interpreting ...those instructions [from the DPH], but

nonetheless in general...he wouldn't want, to substitute their own professional judgment because he isn't himself a public health professional... he's a doer and an implementer. ...So when he's got that

policy, erm that lead he, the he kind of really takes it on and runs with it

DPH_10

....Alistair’s almost the acceptable face of mad DPHs, isn't he really. Managerial translation, I'll have a chat

with him behind the scenesCouncil officer _6

NHS manager_10 = Alistair

Me, Alistair and Evan, we’re running this place, in the core group... we know where power

centres are, we know how far to nudge, we know how to attach an idea to [his chief exec}... that’ll

make her look good in AGMA Chief Execs. Council Officer_6

We can’t just sit in an office and dream things up... I think a lot of people forget that that’s how

things work in the real world, is through relationships and it does take time to build

relationships, to build trust, and so you know, reorganisations that lose lots of people mean

you just have to start all over again because that is how it, that is how the world works, that’s how

you get things done. DPH_8

[Alistair’s] connectedness is indisput...you know his capacity to take, the information that he gets

from the DPHs to influence... right across the AGMA structures...and that sort of work and

relationship with a very wide range of officers where he keeps his fingers on the pulse that’s...

is very very powerful. DPH_10

Using relationships

Example: alcohol MUP• Creation of GM Health Commission• Had to take action on alcohol as key priority area• Alistair managed papers for meeting

• Alistair, Evan and Sam (policy managers) identified MUP as a possible policy• Identified experts to attach to policy• Drew up policy papers

• Identified executives to present and champion policy • Persuaded local and regional senior figures to endorse the policy

• Policy considered successful because GM now much more visible• Individuals involved had greater credibility• Bargaining position with Westminster strengthened.

Knowledge ≠ evidence

Evidence is used as part of a negotiated political strategy

I'll get a confident view from the DPH when she's in her own space, that it's an evidence-based intervention, that it's adding value... [Then] other senior views coming through around “[is this] giving bang for the buck” and so forth so then the confidence of the DPH not coming through in the same way ...in fact knowing which side her bread's buttered and shutting up. And then in the end the person who made the decision ...was the leader of the council who came up with his own elegant solution, which was “we'll continue to give it to the under-16s because that's a political winner, we'll do a little bit of targeted stuff for means-tested” ...after all the heat and noise from the evidence-based experts.. Council officer_6

Understanding and using relationships vital

Even within acadaemia, if you said... oh I searched the evidence and so on, if you want the answer to something, usually what you do is you email somebody you know, and say “What about this?” and they’ll connect back to you with people…You could argue it's a way of quickly getting to the evidence cos all you're trying to do is use your contacts to try and find someone who knows about the issue that you're interested in

(Clinical academic)

Message or messenger?

Individuals’ characteristics (credibility, likeability, trustworthiness) influenced how messages were received

[The individual] with the responsibility for this piece of work erm is somebody who erm has had a very very longstanding interest in [the area] but at the same time, [their] manner can antagonise some people. So there was that, I think, something about the messenger.....The messenger kind of clouded the message...

(Board member, NHS)

Insiders and outsiders: qualitative descriptions

•Core group of actors involved in all stages of policy

•Some actors were not influential - did not want to be, did not have skills, had wrong characteristics

•Key characteristics included: being ‘sensible’, ‘credible’, being ‘on message’ i.e. endorsed by other influential people

•Being able to identify, create, maintain & finally exploit relationships as a strategy to influence policy

Revisiting the KB concept

Academia

Policy-makers

Revisiting the KB concept

Conclusions• KB activities can and do influence policy...

• ...but only when used by the right people as part of a wider ‘toolkit’ of strategies

• Very difficult to do effectively if not embedded in policy community

• “Message” content is not as important as “messenger” characteristics

• Current approaches to ‘tackling’ EBP are likely to fail unless actor- and relational factors are taken into account

• Effective leadership and mobilisation of the policy machinery is dependent on an ability to make and exploit relationships beyond those associated with knowledge production and translation

Implications

Proposing the ‘solution’ of KB to the ‘problem’ of EBP risks ignoring (the importance of) day-to-day activities of policy makers

While important to help policy makers find and use evidence, literature does not acknowledge the fact that there are already individuals using KB activities

Identifying these actors and describing their strategies / activities used to influence policy illuminates components of the policy process itself

Focus on empirical descriptions sheds new light on the policy process and questions utility of current research foci in EBP

Implies that to be influential, researchers should consider adopting a pro-active approach to make & exploit links with influential actors, using practical targeted messages

So what?• Assumptions that policy makers do not use evidence

& require help from generalist researchers are challenged

• Should we continue to focus on knowledge brokerage and transfer as a means of researchers influencing policy?… or

• Does the policy entrepreneurship framework of activities offer a new way of understanding policy processes?

• Does this imply that researchers who wish to influence policy need to create their own relationships and ties with relevant actors?

• Funded by DG Research, European Commission

• Thanks to Frank de Vocht, Annemarie Money & Martin Everett

http://www.ccsr.ac.uk/mitchell/

Mitchell Centre for Social Network Analysis

Oliver K, de Vocht F, Money M, Everett M (2013) Who runs public health? A mixed-methods study combining network and qualitative analyses. Journal of Public Health (epub 5th April)

Oliver K, Everett M, Verma A, de Vocht F (2012) The human factor: reorganisations in health policy. Health Policy 106:6

Oliver K, Lorenc T, Innvaer S (under review) New Directions in Evidence-Based Policy Research. Public Administration

Oliver K, Money A, Everett M, de Vocht F. (under review) How to make friends and influence policy. Social Science and Medicine

Who influences policy and why? Understanding strategies to influence the policy process Kathryn...

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