Research into Practice

Integrating the Needs of Users into Research Education

NRSA Trainees Research Conference Slide Presentation (Text Version)

By Thomas C. Ricketts, Ph.D.

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On June 5, 2004, Thomas C. Ricketts, Ph.D., made a presentation at the 10th Annual National Research Service Award (NRSA) Trainees Research Conference. This is the text version of his slide presentation. Select to access the PowerPoint® slides (700 KB).

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Slide 1

Research into Practice: Integrating the Needs of Users into Research Education

Thomas C. Ricketts, Ph.D.
University of North Carolina at Chapel Hill

Slide 2

First Question: Who, or What are Users of Research?

Obvious answers:

• Policymakers.
• Practitioners.
• Patients.

Not so obvious:

• Media.
• Citizens.
• Gadflies.
• Researchers and their support groups.

Slide 3

Problem: A focus on the researchers and their support groups

The slide features a picture of three intertangled system loops with a curved arrow around them. The image is captioned: "What goes in often stays in."

Slide 4

Second Question: Are research and application naturally at odds?

"The true test of a first-rate mind is the ability to hold two contradictory ideas at the same time and still function."

- F. Scott Fitzgerald.

So, if you're a first rate mind (and we all are) it's no problem.

Slide 5

Consider the "world" of information:

It's everywhere, it's all the time, it's overwhelming.

It's like the millions upon millions of pieces of viral matter ready to infect our bodies.

Slide 6

The biology of HIV as a metaphor:

The slide features several microscopic images of viruses.

Slide 7

We're trying to "infect" a host that operates by precoded patterns.

The slide features 3 microscopic images of a virus breaching a cell.

Slide 8

Researchers are often the co-opted Helper T-Cells.

The slide features 3 microscopic images of T-Cells.

Slide 9

Infection (USE of Information)

Requires:

• Receptivity of the host.
• Modification of the role of the "T-cell" people and their roles.
• The ability to rapidly replicate and disseminate copies of the material.

The slide features an image of a double helix, captioned, "Task: Turn your research results into RNA."

Slide 10

What's the surface of the host cell (USER) like?

• Covered with complex information Processing Structures.
• Called Values and Beliefs and Political Expedients.

Slide 11

"values, beliefs and personal preferences play a critical role in health care decision making"

- Ray Moynihan. Evaluating Health Services: A Reporter covers the science of research synthesis. Milbank Memorial Fund, 2004.

Slide 12

Theme: Build strong roots for researchers to let their work leaf out into application.

The slide features an image of a tree.

Slide 13

Is this suppressing the thrill of "natural" inquiry?

The creation of new knowledge using original data, testing a long-held theory, publishing in a high quality journal.

Versus

A contracted investigation into an already researched issue with an existing data base to report to a agency or firm something they already know.

Slide 14

Can we do both... through investments in the contexts of training?

Slide 15

Investing in Data

• To support learners, develop longitudinal data sets already tied to decisions:
  • Licensed practitioner data base.
  • Hospital discharge data base.
  • Clinical summaries used for review.
• Built trust with partners and "owners" of the data (agencies, hospital administrators, clinical chairs).
• Market the data for research selling questions rather than answers.

Slide 16

Getting data is always tough.

The slide features a picture of the Three Stooges pulling a tooth.

Slide 17

Invest in Policy Streams

Develop "fact Sheets" and briefing papers that responded to policy clients' needs:

• Them: Do we need a pharmacy school?
• Researcher: What are the factors that drive demand for pharmaceuticals?
• Synthesis: Fact sheet combining the two; articles and papers are necessary but really extra.

Slide 18

Invest in Answers that Create Questions

Create answers that suck questions out of the users as well as draw conclusions:

• What is a FTE Nurse?
• Flows to: "we can now control ratios and create rules."
• Which flows to: "how will those rules affect patient care quality."
• Which flows to funded research.

Slide 19

Preparing Learners to love Cross Subsidy

Sometimes research pays for the policy part:

• Creating a shortage designation required feedback from stakeholders.
• The advisors advocate for answers to their questions that arose in the inquiry.

Sometimes policy pays for research:

• A "Bright Legislative Idea" becomes an agenda for inquiry: Prospective Payment, Medical Savings Accounts.

Slide 20

Citizenry in Research

Citizens resolve issues with politics (who gets what, when, how, why).

Politics is often viewed as the realm of the cynical, but it is a real-world necessary for the citizenry to prosper.

Therefore, prepare researchers to be citizens, if not cynical.

For example:

Slide 21

Playing with Odd Bedfellows

Slide 22

Lessons from Martha M. McKinney

• Law of political advantage:
  • Policymakers will support the health issues that provide the most political benefit at the least possible cost.
• Law of diminishing data:
  • The more complex the issue the lower the likelihood of finding the data needed.
• Law of rational ignorance:
  • Policymakers who think they understand a health issues will tend to ignore data and research.

Slide 23

More Lessons

• Law of infinite solutions:
  • As the number of decisionmakers increases proposed solutions multiply exponentially.
• Law of suspect data:
  • Policy makers and practitioners will question the applicability of research done "somewhere else."
• Law of data burden:
  • Policymakers and practitioners swill oppose data collection seen as even a little burdensome.
• Iron law of partisanship:
  • As political competition rises, the opportunities for research to inform decisions falls.

Slide 24

Rickett's Law of Health Policy Physics

For every Ph.D. there is an equal and opposite Ph.D.

Slide 25

A policymaker person once told me:

"Reality is not theory-driven"

However... most actions and decisions.are based on some underlying notion of.what the world ought to look like, so...

Slide 26

Don't dance around belief systems when discussing topics for research approaches to answer questions the biases in the data.

Another policy person said to me: "That was the finest bit of advocacy research I've ever seen."

If you don't teach researchers to accept the context of interpretation, someone else will and they will get chased out.

Slide 27

Interpretation outside policy—the cult and problem of personality

Individuals whose attitudes affect acceptance of research:

• Patients.
• Practitioners.
• Communities.

Solution: Teach researchers to accept and even identify personalities.

Current as of September 2004

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Internet Citation:

Research into Practice: Integrating the Needs of Users into Research Education. Text Version of a Slide Presentation at a National Research Service Award (NRSA) Trainees Research Conference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/fund/training/rickettxt.htm

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