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Scientific integrity was a prominent issue in the Canadian federal election of 2015, with incumbent Conservative Party prime minister Stephen Harper being increasingly criticised for appearing to dismiss evidence that did not support his agenda. In the lead-up to the election, Liberal Party leader Justin Trudeau focused on this issue, committing to a number of actions to strengthen evidence-based decision making in Canada. Many believe this played a role in his successful election as prime minister.
Of course, Canada’s federal government is not the only, or even the ultimate, authority on evidence production and use within Canada. Provincial, territorial and municipal governments, as well as individual public sector organisations, also hold various policy- and decision-making powers. However, it is the case that the value placed on evidence by the highest level of government – and the ways in which that value is enacted, for example, through funding – is without doubt influential, and it provides an important context for this chapter.
Although evidence – the available body of information indicating whether a proposition is valid – is produced and used in many sectors, in this chapter we draw on our experiences as a clinician/researcher (Straus) and a researcher/funder (Holmes) to focus primarily on Canada’s healthcare system. Under this system, which serves a culturally diverse population of 36 million people across a largely rural and remote landscape (apart from a few major cities), all Canadian residents have access to medically necessary services without charge.
Federally, the government sets national standards for the healthcare system and supports healthcare for specific groups (for example, indigenous populations, serving members of the Canadian Forces, inmates of federal penitentiaries and some refugee claimants).
The way we think about how research, policy and practice inform and interact with each other shapes our efforts to improve health and social outcomes. In this paper we describe linear, relationship and systems models with regard to how they approach bridging evidence and policy/practice, or turning knowledge into action. We contribute to the knowledge to action (KTA) systems thinking discussion by highlighting four interconnected aspects of this model we believe merit exploration: evidence and knowledge, leadership, networks and communications. We conclude with the challenge of developing measurement methods for systems research to better understand the KTA process.
Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.
