Table 4 KTE strategies with policymakers based on a political economy approach

Collective impact: a collaborative, multi-sectoral approach to achieving policy change, with five characteristics: “a common agenda; shared measurement systems, mutually reinforcing activities, continuous communication, and the presence of a backbone organization” [21]

Reductions in a wide range of health-related outcomes, e.g. obesity, substance use, nutritional deficiencies [18–21]

While“evidence of the effectiveness of this approach is still limited” [21], there are now multiple large case studies suggesting that multi-sectoral collective impact approaches can have a larger effect than working in isolation [18–21]

Learning collaboratives: these bring policymakers together in an ongoing way to share knowledge about how to improve a specific health outcome. Common characteristics of learning collaboratives are:

 • An explicit mission

 • Routine learning activities (e.g. continuous learning groups)

 • Relationship-building (e.g. through social networking)

Modest benefits in improving quality of care

A systematic review identified 9 studies using a controlled design (two were RCTs); these measured the effects of collaboratives on care processes or care outcomes. The evidence for quality improvement was “positive but limited and the effects cannot be predicted with great certainty” [24]. Other case studies have suggested positive outcomes [22, 23].