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On evidence-based policy making

Alternatives

Yes, many of you cynics out there will be thinking that this is a bit of an oxymoron, combining incongruous and contradictory terms. Evidence-based policy making must exist: it is just that we never see the processes. Yet we know that processes exist to help, like health technology assessment, or NICE in the UK and similar organisations in other countries. Inevitably it all gets a bit bureaucratic, and decision-making can seem glacial, but that is the price we pay for doing things right.

The long view is that this must be the right way of doing things. Yes there are glitches and delays, but if we keep grinding away at it we'll get it right in the end, and healthcare will enter the broad, sunny, uplands we have been waiting for.

There is an alternate view though, or possibly views. Two main objections to evidence-based policy making argue that it will never work.

The first is that top-down policy will always fail. Professionals resent it, it will often be wrong or at best out of date, the bureaucracy will subvert it to its own ends, and the result will be order, counter-order, and disorder. Some would say that is about where we are in the UK right now.

The other argument is that large organisations run on budgets deploy any arguments they like to make the evidence fit the budget. It can all get very murky, and because professionals are not fools and can spot policy-based evidence, it makes for a generally uncomfortable time all round.

Alternatives

"Trust the professionals" might be a slogan for at least one alternative, and give them the tools to finish the job. It means letting small groups who have a sense of ownership for one part of the whole get on with their own bottom up redesign, and develop care pathways based on best evidence and local circumstance.

This issue of Bandolier has a lovely example of improved diabetes care from a large care pathway in Israel. Using good IT, best evidence, and multidisciplinary ownership, they created a system that did better for patients, gave more satisfaction to professionals, and at a lower cost per patient. Success.

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