Involving stakeholders helps research influence policy

This case study shows how involving stakeholders enhanced the impact of research on health policy. In 2004, Washington State enacted a three-year pilot program enabling nurse practitioners to work in an expanded role as “attending providers” for injured workers. Following an evaluation, the program was made permanent. This case study may help other researchers seeking to influence health care and/or health-care policy.

This study describes how researchers analyzed the policy environment and worked with five key stakeholder groups before, during and after an evaluation of the pilot program. The stakeholders were nurse practitioners, physicians, employers, labour unions and the Department of Labor and Industries. Researchers involved these stakeholders in various ways. For instance, the researchers solicited feedback from semi-structured interviews and used it to refine the research design.

Only two organized groups – nurse practitioners and labour unions – initially supported the new, expanded role for nurse practitioners. Two groups, physicians and employers, were opposed to it. Early in the evaluation, researchers identified the positions and values important to each group. For instance, physicians were concerned about protecting the scope of their work and quality of care, while employers’ priorities were low costs and system efficiencies. By involving and communicating with stakeholders throughout the evaluation, negative positions changed. After the evaluation, all groups supported the change except physicians (who moved to a neutral position from a negative one).

The researchers identified a number of facilitators, barriers and strategies to enhancing the effective impact of the research on policy:

• identifying needs by interviewing stakeholders early
• ensuring research information was relevant to real-life circumstances
• analyzing stakeholders’ underlying interests and values
• holding ongoing interactions between researchers, policy-makers and stakeholders
• presenting research results clearly and disseminating them beyond the stakeholders involved.

(The results of the evaluation were published elsewhere. In summary, the role expansion did not have any negative impact on quality of care, claim disputes, medical costs or work disability outcomes.)

The case study offered a thorough presentation of strategies enhancing the impact of research on policy, and was well grounded in the existing research on facilitators and barriers to policy impact. However, as this was a single case study, the findings may not generalize to all policy settings.