post by Bill Gardner
The AHRQ and other research funders put considerable effort into training researchers in how to communicate their research to decision makers. The goal is to make research findings actionable in the real world quickly and to inform public discussion of health policy. I am all for it. But it is not working as well as it should. I want to suggest why this is and what we might do about it.
Let's simplify the world of health policy discourse, and think of there being four strata of participants: decision makers, their policy staff, policy intellectuals and journalists, and academics. There is an an insider culture grounded in a network of peer interaction within each stratum. The arrows are meant to suggest patterns of communication between strata, and examples of the media that support them.
The first point of the diagram is that it is a long way from academics to decision makers. Seriously, you can't reach them directly. Research findings need to diffuse through several social filters to reach actual decision makers. As a researcher, it may not be realistic to seek an audience of decision makers. Just getting read and discussed in the next tier of policy discourse is your feasible goal.
The second point is that if you want to effectively diffuse information across strata, you need to write in a venue that is read by your target audience. Moreover, you need to be visible to, recognized by, and trusted by them. You need to learn to write for them. Your academic credentials are necessary but not sufficient here. It's true that the glorious intertubes make all of this much easier than it used to be. Nevertheless, if you are a researcher, getting your voice heard by the policy intellectuals takes significant work.
So the question to ask is, given the effort involved, what could motivate more academics to do it? For better or worse, health researchers' careers are driven by journals with 5% acceptance rates and NIH institutes with 5% funding rates. These facts concentrates your mind on the value of your time. It is easy to put words on a blog, but harder to make them good words, and harder still to get career value that is commensurate with the time required.
What we need, I think, is two, three, many Health Affairs. That is, publication outlets that have as many as possible of the following attributes:
- Writing that is conscise, data-driven, and policy-relevant.
- Good editing and high production values.
- Quality and prestige through peer review, providing academics with career incentives.
- Authors and readers from every stratum of the policy discourse world, and every provider / stakeholder discipline (including patients!).
- Excellent social media marketing to get articles into the discussion.
- And it must not be the creature of any provider guild or health industry.
So, AHRQ and Robert Wood Johnson, please consider supporting some variants on this model. We already have Health Affairs, so perhaps the next step is an enterprise that is one step more specialized. A data/policy journal/web presence devoted to Primary Care? A Mental Health Affairs journal/social media site? A site on Health Disparities? On Child Health? On Caring for the Elderly?