TRIPP: ENLIGHTENING THE ACCIDENTAL TRIPP: ENLIGHTENING THE ACCIDENTAL TOURISTTOURIST

Sandi Isaacson, DirectorDivision of User Liaison and Research TranslationU.S. Agency for Healthcare Research and Quality

September 26, 2003

Travelers’ QuotesTravelers’ Quotes

I thought my job was over once I submitted my analysis and report.

Policymakers work in a fact free environment.

Major Changes UnderwayMajor Changes Underway

Current MissionCurrent Mission– To support researchTo support research designed to improve the designed to improve the

outcomes and quality of health care, reduce its costs, outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and address patient safety and medical errors, and broaden access to effective services. broaden access to effective services.

Proposed MissionProposed Mission– To improve the quality, safety, efficiency, and To improve the quality, safety, efficiency, and

effectiveness of health care for all Americans. effectiveness of health care for all Americans.

User Liaison Program (ULP)User Liaison Program (ULP)

Disseminates health services research findings for State and local health policymakers in easily understandable and usable formats through interactive onsite workshops, teleconferences, distance learning programs, and research syntheses.

Serves as a bridge between State and local health policymakers and the health services research community, by bringing back to the Agency the research questions being asked by key policymakers.

ULP Guiding PrinciplesULP Guiding Principles

User drivenUser driven Objective and politically balancedObjective and politically balanced Syntheses: “Translated” story telling and skill Syntheses: “Translated” story telling and skill

buildingbuilding Networking and relationships—cultivate a communityNetworking and relationships—cultivate a community Safe environmentSafe environment

2001 ULP Evaluation Findings2001 ULP Evaluation Findings

Timeliness and relevance of topics affects Timeliness and relevance of topics affects attendance.attendance.

Majority of those surveyed use the Majority of those surveyed use the information.information.

Participants would like follow up activities.Participants would like follow up activities.

Abt Associates, 2001

Detailed Rather than Broad Detailed Rather than Broad Information is PreferredInformation is Preferred

0

2

4

6

8

10

12

Broad Detailed Both Depends

Executives

Legislators

Executive staff N=27Legislators N=9

Notebooks Viewed as Good Notebooks Viewed as Good ResourceResource

0

10

20

30

40

Used Shared

Executives

Legislators

Executives N=35Legislators N=15

It WorksIt Works

Executive BranchN=35

LegislatorsN=15

Had a direct application to their work

12 6

Added to knowledge base on health matters

13 5

Both direct application and increasedknowledge base

6 1

Did not use the information 4 3

Information Used in Many WaysInformation Used in Many Ways

Introduced legislationIntroduced legislation Developed legislative recommendationsDeveloped legislative recommendations Briefed colleaguesBriefed colleagues Planned servicesPlanned services Evaluated State problemsEvaluated State problems

““6 Touch Program”6 Touch Program”

Used information in presentation to Governor Used information in presentation to Governor encouraging him to announce a “Childrens encouraging him to announce a “Childrens Cabinet”Cabinet”

Educated legislator leading to their approving Educated legislator leading to their approving 3 new drug classes. 3 new drug classes.

State-specific SeminarsState-specific Seminars

Evaluation of State-specific Medical Error Evaluation of State-specific Medical Error and Patient Safety Seminarsand Patient Safety Seminars

Research Triangle Institute, 2001Research Triangle Institute, 2001

States StudiedStates Studied

In PersonIn Person– New YorkNew York– UtahUtah

Telephone InterviewsTelephone Interviews– MinnesotaMinnesota– GeorgiaGeorgia– WisconsinWisconsin

Logic & purposive sampling guided state selection including:Geographic dispersion, meeting size, pre-existing infrastructure, medical error reporting system, etc.

Intermediate Outcomes: Events Intermediate Outcomes: Events Following AHRQ-Sponsored SeminarFollowing AHRQ-Sponsored Seminar

StateState

Expand Expand Involved Involved Stake-Stake-

holdersholders

Error/Error/Safety Safety

Reports Reports DisseminatDisseminat

eded

Work/Work/User User

Groups Groups CreatedCreated

Safety Safety Research Research FundingFunding

Reporting Reporting System System Imple-Imple-

mentedmented

Leap-Leap-frogfrog

Web Web Site Site

CreatedCreated

Subse-Subse-quent quent

Statewide Statewide MeetingMeeting

GAGA xx xx xx

MNMN xx xx xx xx

NYNY xx xx

UTUT xx xx xx xx xx xx

WIWI xx xx xx

Perceived Role of AHRQ-Sponsored Perceived Role of AHRQ-Sponsored Seminars: Stepping StonesSeminars: Stepping Stones

Relationship building: bringing key stakeholders together

Education: learning what others are doing Unifying forum: examining intra-State activities Focus: keeping a focus on error reduction and

enhanced safety

RecommendationsRecommendations

Match state’s stage of evolution on a topic (i.e., Match state’s stage of evolution on a topic (i.e., patient safety) with agency’s intended purpose.patient safety) with agency’s intended purpose.

Continue with tailored approach: there is no one-Continue with tailored approach: there is no one-size fits all mentality.size fits all mentality.

Task states to include action items/next steps as Task states to include action items/next steps as part of seminars whenever possible to directly part of seminars whenever possible to directly assess success.assess success.

Knowledge Transfer ContractKnowledge Transfer Contract

The New ULPThe New ULP– Explicitly based on knowledge Explicitly based on knowledge

transfer/utilization/integration conceptstransfer/utilization/integration concepts– Building on strategies, partnerships, and Building on strategies, partnerships, and

communities of practicecommunities of practice– Skill building, tools, and technical assistance Skill building, tools, and technical assistance

stressedstressed– Expanded AudienceExpanded Audience

"What we really want to get at is not how many "What we really want to get at is not how many reports have been done, but how many people's lives reports have been done, but how many people's lives are being bettered by what has been accomplished. are being bettered by what has been accomplished. In other words, is it being used, is it being followed, is In other words, is it being used, is it being followed, is it actually being given to patients?…it actually being given to patients?…

[W]hat effect is it having on people?”[W]hat effect is it having on people?”Congressman John Porter, 1998Congressman John Porter, 1998

Chairman, House Appropriations Subcommittee on Labor, HHS, Chairman, House Appropriations Subcommittee on Labor, HHS, and Educationand Education

AHRQ’s Challenge

AHRQ DirectorAHRQ Director

Disturbing delays and embarrassing failures existin translating research into practice.

Dr. Carolyn Clancy, July 22, 2003

Giving Translation ProminenceGiving Translation Prominence

Increase partnerships and intermediary Increase partnerships and intermediary relationships.relationships.

Create syntheses/storiesCreate syntheses/stories Change the rules of researchChange the rules of research Impress upon others the importance of translating Impress upon others the importance of translating

evidence into practice and policyevidence into practice and policy

Strategies for Technology BrokeringStrategies for Technology Brokering

Seize one-time opportunitiesSeize one-time opportunities Remain focused on existing markets and Remain focused on existing markets and

customers, but create smaller groups internally customers, but create smaller groups internally that are focused on building innovations, orthat are focused on building innovations, or

Commit the entire organization.Commit the entire organization.

How Breakthroughs Happen: The Surprising Truth About How Companies Innovate, Andrew Hargadon, Kathleen M. Eisenhardt, Harvard Business School Press, 2003

What is the Next Stop?What is the Next Stop?

Developing new internal systemsDeveloping new internal systems Educating knowledge brokersEducating knowledge brokers Adventure travel instead of accidental tourist: Adventure travel instead of accidental tourist:

exploring promising new roads exploring promising new roads