Evaluation is both the end of the policy process (is the policy/strategy effective?) and the beginning (what should be changed?) (Walt 2006). Policymakers, decision- makers, and key stakeholders depend on information from multiple sources. In exploring the relationship between policymaking and consideration of a strategic approach, Walt (2006) proposes the following questions:
• Do policymakers/decision-makers introduce new policies because their attention is drawn to evaluation reports or research?
• Do policymakers/decision-makers commission research because they lack infor- mation or because they want confirmation for predetermined positions?
• Are there actions researchers should take to ensure research findings are dissemi- nated to policymakers/decision-makers?
• Or, should researchers maintain an objective distance only communicating research results for peer group review?
• What role should media play in dissemination of research and evaluation reports?
Research is generally understood as a systematic process of generating new knowledge. The distinction between research and evaluation is not entirely clear and sometimes the term “evaluative research” is used. Evaluations do use research methods and may be as time-consuming as conduct of research studies. Evaluations or assessments of some topic are often seen as relevant to providing decision- makers’ direct feedback on the value of a specific policy, scheme, or program and most often seen as auditing or monitoring. An audit looks at or appraises to what extent a process or performance conforms to predetermined criteria. Monitoring pertains to continuous oversight of the implementation of an activity or action.
Although potentially useful, research is not always perceived as policy or strategy relevant. However, auditing and monitoring are commonly seen as policy-relevant research, seeking to understand various components of change and the impact of policies/strategies.
There are very few instances that show a direct link between research results and policymaking. Contrasting opinions suggest that new knowledge seeps into the political environment and does at various points influence thinking of decision- makers but not in a linear manner. Just as people aspire for a rational approach to policy and strategic planning, this is an ideal but unrealistic; the research-policy connection is extremely complex and cannot be seen as progressing from one step to another along a straight line. It is more realistic to think of research influencing policy development and strategic planning by drawing on knowledge from different, overlapping networks and sources while participating in some form of information exchange and communication. Rather than having an immediate and direct
influence on healthcare policy decisions, research is more likely to have a cumula- tive effect.
6.5.1 Dissemination of Empirical Findings and Information
Communities of individuals developing policy or creating strategies may include civil servants, academics, publishers/editors of professional journals, journalists, elected officials, members of government agencies, professional associations, inter- est groups, among others. Through a common interest in policy issues, there is an ongoing exchange of information discussing or describing activities and ideas.
Some of this is done to gain acknowledgment from other members of the commu- nity of experts thus hoping to be rewarded with esteem and recognition (Walker 1981).
The process of dissemination of information can be described as deliberate or diffused (Walt 2006). Decision-makers may actively request information on a spe- cific topic or to confirm a particular position. Alternatively, decision-makers may become aware of and pay attention to information through professional conferences and participation in grant-giving bodies or through publications. Research is not commonly reported in the mass media; thus, it may take time to reach the attention of policymakers and key stakeholders. It may take years for reported research to permeate the consciousness of policymakers in the international or national levels.
To assess to what extent decisions are affected by research, Weiss (1991) suggests that it is key to define what form of information comes in: data and findings, ideas and criticism, or briefs and advice for action. Each form has its strengths and weak- nesses with one form of information being more useful than the other depending on the situation and topic. Decision-makers will likely choose and remember informa- tion selectively. It may be difficult to pinpoint what links any kind of information directly to policy and strategy. Interpreting reports or research findings may be prob- lematical if the original policies/schemes were vague, offering robust promises resulting in ineffectual results. Scientific uncertainty can lead to distortion and lack of clarity. Confused and frustrated decision-makers will likely be immobilized.
Clear communication and active dissemination of evidence to all relevant decision- makers in easy-to-understand formats are critical to increasing awareness, consideration of the information, and adoption and use of evidence. Communication strategies should concentrate on making evidence interpretable, persuasive, and actionable. Core constructs for communication include (McCormack et al. 2013):
• Adapting and focusing the message so that communication designed for a par- ticular stakeholder is to the point based on information known about or received from the stakeholder relevant to the issue under discussion.
• Target the message to the relevant entity or organization that the stakeholder represents (e.g., knowledge of the person’s attitudes about subjects such as aca- demic education for nurses or prescribing for nurses if the person is an educator or chief nursing officer, awareness of a stakeholder’s opinion of liability
coverage/indemnity for advanced practice nurses if the audience is an insurer or legal counsel).
• Utilize narrative communication – Communicate the evidence in the form of a story or account related to actual experiences or events (e.g., recount how a day- to- day problem occurs in primary care of the elderly or emergency care in mental health situations). Tell the story as it relates to the collected information or evidence.
• Communicate the same or similar message in alternative ways (e.g., emphasize what is gained or what is lost by taking action or making a choice).
Findings from studies and research, especially systematic reviews and similar documents, need to be communicated effectively to influence optimal development of policies. Complicated research and reviews are inherently complex. Subtle dif- ferences in explaining the findings from evidence reports make it difficult for the intended audience or stakeholder to understand and use in decision-making if infor- mation is not communicated clearly.
Conclusion
Integrating advanced practice nurses into the skill mix of healthcare providers in and of itself requires an adjustment in thinking and organization of healthcare systems. In essence, the concept of a strategic approach suggests a process that shapes or reshapes what has been thought to be customary in identifying profes- sionals and healthcare services. Previous chapters have introduced theories and frameworks that serve as guides for strategic thinking. This chapter offers ideas for assessing the healthcare environment and introduces a process for identifying key stakeholders according to the impact they may potentially have on strategy planning and policy development.
Regulation is discussed based on a model that includes aspects of scope of practice, standards, policies, and procedures. This model offers a regulation toolkit to guide stakeholders in the processes of regulatory activities for healthcare pro- fessional. A global overview of nurse prescribing and in-depth country exemplars portray developmental processes related to the introduction of advanced levels of nursing practice. The chapter explores the benefit of debate and discussion in pro- moting the advancement of nursing. There is controversy as to what extent research and empirical evidence informs policy and decision-making; therefore, the signifi- cance of evaluation, research, and dissemination of the information is discussed.
Policy decisions can be influenced in multiple ways; however, the extent of the influence of evidence may not be seen directly. It is more likely to be a pro- cess of exposure and revelation over a period of time depending on the mode of communication. Impediments to a clear understanding of the influence of infor- mation include political or ideological factors, conceptual confusion and uncer- tainty regarding empirical findings, and uncertainty about the usefulness of the information, timing, and communication. Research and evaluation may not be a central point to making policy and developing strategy, but it is useful even if the depth of influence is imprecise.