Background
Methods
Context for this study
Framework underpinning the workbook
Study approach
Sampling and recruitment
Data collection
Data analysis
Results
Participants
Documents
Process
Critical factors affecting the development of the workbook
Themes | Subthemes | Descriptions of themes and subthemes |
---|---|---|
Having well-placed and credible champions | - People promoting ideas (Ideas) - People devoting their time/resources to completing the work (Work) | Champions were people who helped move ideas forward and/or who devoted their time and other resources to complete the work. Without their commitment and persistence, the work may not have occurred. Champions could have different levels of involvement, and someone who is a champion at one stage of the process may not be a champion at another. |
Creating and capitalising on opportunities | - Creating opportunities (Creating) - Capitalising on opportunities (Capitalising) - Missed opportunities (Missed) - Potential opportunities (Potential) | The champion(s) either sought out or created opportunities to move the work forward, or other actors presented opportunities to the champion(s) who then capitalised on these opportunities. There were times when the work could have moved forward, but it did not, resulting in missed opportunities. Lastly, there are potential opportunities that could be capitalised upon to move the work even further in the future. |
Finding the right language to engage various actors and obtain buy-in | - Building understanding by using common terminology (Building understanding) - Using persuasive language to ‘sell’ an idea (Persuading) - Following standards (e.g. use of scientific language, page length for publishing) (Standardising) | The champion(s) used persuasive language to gain buy-in from those who were involved in and could have created barriers in the process. However, a more subtle way to help obtain buy-in was to first build a shared understanding of the concepts or issues by using common terminology that resonated with the target audience. This level of shared understanding was seen as especially useful for trying to communicate the relevance of or how to apply the work. Following standards for language could be a facilitator when working with specific audiences, such as WHO’s Guideline Review Committee, which requires specific formatting and the use of academic language, but this can be a barrier to other audiences, such as policy-makers, who may not be familiar with scientific or academic language. Poor communication could act as a barrier. |
Obtaining and maintaining meaningful buy-in | - Obtaining buy-in (Obtaining) - Maintaining buy-in for the current work (Maintaining) - Institutionalising the process or work (Institutionalising) | First, one needed to obtain buy-in and then buy-in needed to be maintained. Institutionalisation can be seen as a type of ‘permanent buy-in’ by an institution. Unless a process is institutionalised, a change in leadership could result in previous buy-in being lost. Therefore, either continuous communication with new leadership is required to secure meaningful buy-in from new leadership, or institutionalising a process by one group or leader could bypass the future need to obtain buy-in. The difficult part can be knowing if there is meaningful buy-in or if the buy-in is for a secondary purpose (e.g. advancing other work). This could manifest itself as appearing to have meaningful buy-in at one stage of the process but not having buy-in at another. However, ascertaining this level of information could require immense transparency on the part of the actors involved as it seems it would be unlikely for people to be open about secondary motives. Also, this problem could be difficult to distinguish from a separate problem of lacking resources (e.g. buy-in from one group of people may not secure resources from other groups of people). |
Ensuring access to human, financial and other resources | - (Human resources) - (Motivation) - (Knowledge) - (Finances) - (Time) - (Technology) | Resources were used in carrying out the work and included human resources, finances, time, motivation, knowledge and technology. Without these resources, the work was likely to be abandoned. Human resources include the people involved in doing the work. Further attributes of these individuals, which arose from the data, include motivation and knowledge. Motivation to work on a particular topic is necessary when there are competing demands on an individual or on an agency. This can be seen as prioritising specific work. Knowledge can come from existing knowledge of the individuals involved in the work or can be found through searches for information. So, this attribute can be intrinsic (e.g. expertise) or extrinsic (e.g. library resources). Finances include salaries or payments for those carrying out the work, funding for traveling and funding to secure supplies. Time is required for individuals to do the work, and individuals and agencies have timelines for getting the work done. Technology can also support or be a barrier in advancing the work. |
Having well-placed and credible champions
“…so I think my role was more kind of being the person pushing for this to be brought about, identifying the opportunity for [the person taking on this work as participant-observer], and then after that I moved into much more of a supporting role.” (001, Health systems and policy analyst)
“It took [the head of the Secretariat of the WHO guidance panel on task shifting] a lot of work in the background in the WHO to try and bring everyone on board [to using innovations in the guidance development process].” (002, Member of Secretariat of WHO guidance panel on task shifting)
Creating and capitalising on opportunities
“We knew that the recommendations from the guidance were going to be directed to policy-makers and that is why we involved [the health systems policy expert] in the panel.” (003, Member of Secretariat of WHO guidance panel on task shifting)
Finding the right language to engage various actors and obtain buy-in
“...he [the head of the Secretariat of the WHO guidance panel on task shifting] gave me the opportunity to pitch the idea to the committee members, which I did in the form of a brief presentation and they seemed to be quite excited about the idea. And I also, because in sharing the meeting…after two days, I was able to insert a bunch of examples that had come back, come directly from them, that were the type of things that a good workbook would flag for people.” (001, Health systems and policy analyst)
“I think one of the criticisms we have had of the Optimize guidelines is that it feels, some people have said it feels very academic. You have done quite a good job of pulling together all those current literatures all methodologically sound and all that, but you know it is quite difficult to digest as a user in the field. I can see where they are coming from because we’re – we are researchers and we’re also trying to adhere to these WHO standards which require sort of – kind of requirements of certain kinds of language and so on. I think that is probably true of all the evidence coming out of this project, that’s how we kind of make those things more accessible.” (002, Member of Secretariat of WHO guidance panel on task shifting)
Obtaining and maintaining meaningful buy-in
“It is not the member state, it’s not WHO, it’s not the NGOs [non-governmental organisations], it takes many to tango. It’s more like carnival, it’s not like a tango. But it’s different at the same time because if you want to overcome those obstacles that exist, this petty politics and things like this, you really have to… persevere, it requires lots of perseverance. You have to talk all the time, you have to go to the right people all the time, you have to convince a higher up, a senior person, and then this person gets distracted and you have to go back and press, and you have to ask your friends to call this person. It’s relentless.” (007, Staff of WHO not part of Secretariat of guidance panel on task shifting)
“My sense is that the panel which had more health systems and policy people on it, was very very supportive… but from the WHO staff people we continued to have this problem that if they come from clinical epidemiology backgrounds, their sense is their usual way of doing by and large can be aloofness, but they recognise that they sometimes still need to have people like me in the room to make it look like they are doing things differently, but I am not convinced at the end of the day that they are committed to doing things differently.” (001, Health systems and policy analyst)
Ensuring access to resources
“So right now, you know, everyone puts all the effort into the front end and then the guidance is there and there is no energy or money to see it implemented….we really need to re-think how we develop critical paths for developing guidance and the guidance development process ends relatively early in that timeline and then we have lots of time and resources left to do all this other stuff. Otherwise the whole exercise is for naught.” (001, Health systems and policy analyst)