Storytelling evidence into practice in health and social care

Storytelling

Nick Andrews, John Gabbay, Andreé Le-May, Emma Miller, Alison Petch and Martin O’Neill

Getting research into practice is easier said than done, particularly in fast-paced and often under-resourced health and social care services. This is the story of how we achieved a good measure of success by taking a caring, inclusive and storytelling approach across six sites in Wales and Scotland, involving older people, carers, practitioners, managers and researchers talking and learning together.  

On the understanding that human beings are relational and storytelling animals, who make sense of the world through narrative and dialogue, we developed a story-telling approach to using evidence, which started by developing what has been described as an ‘enriched environment of care and learning’[1]. Within such an environment, everyone involved should gain a sense of security, continuity, belonging, purpose, achievement and significance. To enable this, we started with their priorities and valued their evidence (i.e. practice knowledge, lived experience of older people and carers and organisational knowledge), alongside the research evidence, which we were careful not to impose on them. A challenge for the research team was how to do this.

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To understand evidence use, understand the goals of decision makers

Sign

Justin Parkhurst

What does it mean to use evidence in policymaking? This seemingly simple question has been remarkably under-defined in all the calls for increased use of evidence. Indeed, many of those who champion ‘evidence-based policymaking’ do little to explain what it means for a policy to be evidence-based, and have trouble explaining what evidence use actually means when decision makers have multiple competing goals and social concerns. Evidence is simply seen as a good thing – and more use is better – without really considering what that means or what happens when there is disagreement around which evidence to use for what goals.

Policy scholars who study evidence, on the other hand, have approached the issue from the perspective that ‘evidence use’ can mean any number of things within a policy setting. The literature can, therefore, appear divided into two extremes: either evidence use is taken for granted to be a known (assumed to be good) thing, with little consideration of political realities, or alternatively it is seen as multidimensional, the form of which is constructed by the nature of policy ideas, processes, and interactions.

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Thought experiments with ‘fake’ research abstracts help policy makers visualise actions to be taken on evidence

Scrabble

Our university-policy maker partnership produces ‘fake’ abstracts of articles we’ve not written yet (on results we frankly don’t even know we’ve got) to loosen up thinking. It helps the team visualise pathways for policy action.

Penelope Hawe

Ours is a tricky situation, politically-speaking. A health department is undertaking Australia’s largest ever scale-up of evidence-based childhood obesity programs into every school and childcare centre across the state.[1] It costs $45m. They have an electronic data monitoring system in place. It’s already telling them that targets are being met. But rather than just rest on their success, they invite a team of researchers to do a behind-the-scenes, no-holds-barred ethnography. It could reveal the ‘real’ story of what’s goes on at the ground level.[2]

Foolhardy or brilliant?

I’m opting for brilliant. But let me put this in context. New South Wales Health is renowned for being research-savvy. They invest heavily in research capacity building. I’m talking in-house research, strategic investment, partnership research and peer reviewed publications.[3] The CVs of some of the policy makers in our partnership put some of us at universities to shame really.

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