Celebrating the role of research in British Columbia’s health care system – and issuing a challenge or three
As BC's health research funding agency, we think deeply about how to grow, improve and best support BC health research. Since our first Forward Thinking post, we’ve shared a series of blogs on health research funding and 'helping-it-happen'. In this post, MSFHR's President & CEO Dr. Bev Holmes discusses the role of research in the health care system and what we can do to get further, faster with our efforts to integrate research and health care.
Forward Thinking is MSFHR's blog focusing on what it takes to be a responsive and responsible research funder.
Last fall, I joined Interior Health (IH) staff at their research planning day. Not many years ago such a day would have been unusual for a health authority. Across Canada, “health care” and “research” weren’t often mentioned in the same sentence. Unless it was to voice an opinion that they don’t belong together.
These days, there is increasing evidence that research done in hospitals, health care centres and communities improves patient care and health system functioning. BC’s health authorities and our Ministry of Health are not only aware of this evidence, they are using it and adding to it through related plans and activities.
Back to Interior Health: in 2014, MSFHR partnered on a four-year initiative to build research infrastructure within the health authority. With a summary report on results and recommendations in hand, the IH team had planned a research day on the second phase of their development. I was invited to present some lessons learned as CEO of a funding agency committed to supporting the use of research evidence.
This invitation was exciting for a couple of reasons. On a personal level, evidence use – and all it entails in systems as complex as health care – is my passion. And more importantly, health research capacity building – the range of activities, processes and infrastructure that support the conduct and use of health research – is a priority in MSFHR’s new strategic plan. I was keen to learn more about the IH team’s work and how MSFHR could support their efforts.
Health research capacity in BC – where we’ve been and where we’re going
MSFHR has partnered with BC’s health regions since 2005 to help build health research capacity. The Health Authority Capacity Building Awards, a four-year $4.8 million investment, helped them increase the skills of staff to conduct and use research and hire highly qualified health services and policy researchers. Subsequently, Interior Health (as noted above) and Island Health partnered with MSFHR on further research capacity building initiatives. Summary reports for both the Interior and Island have been prepared and the Island Health team has also published an article on their experiences.
MSFHR also facilitated the $8 million BC Nursing Research Initiative which funded numerous programs designed to build the research capacity of nurses in all of BC’s health regions. Thanks to that program, close to 150 studies have now been conducted by nurses, or about nursing in Fraser Health alone.
In developing our 2020-2025 strategic plan, we reached out to our colleagues in the regions to better understand what BC needs to enhance the work underway and how a health research funder could help. These conversations, backed by our data, revealed that while each region has health research strengths and potential, capacity across BC is uneven. Over the next five years, we are committed to working with our colleagues across the province, in universities as well as health authorities, to further develop the abilities of individuals, organizations and systems to undertake and use high quality health research.
Our challenges to BC
As noted above, there has been some stellar research capacity building work undertaken in our province over the last few years. The invitation from Interior Health, as well as the development of MSFHR’s new strategic plan, provoked a lot of reflection in this area. I’d like to invite the community of those who support evidence use to consider the following three challenges as we partner to continue this important work.
Challenge one: We need to influence as well as do
As individuals and organizations, there are things we can do – that we have control over – and things we can’t do because we don’t hold all the levers. Too many of us stop at “things we can do,” perhaps not surprisingly, since it’s easier. But if we don’t influence change in areas we don’t fully control, the integration of research and health care will never be maximized.
For example MSFHR’s programs are robustly designed based on past program findings, environmental scanning, literature reviews and stakeholder input. But researchers and health system stakeholders who hold our awards tell us that their respective reward and recognition systems sometimes prevent them from doing their best work. This is what happens in complex systems: when people, organizations and sectors have such a range of conflicting accountabilities, responsibilities, authority and allegiances, it’s hard to get things done. 
UK researcher Steve Hanney describes a health research system as the people, institutions, and activities whose primary purpose is to generate high quality knowledge that can be used to promote, restore, and maintain the health status of populations.  To have such a system realize its potential, more of us need to take leadership in not only fulfilling responsibilities under our control, but influencing broader change.
Challenge two: We don’t need more frameworks
The health research capacity building literature is awash in frameworks and models and theories. It does seem true, per the wonderful quote attributed to Karen Ritchie of Health Improvement Scotland, that frameworks are like toothbrushes: everybody has one and no one wants to use anyone else’s.
Tempting as it may be to develop another model of the way things should work, the bigger opportunity is to pick one and use it. For example most capacity building frameworks recommend activities in specific areas such as leadership and culture, skills building, and infrastructure. We have the perfect structure in BC to put such a framework to the test across a large jurisdiction – to use it to inform our work, to study how well it informs our work, and to improve it for others’ future use. The same is true for other frameworks with the potential to impact health system change, for example implementation science.
We can’t get lost in testing frameworks – that is, they can’t be the endpoint – but they are an important means to an end, and the study of them in action as we do our work would enable us to really understand what needs to be in place for researchers and health system stakeholders to partner on generating and using evidence to improve patient care.
Challenge three: There is too much measurement for promotion
It’s the case that funders can be the worst offenders when it comes to measuring impact for promotion purposes. We publicize our successes and our awardees’ achievements to ensure ongoing support from government and the public, and we encourage researchers to use bold impact statements in their funding applications. But the time is right to embrace more measurement for learning – especially learning about what has not been successful.
We live in a results-oriented, quick-win society, where action is often praised over thoughtfulness. Evaluation for learning, in this environment, may seem indulgent and process-heavy. But there is a middle ground, where we measure and publicize impact, but also commit to robust evaluation of research-related activities to help improve evidence-based decision making in health care.
For example, evaluation of MSFHR’s much-anticipated Health Professional-Investigator Program revealed it was not successful in attracting applications from a broad range of health disciplines. Our revised program – with changes that we hope will reverse this trend – has just launched. We aren’t alone in this work. Our colleagues in BC’s health authorities and the Ministry of Health have work underway to evaluate their research plans, and it seems to me there is an increased focus on learning.
Summing it up
My visit to Interior Health left me as passionate as ever about evidence use and reinforced the role that MSFHR can play in supporting it across the province. I also learned that the above challenges are probably not far off the mark. If we partner to influence the system, test and advance validated frameworks, and measure impact for the right reasons, we can get further, faster, with our efforts to integrate research and health care.
Let us know what you think. Do you agree with these challenges or do you have others? Share your comments and feedback below or email email@example.com.
Note: For more insights on the challenges of integrating research and researchers into the health system, check out Bev’s recent commentary in the International Journal of Health Policy Management on Bowen et al’s “Experience of Health Leadership in Partnering with University-Based Researchers in Canada – a Call to Reimagine Research”.
 Holmes, B.J et al, (2017). Mobilising knowledge in complex health systems: a call to action. Evidence & Policy: A Journal of Research, Debate and Practice, 13(3) 539-560 doi: https://doi.org/10.1332/174426416X14712553750311
 Hanney S, Kuruvilla S, Soper B, Mays N. Who needs what from a national health research system: lessons from reforms to the English Department of Health’s R&D Ssystem. Health Res Policy Syst. 2010;8:11. doi:10.1186/1478-4505-8-11
 Phipps, David (2017 Nov 6). #ShitDavidSays About Impact #4: Impact Frameworks Are Like Toothbrushes… / Les idées de David sur l’impact, no 4 : les cadres d’évaluation de l’impact sont comme les brosses à dents… Retrieved from http://researchimpact.ca/shitdavidsays-about-impact-4-impact-frameworks-...