The EEiC materials and resources housed on this website have their origins in a detailed, two-year research study funded by NIHR Health Services & Delivery Research programme.
The context and methods for that project are described below. The abstract and full project report can be found here.
There are significant gaps between the generation of research evidence and its application to healthcare design and delivery. Furthermore, progress towards key policy objectives, such as reducing inequalities in health, is hampered, at least in part, by a failure to translate relevant knowledge into practice.
Recent years have seen a growing volume of studies exploring the barriers and enablers to such ‘knowledge translation’, but there remain important gaps in our understanding about which strategies work to encourage greater and more appropriate use of research evidence. Understanding of these processes within the policy context is particularly weak. The Evidence and Ethnicity in Commissioning research project responded to this gap by exploring the healthcare commissioning cycle; an increasingly powerful determinant of the health services on offer and the care that patients receive. We explicitly focused on the use of evidence relating to ethnic diversity and inequality since this is an area that has so far been overlooked and one that raises particular challenges in terms of accessing, appraising and applying evidence.
Goal and aims
The study’s goal was to support the commissioning of health services that better meet the needs of black and minority ethnic people and thereby help reduce ethnic inequalities in healthcare access, experiences and health outcomes. The specific aims were:
- To describe, across a range of commissioning contexts, how managers seek out, appraise and apply evidence relating to ethnic diversity and inequality alongside other forms of knowledge.
- To identify factors that support or inhibit the critical and effective use of evidence within the commissioning cycle and thereby identify promising routes of intervention.
University researchers and NHS managers worked together across the life of the project to identify research questions, generate data, complete analysis and share findings with stakeholders.
In-depth semi-structured interviews were conducted with 19 national Key Informants. Detailed case studies of real world commissioning work were undertaken focused on three Primary Care Trusts and their partner organisations. Case studies involved over 70 interviews with key strategic and operational actors, extensive observational work and detailed analysis of related documentation. A series of good practice examples from around the country were also documented. Findings across all elements of the study were integrated and drawn on to develop a suite of draft tools and resources aimed at supporting evidence use by commissioners and other stakeholders. Three national workshops were held to test transferability of the findings and utility of the draft tools to a wider set of commissioning contexts.
Brief findings & conclusions
Commissioners often lack clarity on how to access, appraise, weight or synthesise diverse sources of evidence. A narrow understanding of the commissioners’ role can limit the extent to which transformational shaping of health services is achieved. Attention to evidence on ethnic diversity and inequality is frequently omitted at both national and local levels. There is limited understanding of why it is important to consider evidence on ethnic diversity and inequality within commissioning processes. Gaps in this evidence create further barriers to its use within the commissioning cycle.
Commissioning models provide no reward or sanction for inclusion or omission of evidence on ethnicity and commissioning teams or partners are not representative of minority ethnic populations. Neglect of this dimension within national drivers results in low demand for evidence. This organisational context can promote risk-averse attitudes that maintain the status quo. Pockets of good practice exist but are largely dependent upon individual expertise and commitment and are often not shared.
Study findings suggested the need for action at three levels: creating an enabling environment; equipping healthcare commissioners; and empowering wider stakeholders. There is a need for specific guidance alongside incentives and resources to support commissioning for a multi-ethnic population. Key enabling factors would be: attention to ethnicity within policy drivers; senior level commitment and resource; a diverse workforce; collaborative partnerships with relevant stakeholders; and the creation of local, regional and national infrastructure. Most importantly, greater political will is needed to promote practice that focuses on reducing ethnic health inequalities at all stages of the commissioning cycle.