Deliberative Dialogues as a Strategy for System-Level Knowledge Translation and Exchange

I am pleased to welcome this guest journal club from Dr. Anneliese Poetz, Manager, KT Core for NeuroDevNet. She is writing on the following article:
Boyko, J. A., Lavis, J. N., & Dobbins, M. (2014). Deliberative dialogues as a strategy for system-level knowledge translation and exchange. Healthcare Policy, 9(4),122-131.
We undertook a case study in order to explore deliberative dialogue as a system-level knowledge translation and exchange (KTE) strategy and to describe the design features and intended effects of this dialogue. Our data included observations made during the dialogue, evaluations completed by dialogue participants and interviews. We placed these data in the context of our broader experience. We learned that (a) all the design elements we examined could be maintained in future dialogues, but organizers of dialogues that address similar issues and take place in similar contexts should consider the relative importance of these features and (b) the intended effects of a deliberative dialogue that addresses a low-priority policy issue are mainly apparent at the individual level among dialogue participants. Further research is required to explore the key features and intended effects of deliberative dialogues used to address other issues or in different contexts.
‘Deliberative democracy’ or ‘participative democracy’ is an umbrella term that encompasses different methods for public and broader stakeholder consultation strategies for democratic participation in decision-making including for policy development/revision.   Its theoretical underpinnings lie in Habermas’ Theory of Communicative Action. ‘Deliberative dialogue’ as an approach has evolved out of the concept of deliberative democracy and ideally involves face-to-face representation from multiple perspectives on a given subject, with emphasis on including those who are often underrepresented. Multiple perspectives and diverse knowledge is exchanged on a given issue in a structured manner in a neutral, safe (ideally facilitated) setting. Habermas’ theory, and indeed, various forms of deliberative democracy aim to achieve consensus. Whether the group reaches consensus or not, the group (including policymakers) ideally emerges with an opinion informed by a deeper understanding of the complexities of the issue.
This paper describes the research process for conducting and evaluating a ‘system-level’ KTE strategy, which they refer to as a ‘deliberative dialogue’ developed by the McMaster Health Forum (MHF).   The process includes several steps including (but not limited to) initial consultation in order to identify a specific policy issue to examine, in-person dialogue, and follow-up afterwards to evaluate whether the process was successful at transferring scientific evidence into policy; and does not require consensus. The main thing I learned from this paper is that the MHF’s standardized process or ‘deliberative dialogue approach’ seems to work. According to the findings of this paper, many of the participants did use what they learned as part of the dialogue process.
However, there were a few things I was left wondering about:

  1. First, who are the « stakeholders » they invited among the « health system policy makers, managers, stakeholders and researchers »? The issue examined in this paper was chronic pain management, so I would expect an important stakeholder would be a patient with lived experience on the receiving end of the policies that govern their care. On a related note, I was also unclear about what types of individuals were considered by the steering committee when consulted for a Federal level policy maker – was their thinking limited to MPs or did it also include Medical Officers of Health, members of Health Canada or Public Health Agency of Canada? Each of these policy makers has different backgrounds and abilities to influence health policy.
  2. Since the forum was limited to 18-22 participants, I wondered how the process could be re-imagined to have broader impact.   How can the findings of this study extend the same evidence-informed policy and management decisions beyond the study participants to others also concerned with chronic pain management policy?
  3. Related to 2), in terms of the forum’s participants, how can their participation in this forum impact their future decision-making processes? Participants were provided with current evidence and experiential knowledge from their peers, but as scientific knowledge in this area evolves, the information shared during this particular forum will become outdated.   In addition, I would expect that the individuals involved in the forum will change employment positions over time. If resources were unlimited, it would be ideal to have a plan for either repeating the forum on the same topic area with the same people every few years. Better yet, training could be integrated into the forum so that participants could take the process and repeat it within their own organizations and systems. However, this could be problematic when it comes to staff time and other resources needed to generate evidence briefs and since resources are limited, it likely wouldn’t work. Overall, what was missing from the paper was a sense of longevity and amplification of the forum’s positive outcomes over time, in a fluid and constantly evolving health system.

Furthermore, the concept of the « health system » which is the focus of this study is not adequately defined. I would argue that for systems-based KT one needs to first map out the system using a detailed and structured approach such as grounded theory methodology with situational analysis (for creating situational maps of the actors within the system, and their complex interactions within the different levels of that system). Detailed mapping from individual through community, organization, municipal, provincial, national and international levels would help to ensure the diversity of participants invited, adequately represent the system and sub-systems they operate within. I appreciated the fact that the study involved an international representative but it is not clear what part of the system this individual represented, was it someone from the World Health Organization? What was the linkage between that individual (and the organization they represented) and the national Canadian health system (e.g. does their international organization drive research and/or regulations that influence Canadian policies)? We don’t know the answer to these questions because the system was not mapped out first. In addition to mapping out the actors and their interactions, situational analysis provides a framework for articulating issues (especially controversial ones) that may not otherwise be captured by the pre-dialogue consultation.
Questions for brokers:

  1. The application of information learned during the forum is only useful when the evidence provided is current. Do you think it is worth the investment to repeat this process at regular time intervals in order to ensure the most current information is applied to address specific issues (e.g. chronic pain management) concerning health policy in Canada? Why or why not?
  2. Is there a more cost-effective way to help policymakers in Canada use evidence in policy and other decision-making? What does it look like?

ResearchImpact-RéseauImpactRecherche is producing this journal club series as a way to make the evidence and research on knowledge mobilization more accessible to knowledge brokers and to create on line discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Since this is not an open access article find a unviersity based knowledge mobilization colleague to get the article for you. Read the article. Then come back to this post and join the journal club by posting your comments.