Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.
The purpose of the work reported here was to delineate the strategies of practice which are associated with excellent outcomes in contemporary primary health care in Australia, and to provide wider access to exemplary and illustrative cases. One hundred and eighty five published accounts of primary health care practice were collected and abstracted. Ninety nine of these cases were evaluated, each by a panel of two or three reviewers, and the 25 most highly rated cases were studied in more detail through interviews with the authors and other protagonists. Eight broad strategies of primary health care practice were identified which appeared to have contributed to excellent outcomes in the cases studied: consumer and community involvement; collaborative local networking; strong vertical partnerships; intersectoral collaboration; integration of the macro and micro; organisational learning; policy participation; and good management. Some of the finer elements of practice which are encompassed by each of these broad strategies and some of the dynamics through which they appear to contribute to good outcomes are delineated. Illustrative cases are cited which might serve as benchmarks to inspire and guide the wider pursuit of excellence in primary health care.
Background: Evidence regarding the impact of psychological problems on recovery from injury has limited influence on practice. Mindlines show effective practice requires diverse knowledge which is generally socially transmitted.Aims and objectives: Develop and test a method blending patient, practitioner, and research evidence and using Forum Theatre to enable key stakeholders to interact with it. Assess this methods; impact on contributing individuals/groups; on behaviour, practice, and research; mechanisms enabling these changes to occur.Methods: Stage-1: captured patient (n=53), practitioner (n=62), and research/expert (n=3) evidence using interviews, focus groups, literature review; combined these strands using framework analysis and conveyed them in a play. Stage-2: patients (n=32), carers (n=3), practitioners (n=31), and researchers (n=16) attended Forum Theatre workshops where they shared experiences, watched the play, re-enacted elements, and co-produced service improvements. Stage-3: used the Social Impact Framework to analyse study outcome data and establish what changed, how and why.Findings: This approach enhanced individuals’/group knowledge of post-injury psychopathology, confidence in their knowledge, mutual understanding, creativity, attitudes towards knowledge mobilisation, and research. These cognitive, attitudinal, and relational impacts led to multilevel changes in behaviour, practice, and research. Four key mechanisms enabled this research to occur and create impact: diverse knowledge, drama/storytelling, social interaction, actively altering outcomes.Discussion and conclusions: Discourse about poor uptake of scientific evidence focuses on methods to aid translation and implementation; this study shows how mindlines can reframe this ‘problem’ and inform impactful research.EPPIC demonstrated how productive interaction between diverse stakeholders using creative means bridges gaps between evidence, knowledge, and action.<br />Key messages<br /><ul><li>Improving healthcare practice by means of research can be problematic.</li><br /><li>Knowledge translation models often neglect healthcare’s complexity and gaps between evidence, knowledge and action.</li><br /><li>The mindlines model shows how diverse healthcare knowledge is effectively melded, used, and transmitted.</li><br /><li>Forum Theatre enables key stakeholders to share and co-create knowledge, enhancing mindlines and hence practice.</li></ul>
In advocating for significant reform of the health care system, the Australian Health Care Reform Alliance (AHCRA) supports a process of citizen engagement that will allow the wider community to have a say in the future direction of their health care system. Models that have engaged community opinions have been successful overseas, and Aust Health Rev 2007: 31 Suppl 1: S13-S15 this article calls for similar processes in Australia.
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