Guest post by Ellen T. Kurtzman, PhD, MPH, RN, FAAN, associate professor, School of Nursing, The George Washington University
As a health services researcher, I have always been interested in how to bridge the divide between research and policy. I constantly ask myself, “Which of my research questions will inform today’s most pressing policy debates?” and “How can I teach the next generation of nurse scientists to conduct policy-relevant research?” I recently left my academic position and spent a year working on Capitol Hill as one of eight 2018 –2019 Robert Wood Johnson Foundation Health Policy Fellows. In this blog, I offer a few key lessons from my time as a fellow that influenced my scholarship.
Lessons from my fellowship year
- Right place, right time. The policymaking environment is fast paced. New issues emerge quickly, moving others lower on the priority list. The deck is constantly being reshuffled. Perhaps there is no better example of this than COVID-19. Who knew a year ago that a pandemic would draw decision makers’ attention away from other pressing policy issues? When a policy issue like this emerges unexpectedly, the need for evidence is virtually instantaneous. But the research process is methodical and cannot easily be accelerated. Randomized studies and clinical trials take time. Which implies that the scientific process and policymaking timelines do not naturally mesh. Recognizing that available evidence needs to be ready at precisely the moment that a policy issue is being contemplated suggests that the relationship between science and policymaking should be reframed.
- Positioning researchers to contribute. Because there are so many policy issues being contemplated simultaneously, deep subject matter expertise from authoritative and independent sources is highly valued. Scientists and academics are ideally situated to be honest brokers, yet it is not always easy for policy staff to find expertise on short notice. Researchers need to better position themselves and their science during a noncrisis period so that they are ‘top-of-mind’ when urgent needs emerge.
- All about trade-offs. Harold Lasswell, an influential political scientist and theorist, helped define “politics” by asking, “Who gets what, when, and how?” Public policy is the art of allocating scarce resources to competing parties. I have always been interested in research questions about health care quality and value, but many of the secondary data sources I rely on lack the variables that would enable me to examine price or cost outcomes. In the short time I spent on Capitol Hill, it became abundantly clear to me why research that examines quality in the absence of cost considerations is insufficient.
Possible solutions
- Policy in all things. Nursing, medical, and health sciences programs typically include a single health policy course and/or rotation. Rather than relegating policy to just one course, why not see “policy in all things”? During OB-GYN grand rounds, why not discuss policy solutions that address maternal mortality? What keeps us from asking our psychiatric nursing students to debate mental health parity issues or veteran suicide rates? If we incorporate policy into every course, our students will leave their programs better prepared to bridge the divide between science and policy.
- New definitions of scholarship. Historically, academia has viewed scholarship in narrow terms. For example, criteria for appointments, promotion, and tenure (APT) reward refereed journal articles and colloquia, yet these materials are not generally accessible or readily available outside of academic circles. To bridge the divide between science and policy, academics might consider adopting a broader definition of scholarship and creating incentives for deliverables that appeal to decision makers. Could we, for example, adjust APT criteria so that the process rewards policy papers, issue briefs, and congressional testimony equally? By encouraging scholarship that reaches decision makers, we would be optimizing the policy impact of our science.
- Enhanced dissemination and outreach. Policymakers need the deep expertise that scientists and academics possess, but we are often siloed from one another. With rare exceptions, we tend not to attend the same meetings or conferences, read the same journals or books, or consume the same news or other media. I now realize that, for my work to inform policy, I need to reconsider how I package and disseminate my findings as well as how I position myself as a subject matter expert. By understanding and following key policy issues, learning how to communicate with policymakers, and investing time and energy in building relationships during times of calm, I will be facilitating swifter adoption of my science and more meaningful dialogue with policy staff when there is a critical need for information.
Dr. Kurtzman is a health services researcher and a tenured associate professor of nursing with secondary appointments in the university’s Milken Institute School of Public Health and Trachtenberg School of Public Policy & Public Administration. Her investigator-initiated research explores the impact of federal, state, and institutional policies on health care quality and the role of the health care workforce in achieving higher value care. She is currently exploring the impact of states’ cannabis policies on health outcomes including the consequences for pregnant women and their infants.