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Governance of health research funding institutions: an integrated conceptual framework and actionable functions of governance.

ABSTRACT: BACKGROUND:Health research has scientific, social and political impacts. To achieve such impacts, several institutions need to participate; however, health research funding institutions are seldom nominated in the literature as essential players. The attention they have received has so far focused mainly on their role in knowledge translation, informing policy-making and the need to organise health research systems. In this article, we will focus solely on the governance of national health research funding institutions. Our objectives are to identify the main functions of governance for such institutions and actionable governance functions. This research should be useful in several ways, including in highlighting, tracking and measuring the governance trends in a given funding institution, and to forestall low-level governance. METHODS:First, we reviewed existing frameworks in the grey literature, selecting seven relevant documents. Second, we developed an integrated framework for health research funding institution governance and management. Third, we extracted actionable information for governance by selecting a mix of North American, European and Asian institutions that had documentation available in English (e.g. annual report, legal status, strategy). RESULTS:The framework contains 13 functions - 5 dedicated to governance (intelligence acquisition, resourcing and instrumentation, relationships management, accountability and performance, and strategy formulation), 3 dedicated to management (priority-setting, financing and knowledge transfer), and 5 dedicated to transversal logics that apply to both governance and management (ethics, transparency, capacity reinforcement, monitoring and evaluation, and public engagement). CONCLUSIONS:Herein, we provide a conceptual contribution for scholars in the field of governance and health research as well as a practical contribution, with actionable functions for high-level managers in charge of the governance of health research funding institutions.

SUBMITTER: Smits P

PROVIDER: S-EPMC7029568 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Governance of health research funding institutions: an integrated conceptual framework and actionable functions of governance.

Smits Pernelle P Champagne François F

Health research policy and systems 20200218 1

<h4>Background</h4>Health research has scientific, social and political impacts. To achieve such impacts, several institutions need to participate; however, health research funding institutions are seldom nominated in the literature as essential players. The attention they have received has so far focused mainly on their role in knowledge translation, informing policy-making and the need to organise health research systems. In this article, we will focus solely on the governance of national heal ...[more]

PMID: 32070372

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Project description:BackgroundGrowing interest in public involvement in health research has led to organisational and policy change. Additionally, an emerging body of policy-oriented scholarship has begun to identify the organisational and network arrangements that shape public involvement activity. Such developments suggest the need to clearly conceptualise and characterise public involvement in health research in terms of governance.MethodsWe drew on an established health research system framework to analyse governance functions related to public involvement, adapting scoping review methods to identify evidence from a corpus of journal papers and policy reports. We drew on the logics of aggregation and top down configuration, using a qualitative interpretive approach to combine and link findings from different studies into framework categories.ResultsWe identified a total of 32 scholarly papers and 13 policy reports (n = 45 included papers) with relevance to governance for public involvement. Included papers were broadly consonant in identifying the need for activity to specify and support public involvement across all four governance functions of stewardship, financing, creating and sustaining resources, and research production and use. However, different visions for public involvement, and the activity required to implement it and achieve impact, were particularly evident with respect to the stewardship function, which seeks to set overall directions for research while addressing the potentially competing demands of a system's many constituents.ConclusionsA governance perspective has considerable value for public involvement in health research systems, supporting efforts to coordinate and institutionalise the burgeoning public involvement enterprise. Furthermore, it highlights challenges for what is, ultimately, a highly political intervention, suggesting that diverse publics must be both involved within health research systems and enrolled as governors of them.

Project description:While the quantity of sustainability governance initiatives and systems has increased dramatically, crises persist over whether specific governance systems can be trusted as legitimate regulators of the sustainability of economic activities. This paper focuses on conceptual tools to improve our understanding of these crises as well as the facilitating factors and barriers for sustainability governance to play a role in transitioning to profoundly more sustainable societies than those that currently exist. Bioenergy is used throughout the paper as an example to aid contextually in understanding the theoretical and abstract arguments. We first define eight premises upon which our argumentation is developed. We then define sustainability, sustainability transition, legitimacy, and trust as a premise for obtaining effectiveness in communication and minimising risks associated with misunderstanding key terms. We proceed to examine the literature on "good governance" in order to reflect upon what defines "good sustainability governance" and what makes governance systems successful in achieving their goals. We propose input, output, and throughput legitimacy as three principles constituting "good" sustainability governance and propose associated open-ended criteria as a basis for developing operational standards for assessing the quality of a sustainability governance system or complex. As sustainability governance systems must develop to remain relevant, we also suggest an adaptive governance model, where continuous re-evaluation of the sustainability governance system design supports the system in remaining "good" in conditions that are complex and dynamic. Finally, we pull from the literature in a broad range of sciences to propose a conceptual "governance research framework" that aims to facilitate an integrated understanding of how the design of sustainability governance systems influences the legitimacy and trust granted to them by relevant actors. The framework is intended to enhance the adaptive features of sustainability governance systems so as to allow the identification of the causes of existing and emerging sustainability governance crises and finding solutions to them. Knowledge generated from its use may form a basis for providing policy recommendations on how to practically solve complex legitimacy and trust crises related to sustainability governance.Supplementary informationThe online version contains supplementary material available at 10.1186/s13705-021-00280-x.

Project description:BACKGROUND:Prognostic research has many important purposes, including (i) describing the natural history and clinical course of health conditions, (ii) investigating variables associated with health outcomes of interest, (iii) estimating an individual's probability of developing different outcomes, (iv) investigating the clinical application of prediction models, and (v) investigating determinants of recovery that can inform the development of interventions to improve patient outcomes. But much prognostic research has been poorly conducted and interpreted, indicating that a number of conceptual areas are often misunderstood. Recent initiatives to improve this include the Prognosis Research Strategy (PROGRESS) and the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) Statement. In this paper, we aim to show how different categories of prognostic research relate to each other, to differentiate exploratory and confirmatory studies, discuss moderators and mediators, and to show how important it is to understand study designs and the differences between prediction and causation. MAIN TEXT:We propose that there are four main objectives of prognostic studies - description, association, prediction and causation. By causation, we mean the effect of prediction and decision rules on outcomes as determined by intervention studies and the investigation of whether a prognostic factor is a determinant of outcome (on the causal pathway). These either fall under the umbrella of exploratory (description, association, and prediction model development) or confirmatory (prediction model external validation and investigation of causation). Including considerations of causation within a prognostic framework provides a more comprehensive roadmap of how different types of studies conceptually relate to each other, and better clarity about appropriate model performance measures and the inferences that can be drawn from different types of prognostic studies. We also propose definitions of 'candidate prognostic factors', 'prognostic factors', 'prognostic determinants (causal)' and 'prognostic markers (non-causal)'. Furthermore, we address common conceptual misunderstandings related to study design, analysis, and interpretation of multivariable models from the perspectives of association, prediction and causation. CONCLUSION:This paper uses a framework to clarify some concepts in prognostic research that remain poorly understood and implemented, to stimulate discussion about how prognostic studies can be strengthened and appropriately interpreted.

Project description:BackgroundHealth professions education has undergone major changes with the advent and adoption of digital technologies worldwide.ObjectiveThis study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education.MethodsWe searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework.ResultsWe identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations).ConclusionsWe identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.

Project description:Over the past century, the environment of the Gulf of Mexico has been significantly altered and impaired by extensive human activities. A national commitment to restore the Gulf was finally initiated in response to the unprecedented Deepwater Horizon oil spill in 2010. Consequently, there is a critical need for an assessment framework and associated set of indicators that can characterize the health and sustainability of an ecosystem having the scale and complexity of the Gulf. The assessment framework presented here was developed as an integration of previous ecological risk- and environmental management-based frameworks for assessing ecosystem health. It was designed to identify the natural and anthropogenic drivers, pressures, and stressors impinging on ecosystems and ecosystem services, and the ecological conditions that result, manifested as effects on valued ecosystem components. Four types of societal and ecological responses are identified: reduction of pressures and stressors, remediation of existing stressors, active ecosystem restoration, and natural ecological recovery. From this conceptual framework are derived the specific indicators to characterize ecological condition and progress toward achieving defined ecological health and sustainability goals. Additionally, the framework incorporates a hierarchical structure to communicate results to a diversity of audiences, from research scientists to environmental managers and decision makers, with the level of detail or aggregation appropriate for each targeted audience. Two proof-of-concept studies were conducted to test this integrated assessment and decision framework, a prototype Texas Coastal Ecosystems Report Card, and a pilot study on enhancing rookery islands in the Mission-Aransas Reserve, Texas, USA. This Drivers-Pressures-Stressors-Condition-Responses (DPSCR4 ) conceptual framework is a comprehensive conceptual model of the coupled human-ecological system. Much like its predecessor, the ecological risk assessment framework, the DPSCR4 conceptual framework can be tailored to different scales of complexity, different ecosystem types with different stress regimes, and different environmental settings. Integr Environ Assess Manag 2019;15:544-564. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Project description:BackgroundReliance on interdisciplinary teams in the delivery of primary care is on the rise. Funding bodies strive to design financial environments that support collaboration between providers. At present, the design of financial arrangements has been fragmented and not based on evidence. The root of the problem is a lack of systematic evidence demonstrating the superiority of any particular financial arrangement, or a solid understanding of options. In this study we develop a framework for the conceptualization and analysis of financial arrangements in interdisciplinary primary care teams.MethodsWe use qualitative data from three sources: (i) interviews with 19 primary care decision makers representing 215 clinics in three Canadian provinces, (ii) a research roundtable with 14 primary care decision makers and/or researchers, and (iii) policy documents. Transcripts from interviews and the roundtable were coded thematically and a framework synthesis approach was applied.ResultsOur conceptual framework differentiates between team level funding and provider level remuneration, and characterizes the interplay and consonance between them. Particularly the notions of hierarchy, segregation, and dependence of provider incomes, and the link between funding and team activities are introduced as new clarifying concepts, and their implications explored. The framework is applied to the analysis of collaboration incentives, which appear strongest when provider incomes are interdependent, funding is linked to the team as a whole, and accountability does not have multiple lines. Emergent implementation issues discussed by respondents include: (i) centrality of budget negotiations; (ii) approaches to patient rostering; (iii) unclear funding sources for space and equipment; and (iv) challenges with community engagement. The creation of patient rosters is perceived as a surprisingly contentious issue, and the challenges of funding for space and equipment remain unresolved.ConclusionsThe development and application of a conceptual framework is an important step to the systematic study of the best performing financial models in the context of interdisciplinary primary care. The identification of optimal financial arrangements must be contextualized in terms of feasibility and the implementation environment. In general, financial hierarchy, both overt and covert, is considered a barrier to collaboration.

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Governance of health research funding institutions: an integrated conceptual framework and actionable functions of governance.

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Governance of health research funding institutions: an integrated conceptual framework and actionable functions of governance.

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