We do not know enough about the reasons why some organisations are better than others at using evidence to make decisions. Attention has shifted in recent years from a focus on how individuals seek and use information, to how organisations draw on evidence and what support they need to do this well.
The capability of organisations to use evidence is known as ‘absorptive capacity’. This concept of the readiness of organisations to use research was developed outside health, linked to concepts of learning organisations (Davies 2000). A study by Jacqueline Swan published in 2017 used comparative case studies in eight locations to look at how commissioners use NICE and other evidence to redesign services.
An important finding was that the capabilities needed by organisations to make sense of evidence were not just technical (in reviewing research). The ability to engage experts and know how to frame and interpret findings which would resonate with target audiences, were also required.
Another study, not yet published, is looking at the absorptive capacity or critical use of evidence in six commissioning networks, with a focus on decisions about keeping people safely out of hospital. It includes the evaluation of a tool for commissioners to assess and improve their own ability to make appropriate use of evidence in everyday decisions.
Some have argued that organisations, particularly those commissioning services and making substantive investment decisions, need specific support to find and package relevant evidence.
One study by Paul Wilson evaluated different forms of support for commissioners. Nine organisations tested options, from a full briefing service on demand through to an unsolicited push of non-tailored evidence, with an intermediary level of service with some contact.
Although the follow-up response was low, findings published in 2017 suggested that access to a demand-led evidence briefing service did not improve the uptake and use of research evidence by commissioners, compared to less intensive alternatives.
The authors concluded that managers were well intentioned but inconsistent users of evidence. The informal nature of much decision-making also made it hard to track how evidence was being used.
A number of studies have emphasised the importance of having experts with credibility to interpret and make sense of evidence 'in the room' when decisions are made. Studies note the role of public health staff as trusted critical friends and intermediaries in this capacity. Public health staff were seen as able to combine local intelligence (data and knowledge of services and populations) with 'harder' evidence to inform commissioning and other decisions. This appeared to be true even under new arrangements with relocation of public health function to local authorities.
Many of these studies emphasise that timing is key. Good enough information at the right time trumps high quality evidence which arrives too late for decision makers to use.