Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011-14
WYE Lesley, et al
The aim of this study was to explore how commissioners obtained, modified and used information to inform their decisions, focusing in particular in the knowledge obtained from external organisations such as management consultancies, Public Health and commissioning support units. In eight case studies, researchers interviewed 92 external consultants and their clients, observed 25 meetings and training sessions, and analysed documents such as meeting minutes and reports. Data were analysed within each case study and then across all case studies. Commissioners used many types of information from multiple sources to try to build a cohesive, persuasive case. They obtained information through five channels: interpersonal relationships people placement (e.g. embedding external staff within client teams); governance (e.g. national directives); copy, adapt and paste (e.g. best practice guidance); and product deployment (e.g. software tools). Furthermore, commissioners constantly interpreted (and reinterpreted) the knowledge to fit local circumstances (contextualisation) and involved others in this refinement process (engagement). External organisations that drew on these multiple channels and facilitated contextualisation and engagement were more likely to meet clients’ expectations. Sometimes there was little impact on commissioning decisions because the work of external organisations targeted and benefited the commissioning decision-makers less than the health-care analysts. The long-standing split between health-care analysts and commissioners sometimes limited the impact of external organisations. The paper concludes that to capitalise on the expertise of external providers, wherever possible, contracts should include explicit skills development and knowledge transfer components.