The Players and Their Stakes
Translating research into practice involves many stakeholder groups. Health care professionals are often directly influenced by practice changes based on evidence. Many are quite invested in particular clinical methods or work practices and structures of practice, or, put otherwise, in the status quo in terms of treatment approaches they use and the way their care is organized. They often have preferences, pet projects, and passions and may even have visions for health care and their profession’s role that might be advanced or dashed by change. There can be issues of protecting working conditions, as well as turf issues with other professions, notably the protection of services or programs that are lucrative for particular professions.
There are often direct financial consequences for industries connected with health care when research drives adoption, continued use, or rejection of specific products, such as pharmaceuticals and both consumable (e.g., dressings) and durable (e.g., hospital beds, information technology) medical supplies, but also less visible (but equally expensive and important) products, such as consulting services.
Managers, administrators, and ultimately policymakers have stakes in delivering services in their facilities or organizations or jurisdictions in certain ways or within specific cost parameters. In general, administrators would prefer to have as few constraints as possible in managing health care services and thus may be less than enthusiastic about regulations as a method of controlling practice; however, changes that increase available resources may be better accepted.
For researchers, wide uptake of findings into practice is one of the most prestigious forms of external recognition, particularly if mandated by some sort of high-impact policy or legislation. This is especially the case for researchers working in policy-relevant fields where funding and public profile are mutually reinforcing. Researchers and academics involved in the larger evidence-based practice movement also have stakes in the enterprise. There are researchers, university faculty, and other experts who have become specialists in synthesizing and reporting outcomes and have interests in ensuring that distilled research in particular forms retains high status. Furthermore, funding agency advisers and bureaucrats may also be very much invested in the legitimacy conferred by the use of evidence-based practice processes.
The general public, especially subgroups that have stakes in specific types of health care, wants safe, effective, and responsive health care. They want to feel as if their personal risks, costs, and uncertainties are minimized, and they may or may not have insights or concerns about broader societal and economic consequences of treatments or models of care delivery. Expert opinions and research findings tend to carry authority, but for the public, these are filtered through the media, including Internet outlets.
Elected politicians and bureaucrats want to maintain appearances of being well-informed and responsive to the needs of the public and interest groups, while conveying that their decisions balance risks, benefits, and the interests of various stakeholder groups. Elected politicians are usually concerned about voter satisfaction and their prospects for reelection. They, like the public, receive research evidence filtered through others, sometimes by the media but often by various types of civil servants. Non-elected bureaucrats inform politicians, manage specialized programs, and implement policies on a day-to-day basis. They may be highly trained and come to be quite well-informed about research evidence in particular fields. And top bureaucrats serve at the pleasure of elected officials, so are sensitive to public perceptions, opinions, and preferences.