# Presentation: 525181

## Research into PracticeIntegrating the Needs of Users into Research Education

**Thomas C. Ricketts, Ph.D.**
**University of North Carolina at Chapel Hill**

## First Question:Who, or What are Users of Research?

**Obvious answers: **
**Policymakers**
**Practitioners**
**Patients**
**Not so obvious**
**Media**
**Citizens**
**Gadflies**
***Researchers and their support groups***

## Problem:A focus on the researchers and their support groups

- Problem:A focus on the researchers and their support groups

- What goes in often stays in

- www.scientek.com

## second question:Are research and application naturally at odds?

- “The true test of a first-rate mind is the ability to hold two contradictory ideas at the same time and still function.” F. Scott Fitzgerald.

- So, if you’re a first rate mind (and we all are) it’s no problem

## Consider the “world” of information

- It’s everywhere, it’s all the time, it’s overwhelming
- It’s like the millions upon millions of pieces of viral matter ready to infect our bodies

## The biology of HIV as a metaphor:

- © 2001 - 2004 Boehringer Ingelheim GmbH.

## We’re trying to “infect” a host that operates by precoded patterns

## Researchers are often the co-opted Helper T-Cells

## Infection (USE of Information)

**Requires:**
**Receptivity of the host**
**Modification of the role of the “T-cell” people and their roles**
**The ability to rapidly replicate and disseminate copies of the material**

- Task: Turn your research results into RNA

## What’s the surface of the host cell (USER) like?

**Covered with complex information Processing Structures**
**Called Values and Beliefs and Political Expedients**

## “values, beliefs and personal preferences play a critical role in health care decision making”*

- Ray Moynihan. Evaluating Health Services: A Reporter covers the science of research synthesis. Milbank Memorial Fund, 2004.

## Theme: Build strong roots for researchers to let their work leaf out into application

## Is this suppressing the thrill of “natural” inquiry?

- The creation of new knowledge using original data, testing a long-held theory, publishing in a high quality journal
- Versus
- A contracted investigation into an already researched issue with an existing data base to report to a agency or firm something they already know

## Can we do both....through investments in the contexts of training?

## Investing in Data

**To support learners, develop longitudinal data sets already tied to decisions**
**Licensed practitioner data base**
**Hospital discharge data base**
**Clinical summaries used for review**
**Built trust with partners and “owners” of the data (agencies, hospital administrators, clinical chairs)**
**Market the data for research selling questions rather than answers**

## Getting data is always tough

## Invest in Policy Streams

**Develop “fact Sheets” and briefing papers that responded to policy clients’ needs**
**Them****: Do we need a pharmacy school?**
**Researcher****: What are the factors that drive demand for pharmaceuticals?**
**Synthesis****: Fact sheet combining the two; articles and papers are necessary but really extra.**

## Invest in Answers that create questions

**Create answers that suck questions out of the USERs as well as draw conclusions**
**What is a FTE Nurse? **
**Flows to: “we can now control ratios and create rules”**
**Which flows to: “how will those rules affect patient care quality”**
**Which flows to *****funded***** Research**

## Preparing Learners to love Cross Subsidy

**Sometimes research pays for the policy part.**
**Creating a shortage designation required feedback from stakeholders**
**The advisors advocate for answers to their questions that arose in the inquiry**
**Sometimes policy pays for research.**
**A “Bright Legislative Idea” becomes an agenda for inquiry: Prospective Payment, Medical Savings Accounts**

## Citizenry in research 

- Citizens resolve issues with politics ***(who gets what, when, how, why)***

- Politics is often viewed as the realm of the cynical
- But it is a REAL world necessary for the citizenry to prosper

- Therefore
- Prepare researchers to be citizens, if not cynical.
- For example:

## Playing with Odd Bedfellows

## Lessons from Martha M. McKinney

**Law of political advantage:**
**Policy makers will support the health issues that provide the most political benefit at the least possible cost.**
**Law of diminishing data:**
**The more complex the issue the lower the likelihood of finding the data needed**
**Law of rational ignorance:**
**Policymakers who think they understand a health issues will tend to ignore data and research**

## More Lessons

**Law of infinite solutions:**
**As the number of decision makers increases proposed solutions multiply exponentially.**
**Law of suspect data:**
**Policy makers and practitioners will question the applicability of research done “somewhere else”**
**Law of data burden:**
**Policymakers and practitioners swill oppose data collection seen as even a little burdensome**
**Iron law of partisanship:**
**As political competition rises, the opportunities for research to inform decisions falls**

## Rickett’s Law of Health Policy Physics

***For every Ph.D. there is an equal and opposite Ph.D.***

## “Reality is not theory-driven”

- A policy maker person once told me:

- However...most actions and decisionsare based on some underlying notion ofwhat the world ought to look like, so...

**Notes:**
What they meant was that it wasn’t academic theory driven, it’s political theory driven

## Don’t dance around belief systems when discussing topics for researchapproaches to answer questionsthe biases in the data

- Another policy person said to me:
- “That was the finest bit of advocacy research I’ve ever seen”

- If you don’t teach researchers to accept the context of interpretation, someone else will and they will get chased out

## Interpretation outside policy—The cult and problem of personality

- Individuals whose attitudesaffect acceptance of Research:
***Patients***
***Practitioners***
***Communities***

- Solution: teach researchers to accept and even identify personalities