Damani Zaheed, MacKean Gail, Bohm Eric, DeMone Brie, Wright Brock, Noseworthy Tom, Holroyd-Leduc Jayna, Marshall Deborah A
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
Department of Surgery, University of Manitoba, AE101 - 820 Sherbrook Street, Winnipeg, MB, R3T 2N2, Canada.
Health Res Policy Syst. 2016 Oct 18;14(1):78. doi: 10.1186/s12961-016-0149-5.
Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy.
Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners' perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes.
Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable meeting achieved its purpose (to engage stakeholders, elicit feedback, refine policy directions). Third, our decision-maker partners' expectations of the policy roundtable meeting were exceeded; they re-affirmed its value and described the refined policy directions as foundational to establishing the vocabulary, vision and framework for improving access to scheduled clinical services in Manitoba. Finally, our adaptation of key design elements was conducive to discussion of issues surrounding access to care.
Our policy roundtable process was an effective tool for acquiring broad input from stakeholders, refining policy directions and forming the necessary consensus starting points to move towards evidence-informed policy.
政策对话对于制定响应性强、有效、可持续且基于证据的政策至关重要。我们的多学科团队，包括研究人员、医生和高级决策者，对马尼托巴省温尼伯市的单一入口模式——温尼伯中央接待服务进行了全面评估，以改善患者获得髋关节/膝关节置换手术的机会。我们利用评估结果制定了五项基于证据的政策方向，以帮助改善整个马尼托巴省定期临床服务的可及性。我们依据公众参与过程的指导原则，举办了一次政策圆桌会议，让利益相关者参与其中，并利用他们的意见完善政策方向。在此，我们报告政策圆桌会议的用途和意见输入情况及其在促进基于证据的政策制定方面所起的作用。
我们基于证据的政策方向聚焦于质量的正式衡量/监测、作为首选服务提供模式的中央接待、省级范围、透明的流程/绩效指标以及患者对提供者的选择。我们召开了一次政策圆桌会议，并利用讨论结果完善这些方向。我们团队的成员以及来自马尼托巴省的六个利益相关者群体参与其中（共44人），包括患者、家庭医生、骨科医生、外科办公室助理、温尼伯中央接待团队以及管理人员。我们制定了评估表来评估会议过程，并在会议结束后以及15个月后收集决策者合作伙伴对政策圆桌会议的价值以及利用政策方向改善定期临床服务可及性的看法。我们使用主题分析来分析圆桌会议和评估数据，以确定关键主题。
出现了四个关键发现。第一，参与者支持所有政策方向，并确定了修订内容和关键实施考虑因素。第二，参与者认为政策圆桌会议达到了其目的（让利益相关者参与、征求反馈、完善政策方向）。第三，我们的决策者合作伙伴对政策圆桌会议的期望得到了超出；他们重申了其价值，并将完善后的政策方向描述为建立改善马尼托巴省定期临床服务可及性的词汇、愿景和框架的基础。最后，我们对关键设计要素的调整有利于讨论围绕医疗服务可及性的问题。
我们的政策圆桌会议过程是一个有效的工具，可从利益相关者那里获取广泛的意见输入，完善政策方向，并形成迈向基于证据的政策的必要共识起点。
