Evidence-based policy-making
and the ‘art’ of commissioning
How commissioners access, use and transform
academic research in ‘real life’ decision making:
a qualitative study
Lesley Wye, Emer Brangan, Ailsa Cameron
(University of Bristol)
John Gabbay, Jonathan Klein, Catherine Pope
(University of Southampton)
HSRN conference 1-2 July 2015
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Department of Health Disclaimer:
The views and opinions expressed therein
are those of the authors and do not
necessarily reflect those of the HS&DR
programme, NIHR, NHS or the Department
of Health.
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Why do this study?
 Commissioners from Clinical Commissioning
Groups (CCGs) plan services with an annual
budget of about £95 billion
 Academic research not informing local
commissioning decisions much
 Researchers need to know more about
commissioning and how commissioners
access and use information to better
influence them
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
The approach
 8 case studies of contracts between commissioners
and external providers
 4 CCGs + 3 external providers (2 commercial 1 NFP)
 92 interviews
 36 external consultants
 47 clients
• Commissioners, analysts, public health
 9 other people
 24 observations of commissioning meetings &
training events
 Hundreds of documents (e.g. board papers, minutes)
 Thematic coding, summaries, constant comparison
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
The ‘art’ of commissioning
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
What is evidence-based
commissioning?
 Researchers define evidence as
research while commissioners have a
much broader definition of ‘evidence’
 Influence and collaborate with external
and internal interested parties to build a
cohesive, compelling case for taking a
particular course of action
 Commissioners highly pragmatic – if
info not helpful they will not use it
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Sources of information
 Who?

Local clinicians, commissioning managers,
analysts, patients & the public, freelance
consultants
 What organisations?

Department of Health, NICE, NHS Improving
Quality, Public Health (England & local), CSU,
Think tanks e.g. King’s Fund, Royal Colleges,
local healthcare providers, other CCGs/CSUs/
providers, commercial & not-for-profits
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Sources of information (2)
 What info sought/ received?

Best practice guidance, Department of Health
commissioning guidance, service & population
data, improvement tools, ‘horizon scanning’,
clinical guidelines, how services operate, ‘whole
picture view’, hospital/ primary/ community data,
condition specific expertise, contracting,
procurement, finance, budgets, benchmarking
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Commissioners tend to seek
information from trusted
colleagues via conversations
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Interpersonal relationships were
the most crucial in influencing
commissioning decisions
Conduits of information
Interpersonal
Relationships
People
Placement
Engagement &
Contextualisation
Governance
Copy, Adapt
and Paste
Organisational Pressures
and Tensions
Product
Deployment
A influences
the decision
about B
Organisational
Processes
A much modified
A may influence
decision about B
Pressures, tensions, demands &
implications to be negotiated
before A influences the decision
about B
Role of academic research
 Commissioners predisposed to using research
but found it difficult to access, understand &
apply
 Commissioners rely on public health
departments to supply & interpret research
 Evidence reviews difficult to incorporate into
decision-making
 Local evaluations more helpful than academic
research because evaluations include useful
contextual information
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Role of academic research (2)
 Negative research findings did not
inform disinvestment plans
I’ve had conversations [with colleagues] about, “Well,
we shouldn’t be putting that down to say it will make
savings because there’s no evidence that it will,” versus
me saying, “But actually we’ve still got a statutory
responsibility to deliver a balanced plan, and if I take
those savings out they need to come from somewhere
else.” (Carla, NHS commissioning manager)
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
What can researchers do?
We need to change our ways of reaching commissioners
1.
2.
Start talking & rely on written communication less (F2F)
Produce what they want
• Focus more on context
• Tell stories
3.
4.
Employ people placement strategies e.g. researchers seconded
into commissioning organisations (co-location)
Learn about your local CCG to find out areas of commonality
• attend public governing body meetings
• look at their website to identify commissioners in your area
5.
6.
Carry out local evaluations to build relationships & demonstrate
that researchers have something worthwhile to offer
Develop relationships with your local public health department
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Practising what we preach in Bristol
 LW NIHR Knowledge Mobilisation Fellowship
 Knowledge mobilisation team set up Sept 2013
 2 researchers in residence embedded in Bristol CCG +
2 NHS commissioners at University of Bristol + 1
communications manager
 Development of interpersonal relationships through
 Embedding
 KM team facilitating introductions
 Embedded researchers attached to CCG sub-committees
 Co-production of service evaluations
 More studies including interactive dissemination activities
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Publications
Wye L, Brangan E, Cameron A, Gabbay J, Klein J, Pope C.
Knowledge exchange in health-care commissioning: case studies
of the use of commercial, not-for-profit and public sector agencies,
2011–14. Health Serv Deliv Res 2015;3(19).
Wye, L, Brangan E, Cameron A, Gabbay J, Klein J, Anthwal R,
Pope C. What do external consultants from private and not-forprofit companies offer healthcare commissioners? A qualitative
study of knowledge exchange. BMJ Open 2015: 5: e006558
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL
Acknowledgments
 NIHR HS&DR for funding
 All participants especially the 3 external
providers and 4 CCGs
 Advisory commissioners : Maya Bimson,
Michael Bainbridge, Tim Wye, Jude Carey,
Adwoa Webber, Neil Riley, James Rooney,
William House
 Andrée le May for conceptual help
 FFI: lesley.wye@bristol.ac.uk
School of
SOCIAL AND COMMUNITY MEDICINE
University of
BRISTOL