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When Coproduction Is Unproductive Comment on "Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to 'Re-Imagine' Research".

ABSTRACT: Bowen et al offer a sobering look at the reality of research partnerships from the decision-maker perspective. Health leaders who had actively engaged in such partnerships continued to describe research as irrelevant and unhelpful - just the problem that partnered research was intended to solve. This commentary further examines the many barriers that impede researchers from meeting decision-makers' knowledge needs, and decision-makers from using knowledge that they have coproduced. It argues that not all barriers can or should be dismantled: some are legitimate and beneficial; some are harmful but deeply entrenched; some arise unpredictably. This being the case, it seems unrealistic to expect either existing or emerging strategies to create a macro-context devoid of barriers to the fruitful coproduction of knowledge. However, it may be possible to identify and support micro-contexts (configurations of participants, settings, and project characteristics) in which partnered research is most likely to achieve its aims.

SUBMITTER: Kreindler SA

PROVIDER: S-EPMC7557425 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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When Coproduction Is Unproductive Comment on "Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to 'Re-Imagine' Research".

Kreindler Sara A SA

International journal of health policy and management 20200901 9

Bowen et al offer a sobering look at the reality of research partnerships from the decision-maker perspective. Health leaders who had actively engaged in such partnerships continued to describe research as irrelevant and unhelpful - just the problem that partnered research was intended to solve. This commentary further examines the many barriers that impede researchers from meeting decision-makers' knowledge needs, and decision-makers from using knowledge that they have coproduced. It argues tha ...[more]

PMID: 32610766

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Project description:BackgroundEmerging evidence that meaningful relationships with knowledge users are a key predictor of research use has led to promotion of partnership approaches to health research. However, little is known about health system experiences of collaborations with university-based researchers, particularly with research partnerships in the area of health system design and health service organization. The purpose of the study was to explore the experience and perspectives of senior health managers in health service organizations, with health organization-university research partnerships.MethodsIn-depth, semi-structured interviews (n = 25) were conducted with senior health personnel across Canada to explore their perspectives on health system research; experiences with health organization-university research partnerships; challenges to partnership research; and suggested actions for improving engagement with knowledge users and promoting research utilization. Participants, recruited from organizations with regional responsibilities, were responsible for system-wide planning and support functions.ResultsResearch is often experienced as unhelpful or irrelevant to decision-making by many within the system. Research, quality improvement (QI) and evaluation are often viewed as separate activities and coordinated by different responsibility areas. Perspectives of senior managers on barriers to partnership differed from those identified in the literature: organizational stress and restructuring, and limitations in readiness of researchers to work in the fast-paced healthcare environment, were identified as major barriers. Although the need for strong executive leadership was emphasized, "multi-system action" is needed for effective partnerships.ConclusionCommon approaches to research and knowledge translation are often not appropriate for addressing issues of health service design and health services organization. Nor is the research community providing expertise to many important activities that the healthcare system is taking to improve health services. A radical rethinking of how we prepare health service researchers; position research within the health system; and fund research activities and infrastructure is needed if the potential benefits of research are to be achieved. Lack of response to health system needs may contribute to research and 'evidence-informed' practice being further marginalized from healthcare operations. Interventions to address barriers must respond to the perspectives and experience of health leadership.

Project description:Outcome for mental health conditions is suboptimal, and care is fragmented. Evidence from controlled trials indicates that collaborative chronic care models (CCMs) can improve outcomes in a broad array of mental health conditions. US Department of Veterans Affairs leadership launched a nationwide initiative to establish multidisciplinary teams in general mental health clinics in all medical centers. As part of this effort, leadership partnered with implementation researchers to develop a program evaluation protocol to provide rigorous scientific data to address two implementation questions: (1) Can evidence-based CCMs be successfully implemented using existing staff in general mental health clinics supported by internal and external implementation facilitation? (2) What is the impact of CCM implementation efforts on patient health status and perceptions of care?Health system operation leaders and researchers partnered in an iterative process to design a protocol that balances operational priorities, scientific rigor, and feasibility. Joint design decisions addressed identification of study sites, patient population of interest, intervention design, and outcome assessment and analysis. Nine sites have been enrolled in the intervention-implementation hybrid type III stepped-wedge design. Using balanced randomization, sites have been assigned to receive implementation support in one of three waves beginning at 4-month intervals, with support lasting 12 months. Implementation support consists of US Center for Disease Control's Replicating Effective Programs strategy supplemented by external and internal implementation facilitation support and is compared to dissemination of materials plus technical assistance conference calls. Formative evaluation focuses on the recipients, context, innovation, and facilitation process. Summative evaluation combines quantitative and qualitative outcomes. Quantitative CCM fidelity measures (at the site level) plus health outcome measures (at the patient level; n?=?765) are collected in a repeated measures design and analyzed with general linear modeling. Qualitative data from provider interviews at baseline and 1 year elaborate CCM fidelity data and provide insights into barriers and facilitators of implementation.Conducting a jointly designed, highly controlled protocol in the context of health system operational priorities increases the likelihood that time-sensitive questions of operational importance will be answered rigorously and that the outcomes will result in sustainable change in the health-care system.NCT02543840 ( https://www.clinicaltrials.gov/ct2/show/NCT02543840).

Project description:OBJECTIVES:Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change. METHODS:This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework. RESULTS:Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group's work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success. CONCLUSIONS:The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.

Project description:PurposeTo explore the transformational leadership competency of graduates from one medical university in China and its influencing variables.MethodFrom 2020 to 2021, 851 medical graduates from seven hospitals affiliated with the Capital Medical University participated in this survey. The authors conducted a cross-sectional study to assess transformational leadership competency, particularly from three aspects, including values, Emotional Intelligence (EI) abilities, and behaviors using the socially responsible leadership scale (SRLS), emotionally intelligent leadership, and student leadership practices inventory (EILI and SLPI).ResultsThe SRLS scores were medium except for 'controversy with civility'. The EILI scores were medium. The SLPI scores were high except for 'enable others to act' and 'encourage the heart'. The influencing variables of SRLS, EILI, and SLPI were serving as student cadres, serving longer than two semesters (p = 0.01, 0.02 in EILI and SLPI), joining student organizations, participating in social practice, voluntary service (p = 0.001 in SLPI), in training classes for student cadres (p = 0.02, 0.01, 0.02 in SRLS, EILI, and SLPI), and attending lectures on leadership (except for indicated, p < 0.001). Regression analysis showed that attending lectures on leadership was associated with high SRLS, EILI, and SLPI scores (p = 0.04, SRLS; p < 0.001, others), and SRLS and EILI scores could affect SLPI score (F = 2674.44, p < 0.001, R2 = 0.86).ConclusionsMedical graduates' transformational leadership competency at the Capital Medical University was medium measured from values, EI abilities, and behaviors. Group analysis indicated that knowledge learning, organizational involvement, and social/community involvement were associated with leadership capacity building, meanwhile, leaders' values and EI abilities would affect their behaviors, suggesting medical graduates should undertake leadership training from both knowledge learning and practicing.

Dataset Information

When Coproduction Is Unproductive Comment on "Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to 'Re-Imagine' Research".

Publications

When Coproduction Is Unproductive Comment on "Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to 'Re-Imagine' Research".

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