Evidence-based policy-making and the ‘art of commissioning’ – how English healthcare commissioners access, use and transform information and academic research in ‘real life’ decision-making: An empirical qualitative study

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The problem

Commissioners are encouraged to adopt evidence-based policy-making, with evidence often defined as academic research. To learn how academic research can contribute, researchers need to know more about commissioning, the ways that commissioners access and use information, and the role of research in decision-making.

The approach

This study focused on knowledge exchange between commissioners and those that supply commissioners with information (i.e. private management consultancies, public health, commissioning support units). Using eight case studies, we thematically coded, summarised and compared data, including 92 interviews, observations of 24 training events and meetings, and documentation (e.g. meeting minutes).


The ‘art of commissioning’ entails juggling competing priorities, power relationships, and personal inclinations to build a persuasive, cohesive case. Commissioners pragmatically sought information from many sources to identify options, navigate a way through, justify decisions and convince others. Local evaluations were more useful than academic research. Negative research findings did not inform disinvestment plans. Information was exchanged through conversations and stories, which were fast and flexible.Knowledge acquisition and its transformation were interwoven. The five main conduits through which knowledge flowed were:· interpersonal relationships· people placement (i.e. embedded staff)· governance· ‘copy, adapt, paste’· product deployment (e.g. software tools).Commissioners used the processes of local contextualisation and engagement to refine the knowledge and ensure the right people were on board.


To make a useful contribution to commissioners’ decision-making, researchers should develop relationships of mutual benefit with commissioners by using commissioners’ preferred mode of verbal communication and offering researchers’ input into co-produced local evaluations.


  • Lesley Wye, University of Southampton, Southampton, UK
  • Emer Brangan, University of Southampton, Southampton, UK
  • Ailsa Cameron, University of Southampton, Southampton, UK
  • Jonathan Klein
  • John Gabbay
  • Catherine Pope