Policy and practice

Is evidence-based policymaking driven by Machiavellianism or altruism in US states?

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Luke Yingling and Daniel J. Mallinson

We find that the adoption of evidence-based policies in US states is driven more by Machiavellianism than altruism. Although engagement with evidence-based policymaking (EBP) can produce more efficient and effective government, it can also supply new levers of control to politicians and bureaucrats, which can be used to produce electoral benefits. An appeal to EBP can be used to centralise control of executive functions, as well as to manipulate budgets, that incentivise adoption. Further, the construction, purpose and outcomes of these laws are influenced by the institutions, parties and officeholders who craft them. Our study finds that Democratic governors, Republican legislatures and state innovativeness are significant predictors of EBP adoption in the American states. 

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Knowledge translation opportunities and challenges

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Agnes Black

Complexity in healthcare systems presents knowledge translation (KT) challenges but also opportunities. Our Evidence & Policy article, ‘Connecting knowledge and action in complex health systems: examples from British Columbia, Canada’, illustrates ways we have harnessed complexity to narrow the gap between knowledge and action. We work across different health authorities and funding agencies building strong relationships with those who use research, fostering innovation, supporting evidence-based decision-making and helping people to de-implement obsolete practices. We share a commitment to building strong connections between knowledge and action, and our work is enhanced by embracing the inherent intricacies of the systems in which we work.

We share examples from our practice areas of how we navigate the demands of knowledge translation using responsive solutions and relationship building to support KT that promotes health. While many health systems leaders continue to perceive researchers and research as irrelevant and disconnected from their realities, we have found that when research is undertaken with people who use it, reciprocal and responsive relationships can overcome this barrier and lead to collaborations that support healthcare improvements. Embracing research as a public good requires reimagining the relationships and structures of both research and KT, and we are encouraged by the many ways we’ve seen this happen.

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Implementing shared decision-making into practice: Embracing complexity

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Sarah Munro

How do we implement shared decision-making into routine practice? Health systems are struggling with this question worldwide. Instead of simplifying this challenge into barriers and facilitators, what if we embraced its complexity? 

In recent years there have been increasing calls for the implementation of shared decision-making in routine clinical care. Shared decision-making is particularly helpful for decisions where there are multiple appropriate options, and the ‘best’ decision rests with the patient’s preferences.

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