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Balancing Relevance and Excellence: Organizational Responses to Link Research with Decision Making
Abstract
Research faces the challenge of balancing relevance to decision making and excellence in the strict adherence to the norms of scientific inquiry. This paper examines the organizational responses that can be undertaken to promote integration of these potentially conflicting goals. We posit that there seem to be structural barriers to effective communication between researchers and decision makers, such as differences in priorities, time management, language, means of communication, integration of findings and definition of the final product of research. These barriers must be overcome through solutions aimed at the organization of research. In this respect, there are three possible models to approach the tension between excellence and relevance: academic subordination, segregation and integration. Only the latter makes it possible to reconcile the advantages of proximity to decision making with the procedures to assure academic quality. In addition to organizational design and institutional development, a strategy to promote research must include a set of incentives to prevent the 'internal brain drain', that is, the tendency of researchers to move to managerial positions. There are four guiding principles to address this problem: parallel careers, academic autonomy, administrative sacrifice and inverted incentives. The complexities of health problems demand that we create new organizational formulas to finally balance relevance and excellence in research.
... However, differences in perspectives and priorities regarding the relative merits of alternative research questions and the timeline by which to answer these questions can introduce unique challenges and tensions. For example, researchers are rewarded for increasing generalizable knowledge in the scientific literature, which may take years to produce, while program leaders must focus on solving more specific problems and addressing more immediate organizational needs [5]. Research typically follows a slower timeline, whereas program changes may occur more rapidly and/or in real-time. ...
... This tension is exacerbated by research funding being more available for traditional clinical trials that focus on testing interventions in relatively controlled circumstances rather than assessing effectiveness and implementation approaches in less controlled real-world settings [6][7][8][9]. Frenk (1992) and others have described this tension as navigating tradeoffs between scientific excellence (contributing to internal validity) versus being relevant, responsive, and timely (contributing to external validity) [4,5,[10][11][12][13]. It can take an average of 17 years to translate clinical trial findings broadly into practice [14] and the challenges and delays are even greater for psychosocial treatments (e.g., behavioral interventions related to weight management) [15]. ...
... This tension is exacerbated by research funding being more available for traditional clinical trials that focus on testing interventions in relatively controlled circumstances rather than assessing effectiveness and implementation approaches in less controlled real-world settings [6][7][8][9]. Frenk (1992) and others have described this tension as navigating tradeoffs between scientific excellence (contributing to internal validity) versus being relevant, responsive, and timely (contributing to external validity) [4,5,[10][11][12][13]. It can take an average of 17 years to translate clinical trial findings broadly into practice [14] and the challenges and delays are even greater for psychosocial treatments (e.g., behavioral interventions related to weight management) [15]. ...
Background
Obesity and obesity-related conditions, such as type 2 diabetes, are a major issue for Veteran health. Veterans Health Administration (VA) researchers and health systems leaders have worked separately and together to provide more effective weight management programs for Veterans. Although randomized clinical trials are often considered the gold standard for establishing efficacy of interventions in controlled circumstances, pragmatic clinical trials (PCTs) provide agility for translation. Main textVA researchers and health system leaders collaboratively designed a PCT to compare the Diabetes Prevention Program (VA-DPP) to usual care (MOVE!?) in promoting weight loss and glycemic control among overweight/obese Veterans with prediabetes. Together, they navigated the tensions that exist between quality improvement and research activities, facing challenges but reaping significant rewards. Early findings led to updated national guidance for delivering obesity treatment in VA. Short conclusionPartnered research and the use of PCTs can be powerful strategies for accelerating evidence-based findings into practice. Collaborative partnerships between researchers and health systems leaders can help enhance and sustain translation in real-world settings.
... This study will facilitate the coordination of health research, thus improving the dissemination of health research information locally. Frenk (1992Frenk ( :1399 points out that the inadequate use of research findings in decision making leads to reduced support for research. This, in turn, generates low scientific production which completes the vicious cycle. ...
... These issues also need to be considered when the health research policy framework is developed. Frenk (1992Frenk ( :1397Frenk ( -1404 proposes five sources of potential conflict between researchers and decision makers which are described in Table 2. ...
... -Greater weight placed on relevance in evaluation of researchers. The focus here will be on the potential problems between researchers and decision makers as proposed by Frenk (1992Frenk ( :1397Frenk ( -1404 All the three key stakeholders, namely, councillors, management and researchers need to be aware of these potential problems so that they can either prevent or manage them. Sauerborn et al (1999:827-835) propose the following five strategies, and it is hoped that through such strategies the potential problems, as highlighted by Frenk (1992Frenk ( :1397Frenk ( -1404, can be alleviated. ...
... Such coproduced knowledge demands a broad acceptance of what counts as evidence. 33,101,102 However, as noted earlier, this interpretation fails to fit with the idea of legitimate research evidence in evidence-based medicine. 102 A fuller discussion of linear and interactive models can be found elsewhere. ...
... 33,101,102 However, as noted earlier, this interpretation fails to fit with the idea of legitimate research evidence in evidence-based medicine. 102 A fuller discussion of linear and interactive models can be found elsewhere. 66 To address the commissioning brief, in this report we have adopted the term 'KIT' and we describe those supporting this activity as 'KIT agents'. ...
Background
Knowledge and innovation transfer (KIT) is recognised internationally as a complex, dynamic process that is difficult to embed in organisations. There is growing use of health service–academic–industry collaborations in the UK, with knowledge brokers linking producers with the users of knowledge and innovation.
Aim
Focusing on KIT ‘agent’ roles within Academic Health Science Networks in England and Partnerships in Wales, we show how individual dispositions, processes and content contribute to desired outcomes.
Methods
We studied the KIT intentions of all Academic Health Science Networks in England, and the South East Wales Academic Health Science Partnership. Using a qualitative case study design, we studied the work of 13 KIT agents purposively sampled from five networks, by collecting data from observation of meetings, documentation, KIT agent audio-diaries, and semistructured interviews with KIT agents, their line managers and those they supported (‘Links’). We also used a consensus method in a meeting of experts (nominal group technique) to discuss the measurement of outcomes of KIT agent activity.
Findings
The case study KIT agents were predominantly from a clinical background with differing levels of experience and expertise, with the shared aim of improving services and patient care. Although outside of recognised career structures, the flexibility afforded to KIT agents to define their role was an enabler of success. Other helpful factors included (1) time and resources to devote to KIT activity; (2) line manager support and a team to assist in the work; and (3) access and the means to use data for improvement projects. The organisational and political context could be challenging. KIT agents not only tackled local barriers such as siloed working, but also navigated shifting regional and national policies. Board-level support for knowledge mobilisation together with a culture of reflection (listening to front-line staff), openness to challenges and receptivity to research all enabled KIT agents to achieve desired outcomes. Nominal group findings underscored the importance of relating measures to specific intended outcomes. However, the case studies highlighted that few measures were employed by KIT agents and their managers. Using social marketing theory helped to show linkages between processes, outcomes and impact, and drew attention to how KIT agents developed insight into their clients’ needs and tailored work accordingly.
Limitations
Level of KIT agent participation varied; line managers and Links were interviewed only once; and outcomes were self-reported.
Conclusions
Social marketing theory provided a framework for analysing KIT agent activity. The preparatory work KIT agents do in listening, understanding local context and building relationships enabled them to develop ‘insight’ and adapt their ‘offer’ to clients to achieve desired outcomes.
Future work
The complexity of the role and the environment in which it is played out justifies more research on KIT agents. Suggestions include (1) longitudinal study of career pathways; (2) how roles are negotiated within teams and how competing priorities are managed; (3) how success is measured; (4) the place of improvement methodologies within KIT work; (5) the application of social marketing theory to comparative study of similar roles; and (6) patients as KIT agents.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
... The organization's size, structure, needs and field, as well as the occupational status (professional or manager) influence research utilization if we adopt an organizational perspective to explain research utilization. Research utilization increases as researchers consider and integrate the specific needs of users in their research instead of solely focusing on advances in research (Frenk, 1992;Orlandi, 1996;Chelimsky, 1997;Silverside, 1997;Landry et al., 2003). The explanation that focuses on the different interests of researchers and users states that their respective cultures are in opposition to each other, thereby resulting in a communication deficit and less utilization of research results (Caplan, 1979;Webber, 1987;Frenk, 1992;Oh and Rich, 1996;Landry et al., 2003). ...
... Research utilization increases as researchers consider and integrate the specific needs of users in their research instead of solely focusing on advances in research (Frenk, 1992;Orlandi, 1996;Chelimsky, 1997;Silverside, 1997;Landry et al., 2003). The explanation that focuses on the different interests of researchers and users states that their respective cultures are in opposition to each other, thereby resulting in a communication deficit and less utilization of research results (Caplan, 1979;Webber, 1987;Frenk, 1992;Oh and Rich, 1996;Landry et al., 2003). This opposition will be even more noticeable if the research results are presented in a technical language that has not been simplified and adapted to the needs of decision makers (Caplan, 1979;Dunn, 1980;Webber, 1987;Rich and Oh, 1993;al, 2001, 2003). ...
WHAT FACTORS INDUCE CANADIAN HEALTH ORGANIZATIONS' MANAGERS AND PROFESSIONALS TO USE RESEARCH RESULTS?-A PATH ANALYSIS MODEL The aim of this paper is to study direct and indirect effects among variables involved in knowledge utilization explanations. Based on a survey of 928 HSOs' managers and professionals of Canadian health organizations (ministries, regional health authorities, hospitals), the results of the path analysis indicate that the research utilization can be explained by different categories of determinants borrowed from absorptive capacity, learning and cultural explanations. The results show that factors explaining the research utilization vary from a type of organization to another and allow us to derive various implications for public planners aiming at the calibration of customized public policies for each of the three types of Canadian health organization. In terms of theory building, the paper refines the organizational perspective of the study of knowledge utilization and shows that utilization processes are interdependent in their causes and effects, and thus complicated to study. Finally, it points out the usefulness of concepts inspired from the organizational theory to explain knowledge utilization.
... This reality highlights how important our ability to remain agile and responsive is, and as we strengthen our partner relationships for successful trial conduct with in-depth evaluation. As embedded researchers engaged in systemwide QI, we recognize the need to align with system priorities [90] and be attuned to findings that will best improve care for patients [91]. ...
Background
The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies.
Methods
For each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently.
Discussion
MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings.
Trial registration
ClinicalTrials.gov: NCT05065502 . Registered October 4, 2021—retrospectively registered.
... This reality highlights how important our ability to remain agile and responsive is, and as we strengthen our partner relationships for successful trial conduct with in-depth evaluation. As embedded researchers engaged in systemwide quality improvement, we recognize the need to align with system priorities (92) and be attuned to ndings that will best improve care for patients (93). This project is a non-clinical research project, conducted primarily to produce information that expands the knowledge base of a scienti c discipline or other scholarly eld, and does not involve collecting patient data or performing analyses other than for the purposes of improvement of the quality of care. ...
Background
The adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: 1) a deprescribing approach intended to reduce inappropriate polypharmacy; 2) appropriate dosing and drug selection of direct-acting anticoagulant medications (DOACs); and 3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies.
Methods
For each trial, we will recruit 8–12 clinics (24–36 total). All will have access to a clinical dashboard that flags patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve use of the EBPs: 1) individual-level academic detailing (AD); or 2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate care among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. The dependent variable will be a unified variable representing clinic-level percent of potentially inappropriate care using generalized estimating equations (GEE) at months 13–36 post-baseline.
Discussion
MIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates use of actionable clinical dashboard data and making incremental changes, designed to be feasible within busy clinical settings.
Trial registration
ClinicalTrials.gov: NCT05065502. Registered October 4, 2021 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05065502
... století a byla podpořena řadou dalších výzkumů (např. Head, 2010;Frenk, 1992). V posledních letech se však množí důkazy o tom, že situace není zdaleka tak jednoduchá, jak se Caplan domníval. ...
... Researchers who seek to influence policy often express concern about achieving balance between positive relationships with policy actors and ensuring research independence (Frenk 1992). Policymakers may feel defensive if research findings challenge policy, and researchers may be caught between wanting to maintain these relationships and ensuring research integrity. ...
Objectives
This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research.Methods
Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers’ critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken.ResultsPAGs benefit the research process and can facilitate knowledge translation. PAG membership changes, differing researcher and policy actor agendas, and researchers’ need to balance policy relevance and research independence are challenges when working with PAGs. Strategies to improve the function of health policy research PAGs are identified.Conclusions
The paper suggests a broader adapted approach for gaining the benefits and addressing the challenges of working with PAGs. It opens theoretical and practical discussion of PAGs’ role and how they can increase research translation into policy.
... Firstly, it has been suggested that research utilization increases when researchers focus their research on users' needs by making it pertinent to the objectives pursued by the industry and authorities [49,60,66,67]. Adaptation of research requires gaining knowledge about authorities and the industry's needs and objectives [68] by contacting and inquiring from authorities about issues and problems that require solutions [64]. ...
The literature on maritime risk management is rich and the findings are pertinent to maritime authorities in the Baltic Sea region; however, little is known regarding how much of the available research is actually utilized. This paper aims to evaluate the uptake of maritime risk research by maritime authorities in the Baltic Sea region and to propose recommendations for its improvement. An existing model to evaluate research uptake was adopted. The factors that could improve research uptake were identified and built into a framework of research institutions’ push of research and its pull by the maritime authorities and industry. The level of research uptake and the utilization of push and pull factors were examined using an online survey questionnaire and in addition, policymakers and researchers were engaged in a workshop to identify the best practices and opportunities for research uptake in the Baltic Sea region. The results show that the overall research uptake level is reasonably good, although factors that increase research utilization are not wholly taken up. Policy recommendations are provided to improve research uptake and science communication. The emergent framework of improvement factors and best practices should serve as a guide to policymakers and researchers to optimize the uptake of research, regardless of discipline.
... More recently, those advocating for reductions in research wastage [11] have asserted that communicating the end products of research clearly for a policy audience is not enough to enhance translation if the evidence in and of itself is not relevant to the interests and needs of policy-makers and practitioners. Partnering with potential research users throughout the research process has been posited as a potentially effective method of improving the policy and practice relevance of research [12,13]. This style of research, where there is ongoing engagement between decision-makers (who bring with them contextual and tacit knowledge about what evidence is needed in practice) and researchers (who bring skills in research methodology), is becoming increasingly popular. ...
Background:
Researchers and policy-makers are increasingly working together with the goal of creating research that is focused on solving real-world problems; however, knowledge translation (KT) activities, and the partnerships they often require, can be challenging. The aim of this review is to determine the extent of the literature on training programs designed to improve researcher competency in KT and to describe existing training methods that may be used by those hoping to build capacity for partnership research.
Methods:
MEDLINE, EMBASE, PsycINFO and CINAHL were searched for peer review articles published between January 2000 and July 2019. Studies were eligible for inclusion in the review if they described the development of, curriculum for, or evaluation of KT and/or partnership research training programs. Data extraction included information on evaluation methods, outcomes and implications as well as the format, aims and themes of each capacity-building program.
Results:
The review identified nine published articles that met inclusion criteria - four papers described training events, two papers described participant experiences of specific learning sessions within a larger training course, two papers described part time secondments for KT capacity-building and one paper described a plan for KT training embedded within an existing research training course. All programs were delivered face-to-face, all included practical skills-building opportunities, and all employed multiple learning modalities such as seminars and small group discussions. Evaluation of the training programs was primarily conducted through qualitative interviews or feedback surveys.
Conclusion:
To date, few KT training initiatives have been described in the literature and none of these have been rigorously evaluated. The present review offers insights into the planning, development and participant experiences associated with the small number of training initiatives that have been described. There is insufficient evidence available at present to identify the most effective models for training researchers in KT and partnership skills.
... Documentation and evaluation of efforts to engage knowledge users in the knowledge synthesis process of systematic reviews has also been recommended by research to increase their utility and relevance [53]. The OHTN may, therefore, benefit from increasing exchange efforts to work more collaboratively during and following the production of rapid responses [4,22,53,54]. Some requestors also noted a lack of research in relation to their area of interest, which affected the usefulness of the rapid response. ...
Background:
To support AIDS service organisations and other community-based organisations' use of research evidence to inform HIV-related programmes, services and policies, the Ontario HIV Treatment Network (OHTN) developed a Rapid Response Service. The final product of the rapid response process at the OHTN, which is more streamlined than that of traditional systematic reviews, consists of a detailed report answering questions regarding an HIV-specific issue and how the findings apply within the local context. In 2016, the OHTN conducted an evaluation to assess the effectiveness of its Rapid Response Service. This article reports on the development of this service as well as the results of the evaluation.
Methods:
All rapid responses published between January 1, 2009, and September 30, 2016, by the OHTN (n = 102) were analysed using univariate analyses. Frequency distributions were determined for the following variables for each rapid response: populations observed, topics covered, requestor affiliations and number of downloads from the OHTN's website. Requestors of rapid responses were also interviewed regarding perceived helpfulness and utility of the service and final products, and suggestions for changes to the service. Six-month follow-up interviews were conducted to determine how affiliated organisations used the evidence from the rapid response they requested.
Results:
The 102 rapid responses published covered 14 different populations of interest. Topics covered included the HIV prevention, engagement and care cascade, determinants of health, syndemics, and comorbidities. Requestor affiliations consisted of AIDS service organisations, government agencies and policy-makers, non-HIV-focused community-based organisations, and hospitals, universities or health centres. Requestors perceived most aspects of the Rapid Response Service as very helpful and most frequently suggested that the rapid responses should provide recommendations. Follow-up interviews regarding the impact of rapid responses show that rapid responses have been used to assist organisations in numerous activities.
Conclusions:
Organisations that have used the OHTN's Rapid Response Service describe it as a valuable service useful for the development of programmes and policies. Improvements in capacity-building efforts may increase its utility. Describing the findings of this evaluation may serve as a reference for similar programmes to increase the use of research evidence among public health decision-makers.
... Secondly, the existing structure of the grant proposal reviewing process comprises a set of routines with a clear balance of power, which structure daily activities, communication, and decisionmaking amongst all those involved (Frenk 1992). Incorporating the patients' perspectives in this system tends to destabilize the system, as it requires adjustments to established procedures and routines to accommodate the patients' reviewing process needs. ...
Although academic interest for patient involvement in health research decision-making is growing, in practice it proves challenging to involve patients meaningfully and sustainably. This article aims to unravel systemic factors influencing the embedding of meaningful patients' involvement in proposal appraisal at a private cancer research funding organization. In the case study, the emergent and participatory research approach Reflexive Monitoring in Action was applied. At first, a positive stance of stakeholders towards patient involvement was accompanied by a lack of tools and structures. This lack of tools led to the execution of various interventions. Analysis reveals that structural interventions succeeded in the bureaucratic context. The required cultural shift was also addressed, but took longer to materialize. This may have reduced the meaningful involvement of patients in proposal appraisal in practice. To overcome the underlying systemic barriers, an approach is needed that encourages stakeholders' reflexivity in the structural, cultural, and practical domain.
... It typically works based on the reward and incentive system (for promotion and tenure), which values 'traditional types of within-group activity' (such as publication in peer-reviewed journals and receipt of research grants) over direct outreach and 'activities associated with knowledge transfer' (Blackman and Benson 2010;Bogenschneider et al. 2000;Coburn 1998;Crosswaite and Curtice 1994;Henke 2000;Huberman 1983;Shaperman and Backer 1995;Tornquist and Hoenack 1996). Knowledge transfer, thus, is not at the top of priority scales in academia (Blackman and Benson 2010;Bogenschneider et al. 2000;Coburn 1998;Davis and Howden-Chapman 1996;Frenk 1992;Huberman 1994;Landry, Amara, and Lamari 2001;Jacobson, Butterill, and Goering 2004) When a knowledge transfer eventually takes place, it often involves a complicated process, as knowledge is a product of 'complex cultural and interactive processes' (Blackman and Benson 2010; Carlile and Rebentisch 2003;Tsoukas and Vladimirou 2001). The transfer process may involve some knowledge alteration and losses (Blackman and Benson 2010; Brown and Duguid 2001;Szulanski and Jensen 2006). ...
... It is a predictive statement about the outcome of the research, dictate the method, and design of the research [1] • Understand implications of your research: This is important for application: whether one achieves to fill gap in knowledge and how the results of the research have practical implications, for example, to develop health policies or improve educational policies. [1,8] Brainstorm/Concept map for formulating research question • First, identify what types of studies have been done in the past? • Is there a unique area that is yet to be investigated or is there a particular question that may be worth replicating? ...
Formulation of research question (RQ) is an essentiality before starting any research. It aims to explore an existing uncertainty in an area of concern and points to a need for deliberate investigation. It is, therefore, pertinent to formulate a good RQ. The present paper aims to discuss the process of formulation of RQ with stepwise approach. The characteristics of good RQ are expressed by acronym “FINERMAPS” expanded as feasible, interesting, novel, ethical, relevant, manageable, appropriate, potential value, publishability, and systematic. A RQ can address different formats depending on the aspect to be evaluated. Based on this, there can be different types of RQ such as based on the existence of the phenomenon, description and classification, composition, relationship, comparative, and causality. To develop a RQ, one needs to begin by identifying the subject of interest and then do preliminary research on that subject. The researcher then defines what still needs to be known in that particular subject and assesses the implied questions. After narrowing the focus and scope of the research subject, researcher frames a RQ and then evaluates it. Thus, conception to formulation of RQ is very systematic process and has to be performed meticulously as research guided by such question can have wider impact in the field of social and health research by leading to formulation of policies for the benefit of larger population.
... If countries select and implement one or more options from the framework among particular groups and evaluate them rigorously then 5-10 years from now we should be in a much better posip p tion to refine the framework and ensure that its elements are solidly supported by research. Had such evaluations been undertaken for the frameworks that have already been developed for policyp makers, [9][10][11][12][13] we would have a more rigorp p ous research base from which to draw now. The main purpose of the examples offered here is to highlight how the framework is grounded in promising innovations that are being implemented for one or more user groups. ...
We developed a framework for assessing country-level efforts to link research to action. The framework has four elements. The first element assesses the general climate (how those who fund research, universities, researchers and users of research support or place value on efforts to link research to action). The second element addresses the production of research (how priority setting ensures that users' needs are identified and how scoping reviews, systematic reviews and single studies are undertaken to address these needs). The third element addresses the mix of four clusters of activities used to link research to action. These include push efforts (how strategies are used to support action based on the messages arising from research), efforts to facilitate "user pull" (how "one-stop shopping" is provided for optimally packaged high-quality reviews either alone or as part of a national electronic library for health, how these reviews are profiled during "teachable moments" such as intense media coverage, and how rapid-response units meet users' needs for the best research), "user pull" efforts undertaken by those who use research (how users assess their capacity to use research and how structures and processes are changed to support the use of research) and exchange efforts (how meaningful partnerships between researchers and users help them to jointly ask and answer relevant questions). The fourth element addresses approaches to evaluation (how support is provided for rigorous evaluations of efforts to link research to action).
... In addition, the interview data also suggested that human resource management is vital for the implementation of road safety policies at institutional level, and also for their continuity and sustainability so that researchers and decision makers may be motivated and play prominent roles in the development of new knowledge and decision-making process respectively [40]. ...
This paper examines the current institutional arrangements for the management of road safety in Malaysia in a systematic manner. It focuses on road safety funding and seeks to provide an insight into how funding factors may affect both the effectiveness and the efficiency or road safety management. The study follows an exploratory approach based on semi-structured interviews targeting key stakeholders in road safety management such as policy makers from various government agencies, private sector representatives and academia. The information collected is subsequently analysed using a template analysis technique based on a set of criteria defined by the World Bank. The analysis reveals that the efficiency and effectiveness of the road safety management system in Malaysia may be sustainably improved by addressing the current dependence of funding solely on government sources, the fragmentation of the decision making process of this de facto multi-disciplinary area, the road safety legislative framework, public awareness, local needs and institutional capacity. An institutional model based on 2nd generation road funds is tentative suggested to this effect.
... Indeed, most of the barriers between decision-makers and researchers correspond to structural circumstances, not to mere differences in training or personality. Those barriers are rooted in the different kinds of logic and demands that researchers and decision-makers face in their respective areas of activity (19). The main barriers are summarized in Figure 5, together with some possible solutions for overcoming them. ...
... Although a recent review identified factors facilitating a HPS approach at a school-level [13], there is limited synthesized knowledge on the broader elements that facilitate a HPS approach at a school system-level. Systems-thinking offers a theoretical lens that recognizes interrelationships and interactions across stakeholders that are tied together by organizational structures, processes and contexts but require stronger linkages to promote behaviour change within and across systems [14][15][16]. This perspective is appropriate for interventions within the education system considering the interdependency of a range of system-level elements [17] (e.g., government ministries may develop HPS standards and offer professional development for groups of schools). ...
... This disconnection was interpreted in terms of "excellence" and "relevance"; i.e., academic researchers gave more weight to scientifi c validity of methods and results (excellence), whereas policymakers and practitioners emphasized the utilitarian value of research (relevance). 26 This difference in emphasis resulted in different appreciation of aspects of the research process, such as time taken for research activities (e.g., academic researchers were more comfortable spending a longer time on analyzing all aspects of a phenomenon over time, vs. pressure for timely information to infl uence policy and programs), language and communication (policymakers and practitioners valuing comprehensible language in an accessible format, vs. technical language in specialized communications), and the ideal research product (a frequently cited journal article vs. a policy or program infl uenced by data). In addition, participants across countries raised concerns about research often being conducted by outsiders, particularly by universities in high-income countries, and therefore not being optimally geared towards the concerns on the ground. ...
... Systems-thinking offers a theoretical lens that recognizes interrelationships and interactions across stakeholders that are tied together by organizational structures, processes and contexts but require stronger linkages to promote behaviour change within and across systems [14][15][16]. This perspective is appropriate for interventions within the education system considering the interdependency of a range of system-level elements [17] (e.g., government ministries may develop HPS standards and offer professional development for groups of schools). ...
Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students.
... Head (2010, 88) warns that the research and policy communities must overcome mutual ignorance and indiff erence if policy is to be based on research evidence. Frenk (1992Frenk ( , 1398 argues that researchers and policy makers communicate diff erently-researchers must communicate in complicated, scientifi c language, while policy makers need to make quick, accessible decisions that can be understood by everyone. Others have pointed to the diff erent goals pursued by the two communities, as researchers aim to increase knowledge while policy makers' objectives are more concretely attached to "operational matters" (Hemsley-Brown 2004, 539). ...
Academics and policy makers in many Western countries are perceived as occupying separate communities, with distinct languages, values, and reward systems. However, data from a survey of more than 2,000 policy officials and 126 in-depth interviews with public servants in Australia suggest that the “two communities” conceptualization may be misleading and flawed. More realistically, there is a range of interaction between policy and academia, with some individuals valuing and using academic research more than others. Furthermore, this relationship is complicated by the internal division between the political and administrative components of the public policy process.
Background
Emergency care is facing a steadily rising demand. In response, hospitals have implemented new models of care that locate general practitioners in or alongside the emergency department.
Objectives
We aimed to explore the effects of general practitioners working in or alongside the emergency department on patient care, the primary care and acute hospital team, and the wider system, as well as to determine the differential effects of different service models.
Design
This was a mixed-methods study in three work packages. Work package A classified current models of general practitioners working in or alongside the emergency department in England. We interviewed national and local leaders, staff and patients to identify the hypotheses underpinning these services. Work package B used a retrospective analysis of routinely available data. Outcome measures included waiting times, admission rates, reattendances, mortality and the number of patient attendances. We explored potential cost savings. Work package C was a detailed mixed-methods case study in 10 sites. We collected and synthesised qualitative and quantitative data from non-participant observations, interviews and a workforce survey. Patients and the public were involved throughout the development, delivery and dissemination of the study.
Results
High-level goals were shared between national policy-makers and local leads; however, there was disagreement about the anticipated effects. We identified eight domains of influence: performance against the 4-hour target, use of investigations, hospital admissions, patient outcome and experience, service access, workforce recruitment and retention, workforce behaviour and experience, and resource use. General practitioners working in or alongside the emergency department were associated with a very slight reduction in the rate of reattendance within 7 days; however, the clinical significance of this was judged to be negligible. For all other indicators, there was no effect on performance or outcomes. However, there was a substantial degree of heterogeneity in these findings. This is explained by the considerable variation observed in our case study sites, and the sensitivity of service implementation to local factors. The effects on the workforce were complex; they were often positive for emergency department doctors and general practitioners, but less so for nursing staff. The patient-streaming process generated stress and conflict for emergency department nurses and general practitioners. Patients and carers were understanding of general practitioners working in or alongside the emergency department. We found no evidence that staff concerns regarding the potential to create additional demand were justified. Any possible cost savings associated with reduced reattendances were heavily outweighed by the cost of the service.
Limitations
The reliability of our data sources varied and we were unable to complete our quantitative analysis entirely as planned. Participation in interviews and at case study sites was voluntary.
Conclusions
Service implementation was highly subject to local context and micro-level influences. Key success factors were interprofessional working, staffing and training, streaming, and infrastructure and support.
Future work
Further research should study the longer-term effects of these services, clinician attitudes to risk and the implementation of streaming. Additional work should also examine the system effects of national policy initiatives, develop methodologies to support rapid service evaluation and study the relationship between primary and secondary care.
Trial registration
This trial is registered as ISRCTN51780222.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research ; Vol. 10, No. 30. See the NIHR Journals Library website for further project information.
Purpose
The purpose of this paper is to develop a framework that systematically captures the ambiguity of different understandings about science, the university and its relation to society, while conceptualising sustainability. Following Corley and Gioia (2004, p. 174) on identity ambiguity and change, it seems pivotal to better understanding the ambiguity of sustainability in relation to academic cultures and university models to manage the transition more effectively.
Design/methodology/approach
The nature of this paper’s objectives as well as the wide thematic scope leads to the need of exploring a broad knowledge base. This was best addressed by an exploratory literature review with data collection from primary and secondary sources. The data was interpreted through a hermeneutic analysis and resulted in the inductive development of first categories and goals (further referred to as category development). In addition, a multi-method approach further adjusted the categories and raised their empirical validity and social robustness.
Findings
Implementing sustainability involves dealing with a double bound ambiguity due to organisational and individual identity reasons. Five fields of ambiguity were developed to systemise the conceptualisation of a sustainable university along contradictory understandings of science, the university and sustainability. These fields offer a framework to qualitatively assess the degree of sustainability in higher education institutions. Arguments for and against sustainability in universities have been categorised around five criteria and associated to the fields of ambiguity. The finding indicates that meaning in organisational change management for sustainability can be considered both, a potential driver and barrier for a sustainability transition in universities.
Research limitations/implications
This paper exclusively focussed on the internal perspective and left aside any external factors that influence the sustainability transition, such as political measures to stimulate sustainability in higher education. In addition, the operational dimension of a sustainable university has been neglected, which is by all means a necessary and important aspect. The interrelation of the identified goals has not been discussed.
Originality/value
This paper focusses on the conceptualisation and understanding of sustainability within the institution, an often-forgotten but fundamental aspect of implementation. The fields of ambiguity are designed to be applied for assessing the “degree of maturity” of a sustainable university. The fields reveal the different understandings about the role, the mission and the governance of universities, stemming from competing preferences about goals and their assumed relations by various stakeholders of a higher education institutions. The five fields are not an attempt to resolve the hidden contradictions and tensions in a sustainability transition, but to state them clearly to anticipate resistances and conflicts that hinder the development of a shared understanding.
Previous studies widely recognized the need to generate knowledge with practical implications. A growing interest in analyzing the process of generation, dissemination, and use of new evidence has been detected. In particular, it is widely accepted in the literature that there is the necessity to adopt strategies aimed at increasing the uptake of research findings, since the percentage of current evidence that is translated into current practices is below the 20% and with an enormous delay of time. This is particularly true in the health field, where different tools for enhancing knowledge uptake emerged. Among them, health technology assessment was introduced as a knowledge infrastructure tool aimed at supporting evidence-based decision-making processes. Despite many advancements that have been done in the literature in this context, there are still areas that need further investigation. First, while the literature related to the description of the barriers and enablers of Health Technology Assessment (HTA) is growing, factors affecting the HTA development needs to be further investigated. More precisely, the perceptions of practitioners related to HTA development are rarely captured, even if they play a crucial role, especially when the analysis is conducted at the local level. Second, previous studies identified a significant gap in the analysis of the establishment of evidence advisory systems at national or sub-national levels by comparing countries according to their system. More specifically, current literature lacks an in-depth analysis of how evidence analysis activities can be implemented in health-care systems characterized by decentralization. Therefore, this study is aimed at investigating factors that are affecting the development of HTA activities in decentralized countries with a specific focus of the analysis of perceptions of healthcare professionals related to the identification of possible HTA designs at the local level.
Purpose
There is currently a focus on using networks to drive school and school system improvement. To achieve such benefits, however, requires school leaders actively support the mobilisation of networked-driven innovations. One promising yet under-researched approach to mobilisation is enabling distributed leadership to flourish. To provide further insight in this area, this paper explores how the leaders involved in one professional learning network (the Hampshire Research Learning Network) employed a distributed approach to mobilise networked learning activity in order to build professional capital.
Design/methodology/approach
A mixed methods approach was used to develop a case study of the Hampshire RLN . Fieldwork commenced with in-depth semi-structured interviews with all school leaders of schools participating in the network and other key participating teachers (12 interviews in total). A bespoke social network survey was then administered to schools (41 responses). The purpose of the survey was to explore types of RLN-related interaction undertaken by teachers and how teachers were using the innovations emerging from the RLN within their practice.
Findings
Data indicate that models of distributed leadership that actively involves staff in decisions about what innovations to adopt and how to adopt them are more successful in ensuring teachers across networks: (1) engage with innovations; (2) explore how new practices can be used to improve teaching and learning and (3) continue to use/refine practices in an ongoing way.
Originality/value
Correspondingly we argue these findings point to a promising approach to system improvement and add valuable insight to a relatively understudied area.
Introduction
Youth Excel est une initiative pancanadienne de 3 ans qui a eu comme objectif de favoriser la santé chez les jeunes par le biais de l'amélioration de la capacité de développement et d'échange des connaissances (DEC). La capacité de DEC repose sur un cycle d'amélioration reliant données probantes et interventions. Ses composantes étaient la surveillance locale des comportements des jeunes; l'échange de connaissances; les compétences, les ressources et l'environnement favorable pour l'utilisation des connaissances et enfin l'évaluation.
Méthodologie
Nous avons réalisé des entrevues auprès de membres de Youth Excel relevant de sept équipes provinciales et de deux organisations nationales. Ces entrevues portaient sur les expériences des participants en lien avec le renforcement de la capacité de DEC.
Résultats
L'élément central de la capacité de DEC était constitué par les systèmes de surveillance locale, renforcé par la coordination d'enquêtes au sein des administrations et entre administrations et par le recours à des indicateurs et à des mesures communes. Les échanges de connaissances les plus efficaces étaient ceux qui portaient sur des produits adaptés et qui mettaient à profit les occasions de dialogue et de planification des interventions. La capacité évaluative est demeurée la capacité de DEC la moins élaborée. Le renforcement de la capacité globale de DEC repose sur un dialogue fréquent, des partenariats mutuellement bénéfiques et de la confiance. Il exige également que l'on porte attention au langage, à la vision, au leadership stratégique et au financement.
Conclusion
L'expérience de Youth Excel montre qu'il faut, pour renforcer un système de DEC qui améliore la santé des jeunes, explorer de nouvelles perspectives et obtenir un engagement soutenu de la part des champions ainsi que des organisations concernées.
The recent moves towards incentivising ‘impact’ within the research funding system pose a growing challenge to academic research practices, charged with producing both scientific, and social impact. This article explores this tension by drawing on interviews with sixty-one UK academics and policymakers involved in publicly-funded knowledge exchange initiatives. The experiences of the interviewed academics point to a functional separation of academic practices into three distinct types: producing traditional research, translating research, and producing policy-oriented research. These three types of practices differ in terms of both the epistemic qualities of the produced knowledge and its legitimacy as valid academic work. Overall, the article argues that the relationship between relevance and excellence of research within the impact agenda is characterised by simultaneous contradiction and co-dependence, leading to hybridisation of academic knowledge production and expansion of the boundaries of policy expertise into the traditionally-academic spaces.
en Across many social–ecological systems, policy makers and scholars increasingly call for science to inform policy. The science–policy interface becomes especially complex as collaborative approaches include multiple stakeholders working together across jurisdictions. Unfortunately little is known about how much and how science is used in collaborative governance for social–ecological systems. This exploratory study examines instrumental, conceptual, and symbolic use of science in a science‐rich collaborative planning case in the Puget Sound, USA. It also examines the influence of science, relative to other factors, in collaborative planning, and what factors affect it. Results from a survey and document analysis indicate the prevalence of conceptual use of science, with relatively little symbolic use. Some factors promoting conceptual and instrumental use discourage symbolic use. Overall, while science is seen as influential in this science‐rich context, its influence is balanced by local stakeholder preferences and contextual information.
摘要
zh
协作式治理中科学与政策的复杂关系：生态系统恢复规划中的科学应用
许多社会‐生态系统中，政策制定者和学者都不断呼吁用科学影响政策。科学与政策的交界变得尤为复杂，因为协作措施涉及不同管辖范围内的利益相关者共同合作。遗憾的是，很少有研究聚焦于科学在协作式治理（针对社会‐生态系统）中的使用方式和使用程度。本篇探索文章检验了美国普吉特海湾一项充分使用科学的协作规划案例中，科学的工具性使用、概念性使用和象征性使用。本文还检验了科学（与其他因素相关）在协作规划中的影响力，以及哪些因素会影响协作规划。从一项调查和记录分析得出的结果显示，对科学的概念性使用较为普遍，相对而言象征性使用则很少。一些促进概念性使用和工具性使用的因素会阻止象征性使用。总的来说，尽管科学在这一充分使用科学的背景下被视为影响力代表，但其影响力会受到地方利益相关者偏好和背景信息的平衡。
Resumen
es
El nexo entre ciencia y política en la gobernanza colaborativa: el uso de la ciencia en la planificación de la recuperación ecológica
En muchos sistemas socio‐ecológicos, los creadores de políticas y los académicos piden cada vez más que la ciencia informe la política. La interfaz ciencia‐política se vuelve especialmente compleja ya que los enfoques de colaboración incluyen múltiples partes interesadas que trabajan juntas en todas las jurisdicciones. Lamentablemente, se sabe poco acerca de cuánto y cómo se utiliza la ciencia en la gobernanza colaborativa para los sistemas socioecológicos. Este estudio exploratorio examina el uso instrumental, conceptual y simbólico de la ciencia en un caso de planificación colaborativa rico en ciencia en Puget Sound, EE. UU. También examina la influencia de la ciencia, en relación con otros factores, en la planificación colaborativa y qué factores la afectan. Los resultados de una encuesta y el análisis de documentos indican la prevalencia del uso conceptual de la ciencia, con un uso simbólico relativamente pequeño. Algunos factores que promueven el uso conceptual e instrumental desalientan el uso simbólico. En general, si bien la ciencia se considera influyente en este contexto rico en ciencia, su influencia se equilibra con las preferencias de las partes interesadas locales y la información contextual.
Malnutrition in all its forms has risen on global and national agendas in recent years because of the recognition of its magnitude and its consequences for a wide range of human, social, and economic outcomes. Although the WHO, national governments, and other organizations have endorsed targets and identified appropriate policies, programs, and interventions, a major challenge lies in implementing these with the scale and quality needed to achieve population impact. This paper presents an approach to implementation science in nutrition (ISN) that builds upon concepts developed in other policy domains and addresses critical gaps in linking knowledge to effective action. ISN is defined here as an interdisciplinary body of theory, knowledge, frameworks, tools, and approaches whose purpose is to strengthen implementation quality and impact. It includes a wide range of methods and approaches to identify and address implementation bottlenecks; means to identify, evaluate, and scale up implementation innovations; and strategies to enhance the utilization of existing knowledge, tools, and frameworks based on the evolving science of implementation. The ISN framework recognizes that quality implementation requires alignment across 5 domains: the intervention, policy, or innovation being implemented; the implementing organization(s); the enabling environment of policies and stakeholders; the individuals, households, and communities of interest; and the strategies and decision processes used at various stages of the implementation process. The success of aligning these domains through implementation research requires a culture of inquiry, evaluation, learning, and response among program implementers; an action-oriented mission among the research partners; continuity of funding for implementation research; and resolving inherent tensions between program implementation and research. The Society for Implementation Science in Nutrition is a recently established membership society to advance the science and practice of nutrition implementation at various scales and in varied contexts.
Instrumental knowledge utilization is the process whereby knowledge influences political decision making. Such processes are complex and, consequently, hard to measure. Nevertheless, knowing what determines degrees of knowledge utilization is a prerequisite for fostering more evidence-based policy making. Numerous factors that contribute to, and co-determine, knowledge utilization are beyond the reach of researchers, but among the factors that researchers can influence, one variable has been presented as being crucial: the degree to which researchers adapt their research to meet the demands of intended knowledge users. In other words, making their research comprehensible, operational, realistic in terms of interventions and implications, and appealing to users. Drawing on the conceptual work of Landry, Amara, and Lamari, this paper develops a new, and more direct, measurement of adaptation. This measurement is subsequently applied in an analysis employing the Degrees of Knowledge Utilization (DoKU) scale and, thus, extending Knudsen’s five-year meta-evaluation related to the Danish pesticide area. Surprisingly, the statistical tests show that degrees of adaptation have no significant influence on degrees of knowledge utilization.
Background: Collaboration between researchers and knowledge users is increasingly promoted because it could enhance more evidence-based decision-making and practice. These complex relationships differ in form, in the particular goals they are trying to achieve, and in whom they bring together. Although much is understood about why partnerships form, relatively little is known about how collaboration works: how the collaborative process is shaped through the partners’ interactions, especially in the field of health technology assessment (HTA)? This study aims at addressing this gap in the literature in the specific context of HTA.
Methods: We used a qualitative descriptive design for this exploratory study. Semi-structured interviews with three researchers and two decision-makers were conducted on the practices related to the collaboration. We also performed document analysis, observation of five team meetings, and informal discussion with the participants. We thematically analyzed data using the structuration theory and a collective impact framework.
Results: This study showed that three main contextual factors helped shape the collaboration between researchers and knowledge users: the use of concepts related to each field; the use of related expertise; and a lack of clearly defined roles in the project. Previous experiences with the topic of the research project and a partnership based on "a give and take" relationship emerged as factors of success of this collaboration.
Conclusion: By shedding light on the structuration of the collaboration between researchers and knowledge users, our findings open the door to a poorly documented field in the area of HTA, and additional studies that build on these early observations are welcome.
Me emociona profundamente estar hoy aquí para celebrar con ustedes el trigésimo aniversario del Instituto Nacional de Salud Pública y el nonagésimo quinto aniversario de la Escuela de Salud Pública de México. Debemos sentirnos felices, pues hay muy buenas razones para celebrar. Varias de estas razones se exponen en el libro que me pidieron comentar y que resume las aportaciones del Instituto Nacional de Salud Pública (INSP) a las políticas públicas..
The paper refines the organizational perspective of the study of knowledge utilization and points out the usefulness of concepts inspired from the organizational theory to explain knowledge utilization. A model analyzing the knowledge utilization ladder is introduced. Propositions leading to a better understanding of how knowledge utilization takes place are derived from the model.
This chapter considers a wide range of issues relating to the generalizability of effective interventions. It begins by looking at factors that determine the extent to which the observed effects in a randomized trial can be generalized to other populations. It proposes suggestions to increase generalizability at the design stage. Because populations are heterogeneous, repeat trials in different environments are often required. However, as trials are expensive, the use of computer modelling has been suggested as an alternative to explore likely intervention effects in other populations. The options and limitations of this strategy are discussed. Translating research results into policy and practice is not straightforward. Various strategies towards achieving this objective are considered, including cost-effectiveness analysis. The last two sections of the chapter are concerned with the practicalities of scaling up an intervention and with aspects of sustainability.
This article attempts to develop some of the basic elements for a theory of state intervention in medical care. First, a typology of state intervention is proposed based on two dimensions: the form of state control over the production of medical services and the basis for eligibility of the population. The resulting twelve types provide a means of describing national patterns of state intervention at a given point in time. Next, in order to analyse the changing patterns of state intervention in medical care over time, changes in state control and population coverage are used to construct three hypothetical 'paths' of state intervention, which may serve to depict broad historical trends in major groups of countries. In the final section, several variables are analysed according to their expected effect on the patterns of convergence and divergence in the form and degree of state intervention between countries. This cross-national comparative perspective is offered as a strategy for building a theory capable of explaining state intervention, a process that, to a large extent, informs the medical experience of today.
This article presents arguments that call for a rethinking and redesign of institutional arrangements that now relegate policy-oriented social science work related to population issues in the developing world to the performance of technical functions servicing existing population programs. To the extent that programs do need such technical services, they can, and obviously will and should, continue to purchase them along with other program inputs. But monitoring and analyzing the process that more than doubled the world population since mid-century, assessing and understanding its causes and consequences, and not the least, observing and evaluating actual and potential policy approaches aimed at influencing demographic change, call for systematic, rigorous, and independent social science research efforts that cannot be conducted as activities ancillary to existing population programs.
Health care, in the technologic sense an “industry,” lacks an objective information base for rational formulation of health policy and decision making which at present appear mainly to be based on a compound of perceived need, of programs advocated by professional enthusiasts and pressure groups, and of political considerations. The “industry” has so far been protected from the full consequences of its inefficient operation mainly through the simple procedure of permitting escalating uncontrolled costs. Policy and decision making, leading to better deployment of resources, can be improved substantially by government–directed research and development, the first component of which is the launching of a health care research program. The efforts of one government jurisdiction, Ontario, in this direction are described.
If applied research is to serve as a tool for solving health care delivery problems in developing countries, researchers and managers must work more closely together. At present, research efforts are often directed toward issues and problems of marginal interest to health managers, and research focused on problems important for health delivery often does not capture the attention of those who could most profitably use its results. This paper examines some reasons for the lack of utilization of research and discusses strategies such as training to promote use of applied research for problem solving, orienting decision makers to applied research, and strengthening the use of research in health services management, with examples drawing on the experience of organizations involved in the development of applied research programs.
This paper presents the conceptual and organizational elements that have guided the development of the Center for Public Health Research (CPHR) in Mexico. The CPHR was established in August 1984, in the midst of the most profound health care reform in Mexico in the last 40 years. The reform has included, among other measures, a Constitutional amendment recognizing the social right to health care, an energetic effort to decentralize the system so that each state will run its own services, an ambitious drive to extend primary health care coverage to all the population, and a strong promotion of research as the basis for strategic planning and for the development of standards of care. The creation of the CPHR is a response to the need for a firm base of epidemiologic and health systems research in Mexico. This need arises from the increasing complexity of the country's organizational arrangements for health care. In addition, the patterns of morbidity and mortality are also becoming more intricate, as Mexico is experiencing an epidemiologic transition whereby chronic diseases, mental ailments, and accidents are on the rise even as the incidence of infectious diseases and malnutrition continues to be high. As a unit of the Ministry of Health, the CPHR must strike a balance between relevance to decision making and excellence in the strict adherence to the norms of scientific research. To do so, it has developed a conceptual framework based on a tridimensional matrix. The dimensions of the matrix include substantive areas (i.e., the phenomena to be researched), knowledge areas (i.e., the disciplines pertinent to public health), and methodological areas (i.e., the methods to be applied in each project). The intersection of these dimensions produces different configurations of "research modules" that can be adapted to changing priorities. Current priorities of the CPHR include epidemiologic studies of the emerging conditions in the transition, migration and health, child survival, social organization and primary health care, health systems management, quality of care, and the development of information systems and quantitative models for public health research. Research projects are undertaken in a matrix type of organization in which academic departments are structured according to problems rather than disciplines. The analysis of Mexico's Center for Public Health Research may contribute to similar endeavors in other countries and also to the wider development of comparative studies on research organizations.
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