How to win friends and influence decision makers:

Meeting the challenges to HTA uptake

Challenges in formulating the “right” questions and

providing the right evidence for health services

delivery

Don Juzwishin PhD. FCCHL

2

Objectives

• Explore and identify

the issues with

problem definition

• Identify strategies to

address the issues

• Describe what AHS

AH are doing to

address the

challenges

3

Framing the problem

• Einstein is quoted as

having said that if he had

one hour to save the world

he would spend fifty-five

minutes defining the

problem and only five

minutes finding the

solution.

4

-10

-5

0

5

10

15

20

25

Immigrant Status

Visible Minority

Status

Lowest Income

Quintile

Highest Income

Quintile

Rural Residence

Single Low Physical Activity

Smoker Low Fruit and

Vegetable

High Alcohol

Pop

ulat

ion

Att

ribut

able

Ris

k (%

)

Population Attributable Risk of Self-Reported Obesity, by Risk Factor and Sex, Age 18 and Older, Canada

Social Determinants Health Behaviours

Multiple Determinants Associated With Obesity

https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1636

5

Typology of problems

Diversity

Single Party Multiple parties,

each having

relevant

knowledge

Multiple parties,

conflicting in

values &

interests

Complexity

Both problem and

solutions known

Tame problem

Wicked problem

Wicked problem Super wicked

problem – social

mess

Adapted from Heifetz 1994. 76

6

The problem with problems

• Definition

– Self fulfilling

• Perspective

– Framing

• Whose authority?

• Needs vs. wants

• Needs vs. method

• Facts & values

• Continuum

7

Moving towards Networks

Alberta Health

Ob

es

ity,

dia

be

tes

&

nu

trit

ion

Bo

ne a

nd

jo

int

he

alt

h

Se

nio

rs’ h

ea

lth

Ca

rdio

va

sc

ula

r

he

alt

h a

nd

str

ok

e

Ca

nc

er

ca

re

Ad

dic

tio

n a

nd

me

nta

l h

ea

lth

Po

pu

lati

on

he

alt

h

Ne

uro

log

ica

l

dis

ea

se

, E

NT

New

bo

rn, ch

ild

an

d

yo

uth

he

alt

h

Ma

tern

al h

ea

lth

Pri

ma

ry c

are

an

d

ch

ron

ic d

ise

as

e

Co

mp

lex

me

dic

ine

Functioning by March 31, 2012 Soon to be Functioning

Strategic Clinical Networks (SCNs)

Alberta Health Services & Alberta Health

Em

erg

en

cy

Su

rge

ry

Cri

tical C

are

Operational Clinical

Networks (OCNs)

Functioning by Jan.

2013

Alberta Health

Technology Decision

Process

8

Old Think….New Think

• Safety

• Efficacy

• Effectiveness

• Cost Effectiveness

• Budget Impact

Analysis

• Optimizing the use of

health technologies and

increasing the

appropriateness of care

interventions in health

and health care in

Alberta

• Waste

• Innovation

• Embedded function

9

Character of new think about problems

• Proactive

• Knowledge translation

• Screening committee

of AACHT

• Priority setting

• Value analysis

• Access through

evidence development

• Change management

• Trade offs

• Reallocation of

“savings”

10

How is Alberta addressing the way forward

• Macro, Mezzo and Micro

approaches

• Role & responsibility

• Knowledge translation

• Networking

– SCNs & OCNs

– Integrate & coordinate

• Priority setting

• Post policy

implementation

• Joined approach

11

Condition

Agent

Political Technos Economic Social Ethical Legal Environ

Person

Family

Community

Provincial

National

Global

Pluralistic Model of Problem

Definition

12

References

• Australian Government. Tackling wicked problems: a public policy

perspectives. 2007.

• Brehaut, J. Juzwishin, D., Bridging the gap: The use of research in policy

development, AHFMR, 2005.

– http://www.ihe.ca/documents/HTA-FR18.pdf

• Borowski, H., Brehaut, J., Hailey, D., Linking Evidence from health

technology assessments to policy and decision making: The Alberta

model, International Journal of Technology Assessment in Health Care,

Issue -2, April 2007, pp. 155-161.

• Carthwright, N., Hardie, J., Evidence-based policy: a practical guide to

doing it better, Oxford University Press, 2012.

• Mitchel, S., Unsimple truths: Science, complexity, and policy, University

of Chicago, 2009.