Health Policy Proposal Analysis (Policy Brief)
Assignment 2: Health Policy Proposal Analysis (Policy Brief)
Nurses engaged in the policy arena often are asked to provide information on a health care topic of interest to policy makers. This is frequently accomplished through developing a policy brief. A policy brief advocates for a particular recommendation (prior to the enactment of a policy). Learning how to write a policy brief in a clear, succinct, scholarly, and professional manner is an essential skill for advanced practice nurses.
For this Assignment, you will assess one of the recommendations from the Institute of Medicine’s “The Future of Nursing: Leading Change, Advancing Health: Report Recommendations. You will then develop a policy brief to advocate for this recommendation (the written policy brief is due in Week 7).
To prepare:
Review the Lavis et al. article on preparing and writing policy briefs provided in the Learning Resources (See attached file).
Select one of the recommendations within the IOM The Future of Nursing: Leading Change, Advancing Health: Report Recommendations to focus on for this assignment. (For this assignment, I have selected RECOMMENDATION 1, please see attached file)
Research the history of the problem behind the recommendation and what has been done to try to solve the problem.
What does the recommendation say should be done? Are there any groups, nursing and others, currently supporting work to implement the recommendation (e.g., Kaiser Family Foundation, professional organizations)? Does the recommendation suggest specific groups that should be involved in the implementation? Think critically about how the recommendation should be implemented – did the IOM get it right? What other strategies are possible to consider?
By Sunday 04/15/2018 12pm,
To complete:
Develop a scholarly and professionally written 2- to 3-page single-spaced policy brief on the recommendation you selected from the IOM report following the format presented in the Lavis et al. article (follow the exact format, including how the layout of the paragraphs, and the way the references [at least 10 scholarly references] are displayed at the end, numbered in-text and number plus citation at the end, copy the same exact format as the article please). (See attached file for the article). Include the following:
Short introduction with statement of the problem.
The selected recommendation (from the IOM Report)
Background
Current characteristics
The impact of the recommendation from the perspective of consumers, nurses, other health professionals, and additional stakeholders
Current solutions
Current status in the health policy arena
Final conclusions
Resources used to create the policy brief
Required Readings
Hyder, A., Syed, S., Puvanachandra, P., Bloom, G., Sundaram, S., Mahmood, S., … Peters, D. (2010). Stakeholder analysis for health research: case studies from low- and middle-income countries. Public Health, 124(3), 159–166.
This study demonstrates how the engagement of stakeholders in research and policy making can assist in the successful implementation of policy proposals. The authors propose that by engaging stakeholders, researchers and policy makers are provided with multiple perspectives on proposed policies, which can lead to greater success with policy adoption and implementation.
Lavis, J. N., Permanand, G., Oxman, A. D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Research Policy & Systems, 71–79. doi: 10.1186/1478-4505-7-S1-S13
The purpose of a policy brief is to communicate an issue clearly and definitively to policy makers. The authors of this article propose an outline for policy briefs and also stress the importance of using research when creating a policy brief.
Lowery, B. (2009). Obesity, bariatric nursing, and the policy process: The connecting points for patient advocacy. Bariatric Nursing & Surgical Patient Care, 4(2), 133–138.
This article provides an example of nurse involvement in policy making by examining a bariatric nursing issue. The author stresses that nurses, in their patient-advocacy role, have a responsibility to be involved in the health care policy process.
Moore, K. (2006). How can basic research on children and families be useful for the policy process? Merrill-Palmer Quarterly, 52(2), 365–375.
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health: Report recommendations. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf
Introduced in Week 2, this IOM report highlights four key recommendations in its proposal for the future directions of the nursing profession. These recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking.
National Center for Policy Analysis (2010). Ideas changing the world: Free-market health care policy. Retrieved from http://www.ncpa.org/healthcare/
The NCPA is a nonprofit, nonpartisan organization that promotes private sector solutions to public policy issues (See attached file and choose recommendation 1).
Slack, B. (2011). The policy Process. Retrieved from http://people.hofstra.edu/geotrans/eng/methods/ch9c2en.html
The author presents a policy-making framework and provides details on the four steps of that process: problem definition, policy objectives and options, policy implementation, and policy evaluation and maintenance.
Required Media
Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Agenda setting and the policy process. Baltimore: Author.
Note: The approximate length of this media piece is 17 minutes.
Dr. Kathleen White and Dr. Joan Stanley share their insights into agenda setting and how issues are moved forward into the policy process.
Optional Resources
Barnes, M., Hanson, C., Novilla, L., Meacham, A., McIntyre, E., & Erickson, B. (2008). Analysis of media agenda setting during and after Hurricane Katrina: Implications for emergency preparedness, disaster response, and disaster policy.
American Journal of Public Health, 98(4), 604–610.
Jennings, C. (2002). The power of the policy brief. Policy, Politics & Nursing Practice, 3(3), 261–263. doi: 10.1177/152715440200300310
Neumann, P. J., Palmer, J. A., Daniels, N., Quigley, K., Gold, M. R., & Chao, S. (2008). A strategic plan for integrating cost-effectiveness analysis into the US health care system. American Journal of Managed Care, 14(4), 185-188.
Plan, Policy, Procedure Relationship Diagram. (n.d.). Retrieved from http://www.informationsecurityintel.com/docs/Fig.%204.3.pdf
BioMed Central
Health Research Policy and Systems
ss
Open AcceGuide SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking John N Lavis*1, Govin Permanand2, Andrew D Oxman3, Simon Lewin4 and Atle Fretheim5
Address: 1Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University, 1200 Main St. West, HSC-2D3, Hamilton, ON, Canada, L8N 3Z5, 2Health Evidence Network, World Health Organization Regional Office for Europe, Scherfigsvej 8, Copenhagen, Denmark DK-2100, 3Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N0130 Oslo, Norway, 4Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N0130 Oslo, Norway; Health Systems Research Unit, Medical Research Council of South Africa and 5Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N0130 Oslo, Norway; Section for International Health, Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Norway
Email: John N Lavis* – lavisj@mcmaster.ca; Govin Permanand – gop@euro.who.int; Andrew D Oxman – oxman@online.no; Simon Lewin – simon.lewin@nokc.no; Atle Fretheim – atle.fretheim@nokc.no
* Corresponding author
Abstract This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers.
Policy briefs are a relatively new approach to packaging research evidence for policymakers. The first step in a policy brief is to prioritise a policy issue. Once an issue is prioritised, the focus then turns to mobilising the full range of research evidence relevant to the various features of the issue. Drawing on available systematic reviews makes the process of mobilising evidence feasible in a way that would not otherwise be possible if individual relevant studies had to be identified and synthesised for every feature of the issue under consideration. In this article, we suggest questions that can be used to guide those preparing and using policy briefs to support evidence-informed policymaking. These are: 1. Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed? 2. Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations? 3. Does the policy brief employ systematic and transparent methods to identify, select, and assess synthesised research evidence? 4. Does the policy brief take quality, local applicability, and equity considerations into account when discussing the synthesised research evidence? 5. Does the policy brief employ a graded-entry format? 6. Was the policy brief reviewed for both scientific quality and system relevance?
About STP This article is part of a series written for people responsible for
making decisions about health policies and programmes and for those who support these decision makers. The series is intended
Published: 16 December 2009
Health Research Policy and Systems 2009, 7(Suppl 1):S13 doi:10.1186/1478-4505-7-S1-S13
This article is available from: http://www.health-policy-systems.com/content/7/S1/S13
© 2009 Lavis et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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to help such people ensure that their decisions are well-informed by the best available research evidence. The SUPPORT tools and the ways in which they can be used are described in more detail in the Introduction to this series [1]. A glossary for the entire series is attached to each article (see Additional File 1). Links to Spanish, Portuguese, French and Chinese translations of this series can be found on the SUPPORT website http:// www.support-collaboration.org. Feedback about how to improve the tools in this series is welcome and should be sent to: STP@nokc.no.
Scenarios Scenario 1: You are a senior civil servant and have been sent a policy brief that describes the research evidence about an issue that is of growing concern to the Minister. You are responsible for ensuring that the policy brief profiles research evidence in a way that informs different elements of the issue and recognises the importance of drawing on both local and global evidence. You want to ensure that the policy brief won’t place the Minister in an awkward position by making a recommendation that is not politically or economically feasible.
Scenario 2: You work in the Ministry of Health and have been given a few hours to prepare an assessment of a policy brief that has been sent to the Ministry on a high-priority issue. All that you have been told is that this policy brief is different in a number of ways to the type of policy brief that you have pro- duced in the past including the way in which it profiles research evidence about a problem, the options and implementation con- siderations, and the fact that it does not conclude with a specific recommendation.
Scenario 3: You work in an independent unit that supports the Ministry of Health in its use of research evidence in policymak- ing. You are preparing a policy brief for both the Ministry and key stakeholders to profile what is known and not known about a problem, options for addressing it, and implementation con- siderations. You have been told to prepare the brief in a system- atic way and to report the methods and findings in a transparent and readily understandable way, but you want guidance on how to be both thorough and efficient in your work.
Background For policymakers (Scenario 1), this article suggests a number of questions that they might ask themselves or their staff to consider when assessing a policy brief. For those who support policymakers (Scenarios 2 and 3), this article suggests a number of questions to guide the assess- ment of a policy brief or the preparation of one.
Three major shifts have occurred recently in the focus of many efforts to package research evidence for policymak- ers. Firstly, there has been a shift from packaging single studies to packaging systematic reviews of studies that
address typical policy-relevant questions. A number of research groups, including the SUPPORT collaboration http://www.support-collaboration.org/, now produce policymaker-friendly summaries of systematic reviews. These summaries always highlight the key messages from the review but some of them, like SUPPORT summaries, also address considerations related to quality, local appli- cability, and equity [2]. This shift has made it easier for policymakers to scan broadly across large bodies of research evidence. And it has also enabled them to extract what they need to know easily from particular systematic reviews that directly address key features of any policy issue of interest.
Secondly, there have been more recent complementary efforts to package systematic reviews (together with local research evidence) in the form of a new product – the pol- icy brief – which mobilises the best available research evi- dence on high-priority issues [3]. For policy briefs, the starting point is the issue and not the related research evi- dence that has been produced or identified. Once an issue is prioritised, the focus then turns to mobilising the full range of research evidence addressing the different fea- tures of the issue concerned. These include the underlying problem, options to address the problem, and key imple- mentation considerations. Drawing on available system- atic reviews makes the process of evidence mobilisation feasible in a way that would not otherwise be possible if single studies had to be identified and synthesised for all the features of the issue. In this article, we have restricted our use of the term ‘policy brief’ to those products match- ing this description exactly. But the term has also been applied elsewhere to many other types of products pre- pared by those supporting policymakers. The appropria- tion of this term by those involved in producing and supporting the use of research evidence reflects perhaps their increasing orientation to the needs and contexts of policymakers.
Evidence-packaging mechanisms and policy briefs in par- ticular have been developed largely as a response to the findings of systematic reviews of factors influencing the use of research evidence in policymaking [4,5]. Three fac- tors in particular have emerged as significant. These are: 1. Timing or timeliness, 2. Accordance between the research evidence and the beliefs, values, interests, or political goals and strategies of policymakers and stakeholders, and 3. Interactions between researchers and policymakers.
Having access to both a stock of the summaries of system- atic reviews and policy briefs helps to address the need that policymakers have for timely inputs to policymaking processes [6]. Review summaries and policy briefs can typ- ically be produced in days and weeks rather than the months or years required to prepare a systematic review
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from scratch. Undertaking primary research (i.e. original studies) can be similarly and often more time intensive. Evidence-packaging mechanisms, and policy briefs in par- ticular, can also make it easier for policymakers and other stakeholders to determine whether and how the available research evidence accords with their own beliefs, values, interests, or political goals and strategies. With a problem clarified, what is known and not known about the options clearly described, and key implementation considerations clearly flagged, policymakers may be more readily able to identify viable ways forward.
Thirdly, changes have occurred in the purpose for which packaged research evidence has typically been produced. Policy briefs are increasingly used as an input into policy dialogues involving individuals drawn from those who will be involved in, or affected by, decisions about a par- ticular issue. These dialogues provide the opportunity for greater interaction between researchers and policymakers. Dialogues in which research evidence is just one input in a policy discussion form the focus of Article 14 in this series [7].
The formats used for evidence-packaging have often been developed in response to the few available empirical stud- ies of the preferences of health policymakers for different kinds of mechanisms (and not their usage or effects, which typically have not been evaluated) [4,8]. These studies have revealed a need amongst policymakers to have for- mats that both provide graded entry to the full details of a review and facilitate assessment of decision-relevant infor- mation [4]. A graded-entry format of one page of take- home messages, a three-page executive summary that summarises the full report, and a 25-page report (i.e. a 1:3:25 format) has shown to be particularly promising [9]. Presumably, either the one- or three-page summary should follow a structured format [10]. Structured abstracts have been found to have an effect on intermedi- ate outcomes such as searchability, readability and recall among healthcare providers. However, no studies have compared full text to structured abstracts and no studies have examined the impact of format features on policy- makers [11]. Decision-relevant information can include the important impacts (both benefits and harms) and costs (i.e. resources used) of policy and programme options, as well as local applicability and equity consider- ations [4].
Questions to consider The following questions can be used to guide the prepara- tion and use of policy briefs to support evidence-informed policymaking:
1. Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed?
2. Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations?
3. Does the policy brief employ systematic and transpar- ent methods to identify, select, and assess synthesised research evidence?
4. Does the policy brief take quality, local applicability, and equity considerations into account when discussing the research evidence?
5. Does the policy brief employ a graded-entry format?
6. Was the policy brief reviewed for both scientific quality and system relevance?
1. Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed? Policy briefs are distinguished most clearly from other packaged evidence summaries by the fact that they begin with the explicit identification of a high-priority issue. In instances where an issue has been on the agenda of key stakeholders for some time, policy briefs may act as a way to spur progress. This is highlighted in the example shown in Table 1 of low coverage rates for artemisinin-based combination therapies (ACT) to treat uncomplicated fal- ciparum malaria in sub-Saharan African countries. Alter- natively, if the issue is relatively new, the policy brief may play an agenda-setting role. Either way, it is critical that the issue is deemed a priority by at least some key stake- holders. Ideally the prioritisation process should also be systematic and transparent and Article 3 in this series out- lines an approach for achieving this [12].
A second key feature of policy briefs is that they are typi- cally context-specific. Describing the key features of a con- text in the policy brief is important as a way of creating a level playing field among policy brief readers. Table 2 highlights issues related to limited or inequitable access to sustainable, high-quality community-based primary healthcare in Canada. There, as the policy brief explained, the issue could only be understood in the context of the particular features of Canadian primary healthcare and the existence of ‘private delivery/public payment’ arrange- ments with physicians. These are of particular importance in this context for they have meant historically that most primary healthcare in Canada is delivered by physicians working in private practice with first-dollar, public (typi- cally fee-for-service) payment [13]. Improving access in creative ways, including the use of collaborative practice models, requires an understanding that: 1. Physicians tend to be wary of potential infringements on their profes- sional and commercial autonomy, 2. No other healthcare providers at this time can secure the public payment
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required to function independently as primary healthcare providers on a viable scale, and 3. Many forms of care (including prescription drugs and home care services) would still not be covered [14].
2. Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations? A policy brief would ideally describe different features of a problem, what is known (and not known) about the costs and consequences of options for addressing the problem, and key implementation considerations. As out- lined in Article 4, a problem can be understood in one or more of the following terms [15]:
1. The nature and burden of the actual common diseases and injuries that the healthcare system must prevent or treat
2. The cost-effective programmes, services and drugs that are needed for prevention and treatment, and
3. The broader health system arrangements that deter- mine access to, and the use of, cost-effective programmes, services and drugs, including how they affect particular groups.
A policy brief would help to clarify the problem by diag- nosing it in one or more of these terms.
Ideally, the number of options described in a brief that is to be presented to senior policymakers would conform to local document conventions. Three-option models, for instance, are familiar to many policymakers. But regard- less of the number selected, each option in the policy brief can be characterised in terms of:
• The benefits of each option
Table 1: Outline of a policy brief about supporting the widespread use of a new, highly effective treatment for malaria in an African country
What problem has been identified? • The overarching problem is one of low coverage rates for artemisinin-based combination therapies (ACT) to treat uncomplicated falciparum malaria in sub-Saharan Africa. Key features of the problem include:
• A high incidence of, and death rates from, malaria • Existing treatments have much lower cure rates than ACT. However, patients often favour existing treatments because of their past experiences and the higher price of ACT • The national malaria control policy, treatment guidelines, and drug formulary in many countries do not all support the prescription, dispensing and use of ACT • Delivery arrangements for ACT often rely primarily on physicians but not everyone has regular access to them and many are comfortable receiving care from community health workers. Financial arrangements favour existing treatments over ACT (which is much more expensive) yet some patients are sceptical about heavily subsidised medication. Governance arrangements often do not allow community health workers to prescribe ACT and do not protect against counterfeit or substandard drugs
What information do systematic reviews provide about three viable options to address the problem? • Each of the following three options was assessed in terms of the likely benefits, harms, costs (and cost-effectiveness), key elements of the policy option if it was tried elsewhere, and the views and experiences of relevant stakeholders:
• Enlarge the scope of practice for community health workers to include the diagnosis of malaria and prescription of ACT (governance arrangements), introduce target payments for achieving a defined coverage rate for ACT treatment (financial arrangements), and provide them with training and supervision for the use of both rapid diagnostic tests and prescribing (delivery arrangements) • Introduce partial subsidies for both rapid diagnostic tests and ACT within the private sector where much care is provided in urban areas (financial arrangements) • Restrict the types of anti-malaria drugs that can be imported and introduce penalties for those found dispensing counterfeit or substandard drugs (governance arrangements) and make changes to the national malaria control policy and drug formulary to ensure that ACT is the recommended first-line treatment
• Important uncertainties about each option’s benefits and potential harms were flagged in order to give them particular attention as part of any monitoring and evaluation plan put into place
What key implementation considerations need to be borne in mind? • A number of barriers to implementation were identified, among which were the familiarity of some patients and healthcare providers with existing treatment options and their resistance to change. Systematic reviews about the effects of mass media campaigns, the effects of strategies for changing healthcare provider behaviour generally, and for influencing prescribing and dispensing specifically, all proved helpful in deciding how to address these barriers
Notes about the supporting evidence base: • Six systematic reviews about anti-malarial drugs had been published since the release of the World Health Organization guidelines in 2006, all of which lent further support to ACT as the recommended first-line treatment • Of the systematic reviews identified: two addressed relevant governance arrangements, six addressed financial arrangements, five addressed specific configurations of human resources for health, and fifteen addressed implementation strategies, many of which could be supplemented by local studies
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• The harms of each option
• The costs of each option or their relative cost-effective- ness (if possible)
• The degree of uncertainty related to these costs and con- sequences (so that monitoring and evaluation can focus on particular areas of uncertainty if any given option is pursued)
• Key elements of the policy option if it has been tried elsewhere and adaptation is being considered, and
• Stakeholder views about and experiences with each option
A policy brief would help to make clear the trade-offs involved in selecting one option over others. If the options are not designed to be mutually exclusive, a policy brief would also help to make clear the benefits of com- bining particular elements of the different options and which combination of options might bring about positive synergies. Alternatively, the elements from one or more individual options could be presented first, followed by ‘bundles’ of options combining different elements in var- ious ways.
Barriers to implementation (outlined in further detail in Article 6 in this series) are located at different levels, rang- ing from the consumer (citizen or healthcare recipient) level through to healthcare providers, organisations, and broader systems [16]. Policy briefs would help to identify
Table 2: Outline of a policy brief about improving access to high quality primary healthcare in Canada
What problem has been identified? • The problem is limited or inequitable access to sustainable, high-quality community-based primary healthcare in federal, provincial, and territorial publicly-funded health systems in Canada. Key characteristics of the problem include:
• Chronic diseases represent a significant share of the common conditions that must be prevented or treated by the primary healthcare system • Access to cost-effective programmes, services and drugs in Canada is not ideal. This is the case both when Canadians identify their own care needs or (more proactively on the part of healthcare providers) when they have an indication (or need) for prevention or treatment, particularly for chronic disease prevention and treatment • Health system arrangements have not always supported the provision of cost-effective programmes, services and drugs. Many Canadians do not:
1. Have a regular physician or place of care 2. Receive effective chronic-disease management services, or 3. Receive care in a primary healthcare practice that uses an electronic health record, faces any financial incentive for quality, or provides nursing services What is more difficult to determine is the proportion of physicians who receive effective continuing professional development for chronic disease management and the proportion of primary healthcare practices that: 1. Are periodically audited for their performance in chronic disease management 2. Employ physician-led or collaborative practice models, and 3. Adhere to a holistic primary healthcare model’s (the Chronic Care Model’s) key features [21]
What information do systematic reviews provide about three viable options to address the problem? • Each of the following three options was assessed in terms of its likely benefits, harms, costs (and cost-effectiveness), its key elements if it had been tried elsewhere, and stakeholder views about and experiences with it:
• Support the expansion of chronic disease management in physician-led care through a combination of electronic health records, target payments, continuing professional development, and auditing of their primary healthcare practices • Support the targeted expansion of inter-professional, collaborative practice primary healthcare • Support the use of the Chronic Care Model in primary healthcare settings. This model entails the combination of self-management support, decision support, delivery system design, clinical information systems, health system, and community
• Important uncertainties about each option’s benefits and potential harms were flagged. This was done in order to give these issues particular attention within any monitoring and evaluation plan put into place
What key implementation considerations need to be borne in mind? • Little empirical research evidence could be identified about implementation barriers and strategies. Four of the implementation barriers identified were: 1. Initial wariness amongst some patients of potential disruptions to their relationship with their primary healthcare physician 2. Wariness on the part of physicians (particularly older physicians) of potential infringements on their professional and commercial autonomy 3. The organisational scale required for some of the options is not viable in many rural and remote communities, and 4. Hesitancy on the part of governments about broadening the breadth and depth of public payment for primary healthcare, particularly during a recession
Notes about the supporting evidence base: • Dozens of relevant systematic reviews were identified, some of which addressed an option directly and others of which addressed elements of one or more options [14]
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these barriers and describe what can reasonably be expected (again, in terms of benefits, harms, and costs) as a result of pursuing alternative implementation strategies to address these barriers. A policy brief could also identify considerations related to the preparation of a monitoring and evaluation plan. Table 3 provides a possible outline for a policy brief.
3. Does the policy brief employ systematic and transparent methods to identify, select, and assess synthesised research evidence? Policymakers and a wide range of stakeholders who will be involved in or affected by a decision, are the main audi- ence of a policy brief. Research language should therefore be kept to a minimum as most people will be unfamiliar with it. A policy brief, nevertheless, should still ideally describe how synthesised research evidence was identi-
Table 3: Possible outline of a policy brief
Title (possibly in the form of a compelling question) Key messages (possibly as bullet points) • What is the problem? • What do we know (and not know) about viable options to address the problem? • What implementation considerations need to be borne in mind? Report • Introduction that describes the issue and the context in which it will be addressed • Definition of the problem such that its features can be understood in one or more of the following terms: 1. The nature and burden of common diseases and injuries that the healthcare system must prevent or treat 2. The cost-effective programmes, services and drugs that are needed for prevention and treatment, and 3. The health system arrangements that determine access to and use of cost-effective programmes, services and drugs, including how they affect particular groups • Options for addressing the problem, with each one assessed in a table (an example is shown below)
Category of finding Nature of findings from systematic reviews and other available research evidence
Benefits Harms Costs and cost-effectiveness Uncertainty regarding benefits and potential harms Key elements of the option (how and why it works) Stakeholders’ views and experiences
• Implementation considerations, with potential barriers to implementing the options assessed in a table (please see example below), each viable implementation strategy also assessed in table (please see example above), and suggestions for a monitoring and evaluation plan
Levels Option 1 Option 2 Option 3
Consumer Healthcare provider Organisation System Additional content that could appear on a cover page or in an appendix: • A list of authors and their affiliations • A list of those involved in establishing the terms of reference for the policy brief and their affiliations • A list of key informants who were contacted to gain additional perspectives on the issue and to identify relevant data and research evidence, and their affiliations • A list of funders (for the organisation producing the policy brief and for the policy brief itself) • A statement about conflicts of interest among authors Additional content that could appear in boxes or in an appendix • Methods used to identify, select, and assess synthesised research evidence (including assessments of quality, local applicability and equity considerations) • Review process used to ensure the scientific quality and system relevance of the policy brief
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fied, selected and assessed in ways that are easily under- stood. This objective can be achieved by using techniques such as explanatory ‘boxes’ within the brief to clarify or highlight particular concepts, or through the inclusion of additional appendices. The methods, too, should be sys- tematic in nature and reported in a transparent yet under- standable way. For example, users could be provided with a description of how systematic reviews addressing the benefits and harms of particular health system arrange- ments were identified through a search of continuously updated databases containing reviews in particular domains. This could provide significant reassurance to readers that most, if not all, key reviews had been found and that few, if any, key reviews had been missed.
4. Does the policy brief take quality, local applicability, and equity considerations into account when discussing the research evidence? Systematic reviews may be of high or low quality, their findings may be highly applicable to a given policy- maker’s setting or of very limited applicability, and they may or may not give consideration to the impacts an option is likely to have on disadvantaged groups, and on equity in a specific setting. Ideally, a policy brief would flag such variations for policymakers and other readers. As outlined in Article 8, explicit criteria are available to assist with quality assessments [17]. Importantly, some data- bases of systematic reviews, such as Rx for Change http:// www.rxforchange.ca, provide quality ratings for all reviews contained in the database. If possible, a policy brief would provide a quality review for all systematic reviews from which key messages have been extracted. Explicit criteria are also available to assist with local appli- cability assessments and these are outlined in further detail in Article 9 [18]. Given that policy briefs are typi- cally context-specific, a policy brief would also ideally comment on the local applicability of the findings of any systematic reviews that are critical to an understanding of the impacts of any options being considered. Equity con- siderations can also be addressed using explicit criteria (see Article 10) [19]. A policy brief should also note in its introduction whether any groups have been given partic- ular attention in the brief. Group-specific key messages could be added to the overall key messages in each sec- tion.
5. Does the policy brief employ a graded-entry format? A policy brief would ideally allow busy policymakers and other readers to scan the key messages quickly in order to determine whether these corresponded sufficiently closely to their key issue of concern and context to warrant read- ing the entire document. A graded-entry format could take a number of forms. These could be achieved, for example, through a 1:3:25 format – i.e. one page of take-home mes- sages, a three-page executive summary, and a 25page
report [9]. Or a brief may take the form of a 1:12 format, with one page of take-home messages followed by a 12- page report. Whatever form is chosen, the minimum that a policy brief should contain is a list of key messages, a report, and a reference list for those who wish to read more. The key messages would range from the identifica- tion of the problem through what is known about the options, and the key considerations for implementation.
A number of other features of a policy brief could engage potential readers and facilitate assessments of who was involved in preparing, informing and funding it. The title of a policy brief could be worded in a way that would engage policymakers and other stakeholders. This could be achieved, for example, by using a compelling question as a title. The cover and/or the acknowledgements section of a policy brief could provide a list of authors and their affiliations. It could also include a list of those involved in establishing the terms of reference of the policy brief, a list of the key informants contacted for additional perspec- tives on the issue and to identify relevant data and research evidence, and their affiliations. A list of funders for both the organisation producing the policy brief and the policy brief itself, and a statement about any conflicts of interest among authors could also form part of the pol- icy brief document.
6. Was the policy brief reviewed for both scientific quality and system relevance? Policy briefs need to meet two standards: scientific quality and system relevance. To ensure this, the review process could involve at least one policymaker, at least one other stakeholder, and at least one researcher. This so-called merit review process differs from a typical peer review proc- ess that would typically only involve researchers in the review process, and hence focus primarily on scientific quality. Involving policymakers and other stakeholders can help to ensure the brief’s relevance to the health sys- tem.
Conclusion Policy briefs are a new approach to supporting evidence- informed policymaking. Their preparation and use con- tinues to evolve through practical experience. Evaluations of this new approach are needed in order to improve our understanding of which particular design features are well received for particular types of issues and in particular contexts. Describing the different features of a problem may, for example, be perceived as being particularly important for highly politicised topics where the very nature of the problem is contentious. Taking equity con- siderations into account through a focus on only one group may be perceived as inappropriate in political sys- tems that may have a long tradition of either addressing all major ethnocultural groups in policy documents or
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http://www.rxforchange.ca
Health Research Policy and Systems 2009, 7(Suppl 1):S13 http://www.health-policy-systems.com/content/7/S1/S13
perhaps of focusing on no groups in particular. Evalua- tions are also necessary as a way of improving our under- standing of whether, and how, policy briefs influence policymaking. Table 4 provides a description of one approach to the formative evaluation of policy briefs.
Resources Useful documents and further reading – Research Matters. Knowledge Translation: A ‘Research Matters’ Toolkit. Ottawa, Canada: International Develop- ment Research Centre: http://www.idrc.ca/research-mat ters/ev-128908-201-1-DO_TOPIC.html – Source of addi- tional examples of policy briefs (Chapter 8) and, most importantly, guidance about effective communication (Chapters 6 and 7)
– Canadian Health Services Research Foundation. Com- munication Notes: Reader-Friendly Writing – 1:3:25. Ottawa, Canada: Canadian Health Services Research Foundation: http://www.chsrf.ca/knowledge_transfer/ pdf/cn-1325_e.pdf – Source of advice about writing for an audience of policymakers and other stakeholders
– Lavis JN, Boyko JA: Evidence Brief: Improving Access to Pri- mary Healthcare in Canada. Hamilton, Canada: McMaster
Health Forum; 2009 [14] – Example of a policy brief for a specific country (Canada)
– Oxman AD, Bjorndal A, Flottorp SA, Lewin S, Lindahl AK: Integrated Health Care for People with Chronic Condi- tions. Oslo, Norway: Norwegian Knowledge Centre for the Health Services; 2008 [20]: http://www.kunnskapssen teret.no/Publikasjoner/5114.cms?threepage=1 – Example of a policy brief that provides an exhaustive review of the potential elements of policy options before bundling them together into three viable options for a specific country (Norway)
Links to websites – Health Evidence Network/European Observatory on Health Systems and Policies: http://www.euro.who.int/ hen/policybriefs/20070327_1 – Source of policy briefs tar- geted at policymakers in the World Health Organization’s European Region
– Program in Policy Decision-Making (PPD)/Canadian Cochrane Network and Centre (CCNC) database: http:// www.researchtopolicy.ca/search/reviews.aspx – Source of policy briefs as well as systematic reviews and overviews of systematic reviews (with links to policymaker-friendly
Table 4: An example of an approach to the formative evaluation of a policy briefs series
• The McMaster Health Forum surveys those to whom it sends a policy brief, with the long term goal of identifying which design features work best for particular types of issues, and in which particular health system contexts. Participation is voluntary, confidentiality assured, and anonymity safeguarded • Twelve features of the policy briefs series are the focus of questions in the formative evaluation survey:
• Describes the context of the issue being addressed • Describes different features of the problem, including (where possible) how it affects particular groups • Describes three options for addressing the problem • Describes key implementation considerations • Employs systematic and transparent methods to identify, select, and assess synthesised research evidence • Takes quality considerations into account when discussing the research evidence • Takes local applicability considerations into account when discussing the research evidence • Takes equity considerations into account when discussing the research evidence • Does not conclude with particular recommendations • Employs a graded-entry format (i.e. a list of key messages and a full report) • Includes a reference list for those who want to read more about a particular systematic review or research study, and • Is subject to a review by at least one policymaker, at least one stakeholder, and at least one researcher. This process is termed a merit review to distinguish it from a standard peer review which would typically only involve researchers in the review process
• For each design feature, the survey asks: • How useful did they find this approach (on a scale from 1 = Worthless to 7 = Useful)? • Are there any additional comments or suggestions for improvement?
• The survey also asks: • How well did the policy brief achieve its purpose, namely to present the available research evidence on a high-priority issue in order to inform a policy dialogue where research evidence would be just one input to the discussion (on a scale from 1 = Failed to 7 = Achieved)? • What features of the policy brief should be retained in future? • What features of the policy brief should be changed in future? • What key stakeholders can do better or differently to address the high-priority issue and what they personally can do better or differently? • Their role and background (so that the McMaster Health Forum can determine if different groups have different views and experiences related to policy briefs)
• The Evidence-Informed Policy Networks (EVIPNet) operating in Africa, Asia and the Americas plan to use a similar approach in the formative evaluation of their policy briefs
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http://www.idrc.ca/research-matters/ev-128908-201-1-DO_TOPIC.html
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http://www.kunnskapssenteret.no/Publikasjoner/5114.cms?threepage=1
http://www.euro.who.int/hen/policybriefs/20070327_1
http://www.euro.who.int/hen/policybriefs/20070327_1
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Health Research Policy and Systems 2009, 7(Suppl 1):S13 http://www.health-policy-systems.com/content/7/S1/S13
summaries of systematic reviews and overviews of system- atic reviews)
– SUPPORT Collaboration: http://www.support-collabo ration.org – Example of a source of policymaker-friendly summaries of systematic reviews relevant to low- and middleincome countries
Competing interests The authors declare that they have no competing interests.
Authors’ contributions JNL prepared the first draft of this article. GP, ADO, SL and AF contributed to drafting and revising it.
Acknowledegements Please see the Introduction to this series for acknowledge- ments of funders and contributors. In addition, we would like to acknowledge Sandy Campbell and staff in the Ontario Ministry of Health and Long-Term Care (MoHLTC) Planning Unit for helpful comments on an earlier version of this Article.
This article has been published as part of Health Research Policy and Systems Volume 7 Supplement 1, 2009: SUP- PORT Tools for evidence-informed health Policymaking (STP). The full contents of the supplement are available online at http://www.health-policy-systems.com/con tent/7/S1.
Additional material
References 1. Lavis JN, Oxman AD, Lewin S, Fretheim A: SUPPORT Tools for
evidence-informed health Policymaking (STP). Introduc- tion. Health Res Policy Syst 2009, 7(Suppl 1):I1.
2. Rosenbaum SE, Glenton C, Oxman A, Members of the SUPPORT Collaboration: Evidence Summaries Tailored for Health Policy Makers in Low- and Middle-Income Countries Oslo, Norwegian Knowledge Centre for the Health Services; 2009.
3. Colby DC, Quinn BC, Williams CH, Bilheimer LT, Goodell S: Research glut and information famine: making research evi- dence more useful for policymakers. Health Aff (Millwood) 2008, 27:1177-82.
4. Lavis JN, Davies HTO, Oxman A, Denis JL, Golden-Biddle K, Ferlie E: Towards systematic reviews that inform healthcare man- agement and policymaking. J Health Serv Res Policy 2005, 10:35-48.
5. Lavis JN, Hammill A, Gildiner A, McDonagh RJ, Wilson MG, Ross SE, Ouimet M, Stoddart GL: A Systematic Review of the Factors that Influ-
ence the Use of Research Evidence by Public Policymakers. Final Report Submitted to the Canadian Population Health Initiative Hamilton, Canada, McMaster University Program in Policy Decision-Making; 2005.
6. Lavis JN, Davies HT, Gruen RL, Walshe K, Farquhar CM: Working within and beyond the Cochrane Collaboration to make sys- tematic reviews more useful to healthcare managers and policy makers. Healthc Policy 2006, 1:21-33.
7. Lavis JN, Boyko J, Oxman AD, Lewin S, Fretheim A: SUPPORT Tools for evidence-informed health Policymaking (STP). 14. Organising and using policy dialogues to support evidence- informed policymaking. Health Res Policy Syst 2009, 7(Suppl 1):S14.
8. Lavis JN, Wilson MG, Grimshaw J, Haynes RB, Ouimet M, Raina P, Gruen R, Graham I: Towards Optimally Packaged and Relevance Assessed Health Technology Assessments: Report Submitted to the Canadian Agency for Drugs and Therapeutics in Healthcare Hamilton, Canada, McMaster University Program in Policy Decision-Making; 2007.
9. The Canadian Health Services Research Foundation (CHSRF): Com- munication Notes: Reader-Friendly Writing – 1:3:25 2009 [http:// www.chsrf.ca/knowledge_transfer/pdf/cn-1325_e.pdf]. Ottawa, Cana- dian Health Services Research Foundation
10. Haynes RB, Mulrow CD, Huth EJ, Altman DG, Gardner MJ: More informative abstracts revisited. Ann Intern Med 1990, 113:69-76.
11. Hartley J: Current findings from research on structured abstracts. J Med Libr Assoc 2004, 92:368-71.
12. Lavis JN, Oxman AD, Lewin S, Fretheim A: SUPPORT Tools for evidence-informed health Policymaking (STP). 3. Setting priorities for supporting evidence-informed policymaking. Health Res Policy Syst 2009, 7(Suppl 1):S3.
13. Lavis JN: Political elites and their influence on health care reform in Canada. In The Governance of Health Care in Canada Edited by: McIntoch T, Forest P-G, Marchildon GP. Toronto: University of Toronto Press Incorporated; 2004:257-79.
14. Lavis JN, Boyko J: Evidence Brief: Improving Access to Primary Healthcare in Canada Hamilton, Canada: McMaster Health Forum; 2009.
15. Lavis JN, Wilson M, Oxman AD, Lewin S, Fretheim A: SUPPORT Tools for evidence-informed health Policymaking (STP). 4. Using research evidence to clarify a problem. Health Res Policy Syst 2009, 7(Suppl 1):S4.
16. Fretheim A, Munabi-Babigumira S, Oxman AD, Lavis JN, Lewin S: SUPPORT Tools for evidence-informed health Policymak- ing (STP). 6. Using research evidence to address how an option will be implemented. Health Res Policy Syst 2009, 7(Suppl 1):S6.
17. Lewin S, Oxman AD, Lavis JN, Fretheim A: SUPPORT Tools for evidence-informed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst 2009, 7(Suppl 1):S8.
18. Lavis JN, Oxman AD, Souza NM, Lewin S, Gruen RL, Fretheim A: SUPPORT Tools for evidence-informed health Policymak- ing (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst 2009, 7(Suppl 1):S9.
19. Oxman AD, Lavis JN, Lewin S, Fretheim A: SUPPORT Tools for evidence-informed health Policymaking (STP). 10. Taking equity into consideration when assessing the findings of a systematic review. Health Res Policy Syst 2009, 7(Suppl 1):S10.
20. Oxman AD, Bjorndal A, Flottorp S, Lewin S, Lindahl AK: Integrated Health Care for People with Chronic Conditions 2008 [http:// www.kunnskapssenteret.no/Publikasjoner/5114.cms?threepage=1]. Oslo, Norwegian Knowledge Centre for the Health Services
21. Wagner EH, Austin BT, Von Korff M: Organizing care for patients with chronic illness. Milbank Q 1996, 74:511-44.
Additional file 1
Glossary Click here for file [http://www.biomedcentral.com/content/supplementary/1478- 4505-7-S1-S13-S1.doc]
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Abstract
About STP
Scenarios
Background
Questions to consider
1. Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed?
2. Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations?
3. Does the policy brief employ systematic and transparent methods to identify, select, and assess synthesised research evidence?
4. Does the policy brief take quality, local applicability, and equity considerations into account when discussing the research evidence?
5. Does the policy brief employ a graded-entry format?
6. Was the policy brief reviewed for both scientific quality and system relevance?
Conclusion
Resources
Useful documents and further reading
Links to websites
Competing interests
Authors’ contributions
Acknowledegements
Additional material
References
The Future of Nursing Leading Change, Advancing Health
Advising the nation/Improving health
For more information visit www.iom.edu/nursing
Report Recommendations
1 RepoRT ReCommeNdATIoNs
Key messages
Nurses should practice to the full extent of their education and training.•
Nurses should achieve higher levels of education and training through an • improved education system that promotes seamless academic progression.
Nurses should be full partners, with physicians and other health care professionals, • in redesigning health care in the United States.
Effective workforce planning and policy making require better data collection • and an improved information infrastructure.
Recommendations
Recommendation 1: Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends the following actions.
For the Congress:
• Expand the Medicare program to include coverage of advanced practice registered nurse services that are within the scope of practice under applicable state law, just as physician services are now covered.
• Amend the Medicare program to authorize advanced practice registered nurses to perform admission assessments, as well as certification of patients for home health care services and for admission to hospice and skilled nursing facilities.
• Extend the increase in Medicaid reimbursement rates for primary care physicians included in the ACA to advanced practice registered nurses providing similar primary care services.
• Limit federal funding for nursing education programs to only those programs in states that have adopted the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules (Article XVIII, Chapter 18).
For state legislatures:
• Reform scope-of-practice regulations to conform to the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules (Article XVIII, Chapter 18).
• Require third-party payers that participate in fee-for-service payment arrangements to pro- vide direct reimbursement to advanced practice registered nurses who are practicing within their scope of practice under state law.
2 THe FuTuRe oF NuRsINg
For the Centers for Medicare and Medicaid Services:
• Amend or clarify the requirements for hospital participation in the Medicare program to ensure that advanced practice registered nurses are eligible for clinical privileges, admitting privileges, and membership on medical staff.
For the Office of Personnel Management:
• Require insurers participating in the Federal Employees Health Benefits Program to include coverage of those services of advanced practice registered nurses that are within their scope of practice under applicable state law.
For the Federal Trade Commission and the Antitrust Division of the Department of Justice:
• Review existing and proposed state regulations concerning advanced practice registered nurses to identify those that have anticompetitive effects without contributing to the health and safety of the public. States with unduly restrictive regulations should be urged to amend them to allow advanced practice registered nurses to provide care to patients in all circum- stances in which they are qualified to do so.
Recommendation 2: expand opportunities for nurses to lead and diffuse collabora- tive improvement efforts. Private and public funders, health care organizations, nursing educa- tion programs, and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices.
To this end:
• The Center for Medicare and Medicaid Innovation should support the development and evaluation of models of payment and care delivery that use nurses in an expanded and lead- ership capacity to improve health outcomes and reduce costs. Performance measures should be developed and implemented expeditiously where best practices are evident to reflect the contributions of nurses and ensure better-quality care.
• Private and public funders should collaborate, and when possible pool funds, to advance research on models of care and innovative solutions, including technology, that will enable nurses to contribute to improved health and health care.
• Health care organizations should support and help nurses in taking the lead in developing and adopting innovative, patient-centered care models.
• Health care organizations should engage nurses and other front-line staff to work with developers and manufacturers in the design, development, purchase, implementation, and evaluation of medical and health devices and health information technology products.
3 RepoRT ReCommeNdATIoNs
• Nursing education programs and nursing associations should provide entrepreneurial pro- fessional development that will enable nurses to initiate programs and businesses that will contribute to improved health and health care.
Recommendation 3: Implement nurse residency programs. State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to sup- port nurses’ completion of a transition-to-practice program (nurse residency) after they have com- pleted a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.
The following actions should be taken to implement and support nurse residency programs:
• State boards of nursing, in collaboration with accrediting bodies such as the Joint Commis- sion and the Community Health Accreditation Program, should support nurses’ completion of a residency program after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.
• The Secretary of Health and Human Services should redirect all graduate medical education funding from diploma nursing programs to support the implementation of nurse residency programs in rural and critical access areas.
• Health care organizations, the Health Resources and Services Administration and Centers for Medicare and Medicaid Services, and philanthropic organizations should fund the devel- opment and implementation of nurse residency programs across all practice settings.
• Health care organizations that offer nurse residency programs and foundations should evalu- ate the effectiveness of the residency programs in improving the retention of nurses, expand- ing competencies, and improving patient outcomes.
Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020. These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan.
• The Commission on Collegiate Nursing Education, working in collaboration with the National League for Nursing Accrediting Commission, should require all nursing schools to offer defined academic pathways, beyond articulation agreements, that promote seamless access for nurses to higher levels of education.
• Health care organizations should encourage nurses with associate’s and diploma degrees to enter baccalaureate nursing programs within 5 years of graduation by offering tuition reim- bursement, creating a culture that fosters continuing education, and providing a salary dif- ferential and promotion.
4 THe FuTuRe oF NuRsINg
• Private and public funders should collaborate, and when possible pool funds, to expand bac- calaureate programs to enroll more students by offering scholarships and loan forgiveness, hiring more faculty, expanding clinical instruction through new clinical partnerships, and using technology to augment instruction. These efforts should take into consideration strate- gies to increase the diversity of the nursing workforce in terms of race/ethnicity, gender, and geographic distribution.
• The U.S. Secretary of Education, other federal agencies including the Health Resources and Services Administration, and state and private funders should expand loans and grants for second-degree nursing students.
• Schools of nursing, in collaboration with other health professional schools, should design and implement early and continuous interprofessional collaboration through joint class- room and clinical training opportunities.
• Academic nurse leaders should partner with health care organizations, leaders from primary and secondary school systems, and other community organizations to recruit and advance diverse nursing students.
Recommendation 5: double the number of nurses with a doctorate by 2020. Schools of nursing, with support from private and public funders, academic administrators and university trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to increasing diversity.
• The Commission on Collegiate Nursing Education and the National League for Nursing Accrediting Commission should monitor the progress of each accredited nursing school to ensure that at least 10 percent of all baccalaureate graduates matriculate into a master’s or doctoral program within 5 years of graduation.
• Private and public funders, including the Health Resources and Services Administration and the Department of Labor, should expand funding for programs offering accelerated graduate degrees for nurses to increase the production of master’s and doctoral nurse graduates and to increase the diversity of nurse faculty and researchers.
• Academic administrators and university trustees should create salary and benefit packages that are market competitive to recruit and retain highly qualified academic and clinical nurse faculty.
5 RepoRT ReCommeNdATIoNs
Recommendation 6: ensure that nurses engage in lifelong learning. Accrediting bod- ies, schools of nursing, health care organizations, and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan.
• Faculty should partner with health care organizations to develop and prioritize competen- cies so curricula can be updated regularly to ensure that graduates at all levels are prepared to meet the current and future health needs of the population.
• The Commission on Collegiate Nursing Education and the National League for Nursing Accrediting Commission should require that all nursing students demonstrate a compre- hensive set of clinical performance competencies that encompass the knowledge and skills needed to provide care across settings and the lifespan.
• Academic administrators should require all faculty to participate in continuing profes- sional development and to perform with cutting-edge competence in practice, teaching, and research.
• All health care organizations and schools of nursing should foster a culture of lifelong learn- ing and provide resources for interprofessional continuing competency programs.
• Health care organizations and other organizations that offer continuing competency pro- grams should regularly evaluate their programs for adaptability, flexibility, accessibility, and impact on clinical outcomes and update the programs accordingly.
Recommendation 7: prepare and enable nurses to lead change to advance health. Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership positions are available to and filled by nurses.
• Nurses should take responsibility for their personal and professional growth by continuing their education and seeking opportunities to develop and exercise their leadership skills.
• Nursing associations should provide leadership development, mentoring programs, and opportunities to lead for all their members.
• Nursing education programs should integrate leadership theory and business practices across the curriculum, including clinical practice.
• Public, private, and governmental health care decision makers at every level should include representation from nursing on boards, on executive management teams, and in other key leadership positions.
6 THe FuTuRe oF NuRsINg
Recommendation 8: Build an infrastructure for the collection and analysis of inter- professional health care workforce data. The National Health Care Workforce Commission, with oversight from the Government Accountability Office and the Health Resources and Services Administration, should lead a collaborative effort to improve research and the collection and analysis of data on health care workforce requirements. The Workforce Commission and the Health Resources and Services Administration should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor in this effort to ensure that the data are timely and publicly accessible.
• The Workforce Commission and the Health Resources and Services Administration should coordinate with state licensing boards, including those for nursing, medicine, dentistry, and pharmacy, to develop and promulgate a standardized minimum data set across states and professions that can be used to assess health care workforce needs by demographics, num- bers, skill mix, and geographic distribution.
• The Workforce Commission and the Health Resources and Services Administration should set standards for the collection of the minimum data set by state licensing boards; oversee, coordinate, and house the data; and make the data publicly accessible.
• The Workforce Commission and the Health Resources and Services Administration should retain, but bolster, the Health Resources and Services Administration’s registered nurse sample survey by increasing the sample size, fielding the survey every other year, expanding the data collected on advanced practice registered nurses, and releasing survey results more quickly.
• The Workforce Commission and the Health Resources and Services Administration should establish a monitoring system that uses the most current analytic approaches and data from the minimum data set to systematically measure and project nursing workforce require- ments by role, skill mix, region, and demographics.
• The Workforce Commission and the Health Resources and Services Administration should coordinate workforce research efforts with the Department of Labor, state and regional edu- cators, employers, and state nursing workforce centers to identify regional health care work- force needs, and establish regional targets and plans for appropriately increasing the supply of health professionals.
• The Government Accountability Office should ensure that the Workforce Commission mem- bership includes adequate nursing expertise.
7 CommITTee LIsT
Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of medicine
Donna E. Shalala (Chair) President, University of Miami, Coral Gables, FL
Linda Burnes Bolton (Vice Chair) Vice President and Chief Nursing Officer, Cedars-Sinai Health System and Research Institute, Los Angeles, CA
Michael R. Bleich Dean and Dr. Carol A. Lindeman Distinguished Professor, Vice Provost for Inter-professional Edu- cation and Development, Oregon Health & Science University School of Nursing, Portland
Troyen A. Brennan Executive Vice President, Chief Medical Officer, CVS Caremark, Woonsocket, RI
Robert E. Campbell Vice Chairman (retired), Johnson & Johnson, New Brunswick, NJ
Leah Devlin Professor of the Practice, University of North Carolina at Chapel Hill School of Public Health, Raleigh
Catherine Dower Associate Director of Research, Center for the Health Professions, University of California, San Francisco
Rosa Gonzalez-Guarda Assistant Professor, School of Nursing and Health Studies, University of Miami, Coral Gables, FL
David C. Goodman Professor of Pediatrics and of Health Policy, and Director, Center for Health Policy Research, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
Jennie Chin Hansen Chief Executive Officer, American Geriatrics Society, New York
C. Martin Harris Chief Information Officer, Cleveland Clinic, OH
8 THe FuTuRe oF NuRsINg
Anjli Aurora Hinman Certified Nurse-Midwife, Intown Midwifery, Atlanta, GA
William D. Novelli Distinguished Professor, McDonough School of Business, Georgetown University, Washington, DC
Liana Orsolini-Hain Nursing Instructor, City College of San Francisco, CA
Yolanda Partida Director, National Center, Hablamos Juntos, and Assistant Adjunct Professor, Center for Medical Education and Research, University of California, San Francisco, Fresno
Robert D. Reischauer President, The Urban Institute, Washington, DC
John W. Rowe Professor, Mailman School of Public Health, Department of Health Policy and Management, Columbia University, New York
Bruce C. Vladeck Senior Advisor, Nexera Consulting, New York
The Institute of medicine serves as adviser to the nation to improve health. Established in 1970 as the health arm of the National Academy of Sciences,
the Institute of Medicine is a nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.
Advising the nation / Improving health
500 Fifth Street, NW Washington, DC 20001
TEL 202.334.2352 FAX 202.334.1412
www.iom.edu
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