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Scoping study of approaches to Brokering knowledge and Research Information to support the Development and Governance of health systems in Europe

Final Report Summary - BRIDGE (Scoping study of approaches to brokering knowledge and research information to support the development and governance of health systems in Europe)

Lead organisation: European Observatory on Health Systems and Policies
Contacts: Josep Figueras (jfi@obs.euro.who.int by e-mail) and John Lavis (lavisj@mcmaster.ca by e-mail).

Background

The BRIDGE project was designed by the European Observatory to understand and respond to the gap between evidence and information on health systems, and the reforms and strategies designed to shape them. The need for governments and other stakeholders to take well-informed decisions is well recognised and yet policy is often made without reference to the best available health systems information. Knowledge brokering is a term used to describe the efforts to ensure that the two do connect and that there is a link between policymakers and researchers, the information they generate and need, and the contexts they operate in. BRIDGE sought: to map the various organisations undertaking such brokering work on health systems policy across the European Union (EU) and European Free Trade Area (EFTA) countries; to understand the knowledge brokering mechanisms that are being used and the reasons they work and do not work; and to examine the ways that information could be more effectively brought to bear on decision making.

BRIDGE has:
- developed a framework to understand knowledge-brokering approaches and their interconnections;
- produced criteria that can be used to assess knowledge brokering mechanisms and organisational models for knowledge brokering;
- described and compared EU and EFTA country experiences with knowledge brokering mechanisms that package information and that allow interactive knowledge sharing and organisational models (whether national or European focused) that foster knowledge brokering highlighting good practices;
- undertaken a set of national case studies that explore further the contextual factors that support the brokering of research into policy making.

Key lessons

1. There is insufficient sustained effort to support knowledge brokering in European health systems:
- Health systems information is not consistently used to inform decision making.
- The most successful mechanisms are not widely used.
- There is not adequate support for knowledge brokering or enough encouragement of its use.

2. The 'how to' of communicating evidence for decisions is hugely context dependent. Despite this there are lessons that can be learned and models that can be used to help broker knowledge better throughout EU health systems.

3. The models that can usefully be applied include:
- packaging mechanisms (policy briefs, summaries etc.) that are customised to target policy makers and reflect their specific needs, focusing on a specific policy issue, examining the evidence around select options to tackle the policy issue or problem, and presenting messages in a graded format and in language designed to be accessible;
- approaches to knowledge sharing (policy dialogues, networks, workshops etc.) that encourage two way interaction and allow for formal, organised exchange and informal dialogue;
- interactive approaches and specifically organisations that focus on knowledge brokering in light of the evidence on timeliness and trust; on the need to build sustained links between researchers generating knowledge and policy makers taking decisions.

4. There are some underlying and cross-cutting issues that need to be understood and which can be tackled through effective and adequately funded knowledge brokering activities - this implies:
- greater focus on interaction between those that generate evidence and decision makers;
- working within the recognition that groups and individuals are most receptive to information and evidence that is in line with their established beliefs, values and interests;
- making information readily available and accessible and easy to interpret;
- emphasising applicability of information and its practical use, including generating tangible solutions and practical tools;
- building up a track record of quality outputs that inspire confidence in the information source;
- capacity building so that researchers understand how and why information can be policy relevant and so that policy makers can appreciate the value of evidence.

5. Current approaches to brokering are surprisingly traditional and there is strikingly little innovation - this suggests both that while some approaches may be robust and regarded as credible in different settings, there is scope for further development.

6. The European Commission (EC), national governments and other funders could make a significant impact by supporting further research, innovation, rolling out of existing good practice and ongoing evaluation.

Key areas of work, scientific and technical outputs from BRIDGE

- An updated systematic review of the factors that influence the use of health systems information in policy making.
- A 'map' of knowledge brokering mechanisms and organisational models for knowledge brokering.
- A framework capturing the relationship between knowledge generators, knowledge brokers and policy making.
- A glossary of terms around which some consensus has been built.
- Data from 319 organisations outlining their role in knowledge brokering.
- Laying the groundwork for further comparative research on this area.
- Lessons which will help increase health system actors' understanding of knowledge brokering and what it implies for the re-organisation and better management of health information systems.
- Lessons on how to broker knowledge better which will help support the development and governance of European health systems.
- Lesson which will optimise the delivery of health care to European citizens.
- Two policy briefs on knowledge brokering at national and European level:
i. How can knowledge brokering be better supported across European health systems?
Lavis J. N., Permanand G., Catallo C., Fahy N., BRIDGE study team
Brussels, Belgium: European Observatory on Health Systems and Policies (2011).
ii. How can knowledge brokering be advanced in a country's health system?
Lavis J. N., Permanand G., Catallo C., BRIDGE study team
Brussels, Belgium: European Observatory on Health Systems and Policies (2011).
- Three BRIDGE summaries on: information-packaging mechanisms for knowledge brokering; interactive knowledge-sharing mechanisms for knowledge brokering; and organisational models for knowledge brokering:
i. Communicating clearly: Enhancing information-packaging mechanisms to support knowledge brokering in European health systems.
Lavis J. N., Catallo C., Permanand G., Zierler A., BRIDGE study team.
Brussels, Belgium: European Observatory on Health Systems and Policies (2011).
ii. Learning from one another: Enriching interactive knowledge-sharing mechanisms to support knowledge brokering in European health systems.
Lavis J. N., Catallo C., Jessani N., Permanand G., Zierler A., BRIDGE study team.
Brussels, Belgium: European Observatory on Health Systems and Policies (2011).
iii. Matching form to function: Designing organisational models to support knowledge brokering in European health systems.
Lavis J. N., Jessani N., Permanand G., Catallo C., Zierler A., BRIDGE study team.
Brussels, Belgium: European Observatory on Health Systems and Policies (2011).

- BRIDGE volume including the BRIDGE framework and criteria; a systematic review and scoping review of published literature; website reviews from key knowledge brokering organisations in 31 countries; results of site visits to 28 knowledge brokering organisations; multi-method case studies of knowledge brokering in action in Belgium, England, Norway and Spain; and next steps for knowledge brokering in Europe:
i. Bridging the worlds of research and policy in European health systems.
Lavis J. N., Catallo C., (editors).
Brussels, Belgium: European Observatory on Health Systems and Policies (2011).

Project objectives:

BRIDGE comprised six work packages (WPs), four of which had scientific / technological objectives (WPs 1-4) and one of which has a dissemination objective (WP 5). WP 1 focused on framework development and preliminary work on this WP 1 informed WP 2 and WP 3 that respectively described and compared EU countries experiences on knowledge brokering mechanisms and organisational models. The information gathered in the frame of WP 2 and WP 3 was used to implement WP 4, which focuses on selected national examples of how national policy making processes intersect with and are supported by brokering approaches. WP 5 focused on dissemination.

WP 1 - Framework

The objective for WP 1 in the current reporting period was to develop a framework to organise the ways - concepts, mechanisms and organisational models - in which new and existing knowledge can be transferred into policy initiatives, mechanisms and practices.

Significant findings included:

1. in moderate- and high-quality studies, three factors increased the prospects for health systems information being used in policymaking:
i. ongoing linkages between researchers and policymakers, which included both formal, organised interactions at the level of the organisation, as is the case with established policy networks, and informal dialogues between policymakers and researchers;
ii. an accordance between the available health systems information and the beliefs, values, interests or political goals and strategies of elected officials and societal interest groups (whereas conflicts or a lack of accord decreased the prospects for health systems information being used in policymaking); and
iii. timing / timeliness of the information being made available or accessible.

2. in these same studies, three additional factors emerged as important but not with the same consistency:
i. applicability - health systems information that addressed local policy making needs and provide tangible solutions and/or practical tools for application in policymaking increased the prospects for its use;
ii. trustworthiness and interpretability - health systems information that policymakers could trust (for its quality) and could easily interpret increased the prospects for its use (whereas a source or findings that could not be trusted and findings or recommendations that were too complex to interpret decreased the prospects for the use of health systems information); and
iii. accessibility and policy makers' capacity to determine its quality - health systems information that could be accessed easily by policy makers with the capacity to assess its quality increased the prospects for its use (whereas restricted access or a lack of capacity decreased the prospects for the use of health systems information).

3. in the same studies, a targeted review of organisational models for knowledge brokering identified three key findings:
i. governance structures for knowledge-brokering organisations, including the roles and responsibilities of politicians and civil servants in these structures, varied dramatically across organisations;
ii. organisational structures and processes were rarely described (at least beyond staff mix and capacity issues), and the same was true for their contributions to national and regional policy making and use of rapid response functions to support responsive relations between policy makers and researchers;
iii. organisational agenda setting varied across organisations (e.g. from policy maker influenced to based on the quality of the available health systems information) and organisational autonomy, use of formal prioritisation processes and resource allocation rules all influenced agenda setting.

4. a supplementary scoping review of information-packaging mechanisms, which was conducted using the 19 (of 126) studies that explicitly described knowledge-brokering mechanisms, identified five key findings:
i. the information-packaging mechanisms relied on a range of traditional approaches to producing or synthesising health systems information (e.g. economic evaluations, health technology assessments, clinical practice guidelines and decision-support tools) and on traditional output formats;
ii. the mechanisms only rarely involved formal consensus methods to resolve disagreements related to the health systems information being profiled;
iii. the mechanisms only occasionally involved innovative approaches to packaging health systems information (e.g. a graded entry format with key messages, an executive summary and a full report);
iv. the effectiveness of the information-packaging mechanisms in policy making environments was not reported as having been examined; and
v. the dissemination strategies used to support the use of the information-packaging mechanisms relied on traditional approaches (e.g. mailing and posting on a website) and the effectiveness of these strategies was not reported as having been examined.

5. a supplementary scoping review of interactive knowledge-sharing mechanisms, which was conducted using the same 19 (of 126) studies that explicitly described knowledge-brokering mechanisms, identified four key findings:
i. interactive knowledge-sharing mechanisms operated both within formally established relationships (e.g. government support unit with government, externally commissioned research, expert panels, and expert guidance sought out in response to contentious events garnering public attention) and within informally established relationships (e.g. existing professional relationships and networking opportunities such as conferences);
ii. policymakers participating in the research process which is one type of interactive knowledge-sharing mechanism, were interested in and supportive of the findings and their dissemination to key audiences;
iii. knowledge-sharing mechanisms were seen to contribute to organisational success, however, the potential for success was seen as being challenged when policy makers imposed restrictions on organisational decision-making, funding or implementation (e.g. with expert panels); and
iv. the effectiveness of the interactive knowledge-sharing mechanisms in policy making environments was not reported as having been examined.

6. the interim framework for information-packaging mechanisms identifies nine key features of any given mechanism.

Key features
i. It targets policymakers as a key audience.
ii. It stems from one of more of: i) research project (i.e. primary research); ii) systematic review; iii) meeting with policymakers or other stakeholders; iv) collation of research-related products or activities or v) issue raised by policymakers (with mechanisms that stem from systematic reviews, meetings with policymakers and other stakeholders or both seen as more innovative).
ii. It focuses primarily on one or more of: i) problem or policy objective; ii) options for addressing a problem or achieving a policy objective; or implementation considerations (with mechanisms that focus on two or more of these domains seen as more innovative).
iv. It was reviewed before publication by members of its target audience.
v. It uses language that is clearly designed to be accessible.
vi. It follows a graded-entry format with key messages, possibly an executive summary, and a full report.
vii. It highlights decision-relevant information explicitly.
viii. Its wider use is supported by online commentaries or briefings about the product provided by representatives of its target audiences.
ix. Its wider use is supported by an option to sign-up for an e-mail alert/listserv when new products are posted online.

7. The interim framework for interactive knowledge-sharing mechanisms identifies ten key features of any given mechanism (see table below).

Key features
i. It targets policymakers as a key audience.
ii. It targets other stakeholders who will be involved in or affected by decisions that might be informed by the mechanism.
iii. It stems from one of more of: i) research agenda setting; ii) research project (i.e. primary research); iii) systematic review; iv) collation of research-related products or activities; v) issue raised by policymakers; or vi) training need identified by policymakers (with mechanisms that stem from systematic reviews or a collation of research-related products or activities and issues raised by policymakers or both seen as more innovative);
iv. It focuses primarily on one or more of: i) problem or policy objective; ii) options for addressing a problem or achieving a policy objective; or implementation considerations (with mechanisms that focus on two or more of these domains seen as more innovative).
v. Its timing relates explicitly to a policymaking process or to requests from policymakers.
vi. It involves one or more of: i) closed list of invitees; ii) pre-circulation of products; or iii) rule about whether and how comments can be attributed.
vii. It involves one or more of: i) presentations by an 'expert'; ii) questions and answers targeted at an 'expert'; iii) policymaker commentaries on an expert's input; or iv) dialogue where each participant has the potential to contribute equally to the discussion (with the latter seen as more innovative).
viii. it involves one or more of: i) in-person interactions; ii) on-line synchronous interactions; or iii) on-line but asynchronous interactions (with in-person interactions and on-line synchronous interaction seen as more innovative).
ix. Its wider use is supported by products based on the interactions.
x. By an option to sign-up for an e-mail alert / listserv when new interaction-related products are posted online.

Deliverables for this WP include:
- Interim framework reports:
i. Lavis J. N., Permanand G., BRIDGE study team. Policy summary: Brokering knowledge and research Information to support the development and governance of health systems in Europe (BRIDGE). Brussels, Belgium: European Observatory on Health Systems and Policies, 20 July 2010.
ii. Lavis J. N., Catallo C., BRIDGE study team. Glossary: Brokering knowledge and research Information to support the development and governance of health systems in Europe (BRIDGE). Brussels, Belgium: European Observatory on Health Systems and Policies, 20 July 2010.
- Final framework reports (please see deliverable on WP5).

WP 2 - Knowledge brokering mechanisms

The objective for WP 2 was to to describe and compare EU country experiences with knowledge brokering mechanisms (specifically information packaging and interactive knowledge-sharing mechanisms).

Significant findings included the following:

1. Fewer organisations than originally anticipated met the seven eligibility criteria for inclusion in the scoping study:
1. funds, conducts or disseminates research;
2. focuses at least in part on governance, financial and delivery arrangements within health systems;
3. identifies policymakers as being among its target audiences for their research;
4. functions as a semi-autonomous or autonomous organisation;
5. puts all (or almost all) products in the public domain (whether or not there is a small charge) in order to advance the public interest;
6. adds value beyond the simple collection and collation of data;
7. targets EU or EFTA member states, groupings of these member states or those constituent units that are above the level of municipalities.

2. Eligible knowledge-brokering organisations primarily rely on traditional information-packaging mechanisms that:
a. stem from research projects (i.e. primary research) and not from systematic reviews, meetings with policymakers and other stakeholders or both;
b. focus primarily on a problem or policy objective and less often on options for addressing a problem or achieving a policy objective, implementation considerations or two or more of these domains;
c. were not reviewed before publication by members of its target audience (i.e. not just by researchers);
d. (in some cases) use language that is clearly designed to be accessible;
e. do not follow a graded-entry format with key messages, possibly an executive summary, and a full report;
f. do not highlight decision-relevant information explicitly (e.g. benefits, harms, and costs of options);
g. do not have their wider use supported by online commentaries or briefings about the product provided by representatives of its target audiences; and
h. do not have their wider use supported by an option to sign-up for an e-mail alert/listserv when new products are posted online.

3. Eligible knowledge-brokering organisations primarily rely on traditional interactive knowledge-sharing mechanisms that:
a. do not target other stakeholders who will be involved in or affected by decisions that might be informed by the mechanism;
b. stem from research projects (i.e. primary research) and not from systematic reviews or a collation of research-related products or activities and issues raised by policymakers or both;
c. focus primarily on a problem or policy objective and less often on options for addressing a problem or achieving a policy objective, implementation considerations or two or more of these domains;
d. are not timed to relate explicitly to a policymaking process or to requests from policymakers;
e. do not involve a closed list of invitees, pre-circulation of products or a rule about whether and how comments can be attributed;
f. involve presentations by an 'expert' or questions and answers targeted at an 'expert', and less commonly policymaker commentaries on an expert's input a dialogue where each participant has the potential to contribute equally to the discussion (with the latter seen as more innovative);
g. involve in-person interactions and on-line but asynchronous interactions and less commonly on-line synchronous interactions;
h. do not have their wider use supported by products based on the interactions; and
i. do not have their wider use supported by an option to sign-up for an e-mail alert/listserv when new interaction-related products are posted online.

Deliverables for this WP include the following:
- Initial scoping reports
i. Catallo C., Lavis J. N., BRIDGE study team. A systematic review of the factors that influence the use of health system information in policy making. Brussels, Belgium: European Observatory on Health Systems and Policies, 14 December 2009.
ii. Catallo C., Lavis J. N., BRIDGE study team. Examining knowledge-brokering mechanisms and organisational models in 31 European countries. Brussels, Belgium: European Observatory on Health Systems and Policies, 1 December 2010.
- Data elements underpinning these scoping reports:
i. Lavis J. N.. Data-collection tool 1. Brussels, Belgium: European Observatory on Health Systems and Policies, 9 September 2009.
ii. Lavis J. N. List of country correspondents for phase 1 data collection, by country. Brussels, Belgium: European Observatory on Health Systems and Policies, 5 August 2010.
iii. Lavis J. N. Organisations assessed for eligibility in phase 1. Brussels, Belgium: European Observatory on Health Systems and Policies, 5 August 2010.
iv. Catallo C. Data collected for organisations included in phase 1. Brussels, Belgium: European Observatory on Health Systems and Policies, 5 August 2010.
v. Catallo C. Data tables for organisations included in phase 1. Brussels, Belgium: European Observatory on Health Systems and Policies, 6 November 2010.
vi. Catallo C. Data tables for organisations included in phase 1, by country. Brussels, Belgium: European Observatory on Health Systems and Policies, 6 November 2010.
- Final scoping reports (citations):
i. Catallo C., Lavis J. N. (2011). What past research tells us about knowledge brokering: A systematic review and a scoping review. Chapter 3 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
ii. Catallo C., Lavis J. N., BRIDGE study team (2011). Knowledge-brokering mechanisms and models used in Europe: Website reviews in 31 countries. Chapter 4 in Lavis J. N., Catallo C. (editors) (2011) Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
- Data elements underpinning these scoping reports.

WP 3 - Organisational models for knowledge brokering

The objective for WP 3 in the current reporting period was to describe and compare EU country experiences with organisational models for knowledge brokering (both units with a national and an EU focus).

Significant findings included the following:

Knowledge-brokering organisations rely on a broad range of organisational models that differ in the:
a. role of policymakers in their governance and management (e.g. located within government, director appointed by government, and staff paid by civil service grade; arms-length agency with independent board comprised of policymakers from several Ministries and stakeholders such as insurance funds);
b. size, disciplinary mix, and knowledge translation expertise of staff;
c. size of budget and contributions of national and regional policymaking authorities to the budget (scale);
d. approach to setting its agenda or annual program of work (e.g. 30 % directed by government, 70 % set at the discretion of the director);
e. location within another organisation (e.g. government or university) or network; and
f. use of rapid-response functions, exchange programs, and other efforts to support responsive relations between researchers and policymakers.

Deliverables for this WP include:
- Initial scoping reports:
i. Catallo C., Lavis J. N., BRIDGE study team. A systematic review of the factors that influence the use of health system information in policy making. Brussels, Belgium: European Observatory on Health Systems and Policies, 14 December 2009.
ii. Catallo C., Lavis J. N., BRIDGE study team. Examining knowledge-brokering mechanisms and organisational models in 31 European countries. Brussels, Belgium: European Observatory on Health Systems and Policies, 1 December 2010.
- Data elements underpinning these scoping reports:
i. Lavis J. N.. Data-collection tool 1. Brussels, Belgium: European Observatory on Health Systems and Policies, 9 September 2009.
ii. Lavis J. N. List of country correspondents for phase 1 data collection, by country. Brussels, Belgium: European Observatory on Health Systems and Policies, 5 August 2010.
iii. Lavis J. N. Organisations assessed for eligibility in phase 1. Brussels, Belgium: European Observatory on Health Systems and Policies, 5 August 2010.
- Final scoping reports (citations):
i. Catallo C., Lavis J. N. (2011). What past research tells us about knowledge brokering: A systematic review and a scoping review. Chapter 3 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
ii. Catallo C., Lavis J. N., BRIDGE study team (2011). Knowledge-brokering mechanisms and models used in Europe: Website reviews in 31 countries. Chapter 4 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.

- Data elements underpinning these scoping reports:
i. See appendices B, C, D and E in the book (deliverable 8).

WP 4 - National case studies

The objective for WP4 in the second reporting period was to carry out national case studies describing how approaches to brokering research into policy (through different mechanisms and different organisational models) intersect with and support policy making processes. Initial case study plans were focused down (from 5 to 4) to:
- best reflect on the mix of types of government structures, policy making processes and exposure to and engagement with knowledge brokering mechanisms and models in Europe and to generate learning;
- concentrate resources on a core focused and scientifically relevant case studies, best able to provide findings, insights and examples that feed into the overall research.

The case studies developed included three EU MS and one EFTA country. Following the WP 1 mapping exercise, extensive work was carried out including through country visits and interviews to identify the appropriate projects and teams to be studied and to establish the interactions between context and knowledge brokering. The four case studies Belgium, England (in place of the United Kingdom (UK) and Northern Ireland), Spain, and Norway provided the most interesting and innovative examples of knowledge brokering and lent themselves to single and systematic descriptions / case study of real policy relevance and technical quality. A case study of the Czech Republic was delivered only as an initial review and without further analytic development (because of data / scientific challenges).

Deliverables for this WP include:
- national case studies for Belgium, Norway, Spain, UK / England highlighting promising matches between particular approaches to brokering research and particular types of national policy making processes for comparative study, including notes on breadth and depth. Final case studies (citations):
- Leys M. (2011). Knowledge brokering in Belgium: Feeding the process of collaborative policymaking Chapter 6 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies;
ii. McDaid D. (2011). Knowledge brokering in England: Adding value in crowded landscapes and short policy cycles. Chapter 7 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
iii. Permanand G., Lindahl A. K., Røttingen J.-A. (2011). Knowledge brokering in Norway: Bringing rigour and transparency to policy inputs. Chapter 8 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.

iv. Sakellarides C., Repullo J. R., Wisbaum W. (2011). Knowledge brokering in Spain: Matching brokering mechanisms to policy processes. Chapter 9 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.

- Background material for the case study on Czech Republic, including the full list of organisations screened for inclusion in the data collection (and the complete data collection for the ones considered eligible).
- Final data elements underpinning these case studies. See appendices F and G in the book.

WP 5 - Dissemination

The objective for WP5 in the current reporting period was to disseminate support action project deliverables. The related tasks included developing web pages on the observatory website to profile the project and its deliverables and sharing the approach to the study and the initial frameworks for mapping mechanisms and models (deliverable 1) with those involved in funding, commissioning and undertaking comparative research on the organisation and management of health systems information and other appropriate policy makers and researchers. It also involved dissimination in different settings, including conferences, workshops and the organisations of two policy dialogues.

Deliverables for this WP include:
- BRIDGE policy summaries:
i. Lavis J. N., Catallo C., Permanand G., Zierler A., BRIDGE study team (2011). BRIDGE summary 1 - Communicating clearly: Enhancing information-packaging mechanisms to support knowledge brokering in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
ii. Lavis J. N., Catallo C., Jessani N., Permanand G., Zierler A., BRIDGE study team (2011). BRIDGE summary 2 - Learning from one another: Enriching interactive knowledge-sharing mechanisms to support knowledge brokering in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
iii. Lavis J. N., Jessani N., Permanand G., Catallo C., Zierler A., BRIDGE study team (2011). BRIDGE summary 3 - Matching form to function: Designing organisational models to support knowledge brokering in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
iv. Lavis J. N., Permanand G., Catallo C., Fahy N., BRIDGE study team (2011). BRIDGE policy brief: How can knowledge brokering be better supported across European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
v. Lavis J. N., Permanand G., Catallo C., BRIDGE study team (2011). BRIDGE policy brief: How can knowledge brokering be advanced in a country's health system? Brussels, Belgium: European Observatory on Health Systems and Policies.
- Study poster for the Working Conference Health Services Research in Europe, the Hague, the Netherlands, 8-9 April 2010, BRIDGE: Scoping study of approaches to brokering knowledge and research information to support the development and governance of health systems in Europe
- Study presentations:
i. Presentation for the Working Conference Health Services Research in Europe, the Hague, the Netherlands, 8-9 April 2010, Catallo C., Lavis J. N., Pastorino G., Figueras J., Leys M., McDaid D., Permanand G., Rottingen J.-A. Lessof S. BRIDGE: Scoping study of approaches to brokering knowledge and research information to support the development and governance of health systems in Europe.
ii. Presentation at Ryerson University, Toronto, Canada, 4 June 2010, Catallo C., Lavis J. N., BRIDGE study team. What influences policymakers to use evidence for decisions? A scoping review.
iii. Presentation at First Global Symposium on Health Systems Research, Montreux, Switzerland, 16 November 2010, Figueras J., Lavis J. N. Getting evidence into policy: The European experience.
iv. Presentation at First Global Symposium on Health Systems Research, Montreux, Switzerland, 18 November 2010 Catallo C., Lavis J. N., Pastorino G., Figueras J., Leys M., McDaid D., Permanand G., Rottingen J.-A. Lessof S. BRIDGE: Scoping study of approaches to brokering knowledge and research information to support the development and governance of health systems in Europe: Innovative examples from phase 1 data collection.
- Final framework reports. Citations:
i. Lavis J. N., Permanand G., BRIDGE Study Team (2011). A way to approach knowledge brokering: The BRIDGE framework and criteria. Chapter 2 in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
ii. Lavis J. N., Catallo C. (2011). Glossary. Appendix A in Lavis J. N., Catallo C. (editors) (2011). Bridging the worlds of research and policy in European health systems. Brussels, Belgium: European Observatory on Health Systems and Policies.
- Initial data underpinning these final framework reportsL
i. Lavis J. N., Permanand G. BRIDGE workshop workbook. Brussels, Belgium: European Observatory on Health Systems and Policies, 5-6 July 2010.
ii. Catallo C., Lavis J. N. Deliberations about information-packaging mechanisms. Brussels, Belgium: European Observatory on Health Systems and Policies, 5-6 July 2010.
iii. Catallo C., Lavis J.N. Deliberations about interactive knowledge-sharing mechanisms. Brussels, Belgium: European Observatory on Health Systems and Policies, 5-6 July 2010.
iv. Catallo C., Lavis J. N. Deliberations about organisational models for knowledge brokering. Brussels, Belgium: European Observatory on Health Systems and Policies, 5-6 July 2010.
v. Lavis J. N. Notes from the BRIDGE workshops 1 and 2. Brussels, Belgium: European Observatory on Health Systems and Policies, 5-6 July 2010.

Potential impact:

The potential impacts of effective knowledge brokering are extremely significant although difficult to quantify in that lessons from the project will:
- help increase health system actors' understanding of knowledge brokering and what it implies for the re-organisation and better management of health information systems, creating an impetus for the development of those systems with far reaching consequences;
- set out how to broker knowledge better and in ways that are genuinely mindful of context which will in turn promote the uptake of health systems information and evidence thus supporting the development and governance of European health systems;
- ultimately, optimise the delivery of health care to European citizens with all this implies for the health and wealth of European society.

These are undeniably broad statements that touch on a range of issues with far reaching socio-economic and wider societal implications. There is however, ample evidence:
- on the direct costs of poor decision making, for example in the case of investing in hospitals that no longer reflect population health needs and modalities of care; or in information technology (IT) systems that are not able to manage patient records; or in screening or curative interventions that do not provide the health benefits claimed for them;
- on the employment costs of choosing a pursuing a given configuration of services or a training option;
- on the social costs of a population suffering preventable disease or inherent in managing or mismanaging chronic disability;
- on the transaction costs of different stakeholders working at cross purposes and with different understandings of what evidence is available and what it might mean in context;
- on the opportunity costs involved in getting all or any of the above decisions wrong because of a failure to translate what is known into a useable and relevant format that will support better choices.

Clearly policy makers are working within culturally and politically bounded spaces and will make policy that reflects the contextual and ideological settings in which they operate. There is notwithstanding, an enormous amount that information and evidence can do in terms of improving health systems decisions in any given context, provided that the knowledge is brokered effectively. This project outlines what knowledge brokering mechanisms work better or worse and the factors that explain the successes and the blocks to brokering. It outlines how to help information and evidence influence decisions and its potential impact is therefore substantial.

Dissemination:

The observatory uses a mixed rage of media and tools to disseminate its work and will apply them to engage with policy makers and promote the uptake of BRIDGE results. Specific dissemination products include:
- two policy briefs on knowledge brokering at national and European level;
- three BRIDGE summaries on: information-packaging mechanisms for knowledge brokering; interactive knowledge-sharing mechanisms for knowledge brokering; and organisational models for knowledge brokering;
- a book with chapters that will be open access and unpack the detail of the research;
- articles both in peer reviewed journals and in outlets that focus on policy makers including the Eurohealth-Euro Observer of the observatory;
- presentations.

The findings of BRIDGE are already influencing the wider work of the observatory which is developing and will disseminate clear products outlining how it brokers knowledge that will make practical lessons more accessible and facilitate review and evaluation.

List of websites: http://www.euro.who.int/en/home/projects/observatory/activities/research-studies-and-projects/knowledge-brokering-for-health-policy-making-bridge-project