Neil Powe – författare

In response to a growing national awareness that the development and use of new diagnostic, therapeutic, and preventive interventions had been occurring at a quickening pace—one far outstripping the evidence necessary to make informed decisions about their comparative advantage—the Patient-Centered Outcomes Research Institute (PCORI) was established in 2010 as part of the Affordable Care Act legislation. PCORI is guided by the imperative to help patients, families, clinicians, and other health care stakeholders make better informed health care decisions and improve care and outcomes. To inform the next steps in its organizational strategy, PCORI enlisted the National Academy of Medicine (NAM) to leverage its deep experience in convening experts on matters of significant national importance, including its long-standing thought leadership role in the realization of a learning health system. The NAM formed a multi-stakeholder workgroup and held two virtual convenings with the objective of engaging with patients, clinicians, health system leaders, researchers, and other stakeholders from the broader health community to identify and discuss high-priority emerging issues in health, health care, and biomedical science and technology. The key messages from these meetings are outlined in the Special Publication Priorities on the Health Horizon: Informing PCORI''s Strategic Plan.

Given the breadth of the domains considered in the Priorities on the Health Horizon meetings—emerging technologies, social and environmental factors, optimizing value, and infrastructure—a formidable set of pressing health and health care research needs were reviewed and discussed. In addition, certain fundamental strategic priorities emerged as basic and critical to progress in the field: (1) the need to reorient research perspectives and activities to patient and family priorities and values, and in particular, those conditions that drive inequities; (2) the need to foster strategic learning partnerships across groups, organizations, and sectors; and (3) the need to build the continuous learning infrastructure to produce new insights at the pace and scale necessary for health and health care improvement.

Moving forward, building the capacity to continuously improve learning and sharing throughout the system will entail stakeholders working together as seamlessly as possible. The NAM and PCORI worked together to facilitate an expansive dialogue with key stakeholders and engender trust through a focus on shared commitments to progress on improving health for all Americans in the decade ahead.

Change is inevitable in all communities: they both grow and decline. Planning is a means by which we have sought to manage this change. It has not always succeeded in providing the types of settlements and environments which many residents and others want, either because it is operating with the wrong policies or because it is failing to ensure that the right policies are effectively implemented. These failings have opened planning to criticism by a dominant neoliberal orthodoxy which shapes an increasingly difficult environment in which planning has to operate.

Planning for Small Town Change builds on an underexploited selection of international research and the authors’ English case studies to consider the efficacy of planning for change. Drawing on insightful small town experiences, three themes emerge: understanding and conceptualising change; appreciating the potential within place; and the mechanisms for planning and delivery. The research draws on many examples of how key actors have made a significant difference to specific places and provides important insights into how the planning process can be better matched to the long-term and complex challenges faced. Whilst small town experiences are often neglected, they are found to be particularly insightful in understanding the potential roles of local communities and the importance of place quality when planning for change.