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The Island
Island partners
Internal VIHA factors
WHAT’S SPECIAL ABOUT US?
STAKEHOLDER ENGAGEMENT
We asked
1. Importance of regional health research capacity?
2. Top priorities?
3. Services/resources to develop?
4. Suitable collaborators?
5. Strategic supports required?
A robust, self-sustaining health research
community on Vancouver Island, playing an
essential role in the delivery of health services,
and improving health status and health care for
the Island’s population
VISION
Building capacity and/or sustainability
Key strategic areas for Island Health
Seniors health
First Nations health
Mental health and addictions
Creative opportunism
FOCUS
Yr 1 – 2 Yr 3 – 4 Yr 5+
Compliance +++ ++ +
Capacity +++ ++ +
Collaboration + ++ +++
Granting Program + ++ TBD
Patient/public
engagement
+
++ +++
ACTIVITY TRACKS
Research ethics review process
Institutional review
Research governance
Privacy and information access
Research collaboration & skills development
INTERNAL SYSTEMS
Permission to Contact (PtC)
Partnership with BC Biolibrary
Asking capable patients for permission
Genome Canada funding competition
Collaborative, Dr. Andrew Penn as PI
Early diagnosis of stroke
EARLY WINS
Initial seed funding $4.9m, through the Michael
Smith Foundation for Health Research
Transition to sustainable funding
Grant searching and supported applications
Matching with partners
Charitable donations
BUSINESS IMPERATIVE
$1.7m (over 4y) in individual grants
To support new research, research skills
development and knowledge translation
Able to respond to funding opportunities
GRANT FUNDING FOR RESEARCH
Collaboration and
partnerships increase
The research
environment has been
enhanced
Skills to conduct and
use research increase
Health and health
services improve
Sharing and use of
evidence increase
Short term
1 – 2 years
Medium term
3 – 4 years
Long term
5+ years
Starting by building a sound foundation
Defining a niche
Seeking to co-operate, not to compete
WHAT’S DIFFERENT THIS TIME?
HOW WE SEE OUR HEALTH SYSTEM AND
ORGANIZATIONS MATTERS
Lenses (metaphors) we use:
(Morgan, 1997)
Machines
Organisms
Brains
Cultures
Political systems
Psychic prisons
Flux and transformation
Instruments of domination
HOW WE SEE PROBLEMS MATTERS
“…the world does not issue problems in neat disciplinary
packages. Problems come up as complex,
multidimensional, and often confusing congeries of
issues. To deal with them, their multiple dimensions
must be understood, as well as what holds them
together as problems...” (Greenwood & Levin, 2005)
This is the “Humpty Dumpty” problem
(Waddock & Spangler, 2000, as cited by Greenwood & Levin, 2005)
KNOWING HOW WE COME TO KNOW MATTERS
Representational epistemology
Temporal epistemology
“Twisting the lion’s tail”
(Osberg & Biesta, 2003)
PHILOSOPHICAL CONSIDERATIONS
Practical/immediate
- actions
- decisions
- evidence
- procedures
- methods
- methodologies
- rhetoric
- axiologies
- epistemologies
- ontologies
Philosophical/research-oriented
ARISTOTLE REVISITED
Aristotle’s three Intellectual Virtues (Flyvbjerg, 2004; Greenwood & Levin, 2005; Van de Ven & Johnson, 2006)
Episteme
Techne
Phronesis
IN ALIGNMENT WITH THE VISION AND MISSION
OF RRU AND SOLS, TO ADVANCE THE STUDY
AND PRACTICE OF LEADERSHIP IN HEALTH
SYSTEMS AND SERVICES TO IMPROVE
POPULATION HEALTH.
RRU – CENTRE FOR HEALTH
LEADERSHIP AND RESEARCH (CHLR)
CREATE PARTNERSHIPS
DEVELOP A PROGRAM OF APPLIED RESEARCH
CONDUCT APPLIED RESEARCH
ORGANIZE KNOWLEDGE MOBILIZATION
ACTIVITIES
GROW AND BUILD STABILITY
CHLR’S FIVE PRIORITIES
ROYAL ROADS UNIVERSITY – ISLAND HEALTH
MEMORANDUM OF UNDERSTANDING
Health Leadership Research:
creation of a joint applied research agenda pertaining to health
leadership;
sharing of RRU and VIHA expertise in the development of high
quality health leadership research programs;
pursuit of funds to support a joint applied research agenda;
support for further collaborations with other relevant parties to
design and conduct applied research where additional content
expertise will be beneficial;
sharing of research findings and information that is of interest
toward improving the quality of health leadership.
ROYAL ROADS UNIVERSITY – ISLAND HEALTH
MEMORANDUM OF UNDERSTANDING
Health Leadership Programming:
sharing of RRU and VIHA expertise in the design and delivery of high
quality health leadership educational programs, including VIHA
participating on pertinent RRU Advisory Committees to help guide
programming;
exploration of the most appropriate face-to-face, blended, and fully online
learning models for health leadership development;
exploring means by which RRU and VIHA resources might complement
each other in the pursuit of joint health leadership educational programs;
engaging VIHA leaders to develop health leadership skills through active
participation in leadership development programs at RRU;
exploring the potential of VIHA to sponsor students in RRU health
leadership educational programs;
recognizing both Parties’ approval policies and procedures.
ACTION RESEARCH (AR)
“AR is social research carried out by a team encompassing a
professional action researcher and members of an
organization or community seeking to improve their
situation…
Together, the professional researcher and the stakeholders
define the problems to be examined, cogenerate relevant
knowledge about them, learn and execute social research
techniques, take actions, and interpret the results of actions
based on what they have learned.”
(Greenwood & Levin, 1998, p. 4)
HOW CAN AR BE APPLIED TO BUILD CAPACITY
IN PARTNERSHIP WITH A HEALTH AUTHORITY?
(GREENWOOD & LEVIN, 1998; KEMMIS, 1982, AS CITED IN HERR & ANDERSON, 2005)
Co-generate the problems to be solved
Co-generate the questions to be asked
Determine limitations and delimitations of the study
Communicate intent with stakeholders
Identify, invite, inform all study participants
Conduct data gathering using qualitative (and quantitative if
appropriate) methods
Conduct data analysis
HOW CAN AR WITH AN EVALUATION LENS BE
APPLIED IN IHEALTH
IMPLEMENTATION? (continued)
Co-generate knowledge from the findings
Ensure authenticity: fairness; ontological; educative; catalytic;
tactical
Take action based on this new knowledge
Co-observe in local context
Co-reflect
Undertake further cycles of AR as appropriate
WHAT KINDS OF THINGS CAN BE LEARNED?
e.g., from the perspectives of the users:
What kinds of questions we should be asking, especially those that
haven’t been thought of or asked yet
Voice about what and where are the real in situ frustrations,
problems, issues that are being faced during implementation, and
what is working well
How the implementation process could be improved
New knowledge that can be applied
WHAT KINDS OF THINGS CAN BE LEARNED?
(continued) e.g., from the perspectives of the users:
Improved implementation processes that could be incorporated and
re-assessed over time
Ability to scale up successes in other jurisdictions based on what
demonstrably addressed concerns
Actively engaging the user ‘community’ early saves time, energy and
money in the long run, and increases satisfaction
REFERENCES
Flyvbjerg, B. (2004). Phronetic planning research: Theoretical and methodological reflections.
Planning Theory & Practice, 5, 283-306. Retrieved March 27, 2006, from
http://www.metapress.com/media/2ljgrwvyyr8226vrfl1y/contributions/d/7/6/p/d76pbhv4531
1wj4w.pdf
Greenwood, D.J. & Levin, M. (2005). Reform of the social sciences and of universities through
action research. In N. K. Denzin & Y. S. Lincoln (Eds.). The Sage handbook of qualitative
research (3rd
ed.). (pp. 43-64). Thousand Oaks, CA: Sage.
Greenwood, D.J. & Levin, M. (1998). Introduction to action research: Social research for social
change. Thousand Oaks, CA: Sage.
Herr, K., & Anderson, G.L. (2005). The action research dissertation: A guide for students and
faculty. Thousand Oaks, CA: Sage.
Morgan, G. (1997). Images of organization. (2nd
ed.). Thousand Oaks, CA: Sage.
Osberg, D. and Biesta, G. (2003). October. Complexity, representation and the epistemology of
schooling. Paper presented at the invitational conference of Complexity Science and
Educational Research, Edmonton, AB.
Van de Ven, A. H. & Johnson, P. E. (2006). Knowledge for theory and practice. Academy of
Management Review (31), 802-821. Retrieved October 22, 2007, from EBSCOHost database:
Business Source Premier Publications.
ISLAND HEALTH’S PURPOSE
To provide superior healthcare through innovation,
teaching and RESEARCH and a commitment to
quality and safety, creating healthier, stronger
communities and a better quality of life for those
whose lives we touch.
2012
Capacity Funding Collaboration Patient/public engagement Compliance
BUSINESS PLAN DEVELOPMENT
MSFHR
Partnership
Stakeholder
Engagement
Information
Gathering
SWOT Analysis Researcher
Survey
BUSINESS PLAN
Executive
Review/Support
Board (s)
review/support Approval
BUILD
* Michael Smith Foundation for Health Research
Capacity Funding Collaboration Patient/public engagement Compliance
ANNUAL REFRESH
ALIGNMENT – MOVING TARGETS
Island Health Service Plan
Ministry of Health: Setting
Priorities for the BC Health
Care System
Strategy for Patient Orientated
Research
Emerging Academic Health
Sciences Network
HealthCareCAN
Capacity Funding Collaboration Patient/public engagement Compliance
VANCOUVER ISLAND – DIVERSE NEEDS
Collaboration
Capacity
Patient/Public Engagement
Funding
Compliance
Capacity Funding Collaboration Patient/public engagement Compliance
THE BUILD: 2012 TO 2015
Capacity Funding Collaboration Patient/public engagement Compliance
1. CAPACITY
Supports and Services
Data Management
Biostats Consulting
Granting Support
Research Facilitation
Knowledge Translation
Participant Recruitment
Training/Skills
Study Personnel (clinical trials)
Student Placements
The Business End
Contracts
Budgets
Grant management
Capacity Funding Collaboration Patient/public engagement Compliance
CAPACITY (CON’T): RESEARCH
FACILITATION
Services
Collaborators
Knowledge
translation
strategies
Operational Feasibility
Capacity Funding Collaboration Patient/public engagement Compliance
Students Grant Applications
RESEARCH SUPPORTS AND SERVICES –
THEN AND NOW
2 0 1 2
Excel
Nursing research facilitation
Scant training opportunities
2 0 1 5
REDCap
Research Facilitation
Events/Workshops/On-Line Training
Start up to Close Out
Biostats Consulting
Granting Programs, Grant Facilitation
Permission to Contact for Research
Research Privacy Tools/Facilitation
Capacity Funding Collaboration Patient/public engagement Compliance
Clinical Research support limited
2. FUNDING
I N T E R N A L
G R A N T S
1. Seed Grants
2. Research Support Grants
3. Research Catalyst Grants
4. Collaborative Research
Grants
5. Summer Student
Research Grants
6. Investigator Training
Grants
G R A N T
F A C I L I T A T I O N
• Funding opportunities
• Letters of support
• Institutional Sign Off
• Contacts granting
agencies for clarifications
• Reviews and edits
applications
Capacity Funding Collaboration Patient/public engagement Compliance
3. COLLABORATION
Capacity Funding Collaboration Patient/public engagement Compliance
4. PATIENT/PUBLIC ENGAGEMENT
Capacity Funding Collaboration Patient/public engagement Compliance
5. COMPLIANCE
Ethics & Ethics Harmonization
Institutional Review
IM IT research security assessments
Policies and Standard Operating Procedures
“Quality System” for research
Capacity Funding Collaboration Patient/public engagement Compliance
INFRASTRUCTURE – KNOWLEDGE CAPITAL
Contracts/Finance Research Business Manager
Research Finance Coordinator
Part time clerk (Finance)
Grant Facilitation
Education/Skills/
Communication
0.5 Grant Facilitator
0.5 Education Coordinator
Collaboration Research Liaison Officer
Knowledge Translation
Research Facilitation
0.5 KT Coordinator
0.5 Research Facilitator
Data Management
Biostatistics
Manager, Research Bioinformatics
Clinical Research Manager & Contract funded team
Patient/Public Engagement 0.6 FTE Project Manager
Compliance
Ethics
Institutional Review
Manager/Coordinators(2)/Admin
Research Privacy Specialist (PT)
EVALUATION PLAN
Have we increased:
• # researchers
• Volume and quality of research
• Research in Senior’s, Aboriginal and Mental Health/Substance
Use
Have we:
• Strengthened dissemination and uptake of research evidence
• Made research more equitable across Vancouver Island
• Contributed to the self-sustainability of research
And:
• Have there been unanticipated benefits?
Capacity Funding Collaboration Patient/public engagement Compliance
“Unless we can generate and use all types of research and
innovation in care and educational settings, we diminish our
potential for alleviating the burdens of disease and disability”
Bill Tholl
Genevieve Moineau
Our Vision Excellent health and care for everyone, everywhere, every time.
RESEARCH IN THE ISLAND HEALTH CONTEXT
WHY ENGAGE THE PUBLIC?
7/10 British Columbians are interested in participating in health research
But… only 33% are familiar with health & medical research conducted in their province and 24% are aware of opportunities to do so Canada Speaks 2015 Poll. Research Canada. http://www.rc-rc.ca/polling/2015-poll
WHY ENGAGE THE PUBLIC?
Canada Speaks 2015 Poll. Research Canada. http://www.rc-rc.ca/polling/2015-poll
ISLAND HEALTH’S ‘PUBLICS’
Population served: >765,000 people (17% of BC)
Region covered: Vancouver Island, the islands of the Georgia Strait, and
the mainland communities north of Powell River and south of Rivers
Inlet
Facilities: >150 (hospitals, clinics, health units, and residential facilities)
Health services provided:
Acute interventional
services
Medicine
Emergency
Diagnostics
Pharmacy
Home and community
care
Residential services
Seniors health
Population health
Aboriginal health
Primary health care
Mental health
Addictions services
Child, youth and family
health
Public health
• Increase research
awareness
Public
Patients
Participants
• Provide study
opportunities to patients
as a part of their care
• Optimize the research
participant experience
WHO ARE WE ENGAGING WITH?
PATIENT ENGAGEMENT IS A CONTINUUM
More impact
Less control, slower process
Public Patients Participants
HIGHLIGHTS OF INITIATIVES
Public Patients Participants
HIGHLIGHTS OF INITIATIVES
Public Patients Participants
HIGHLIGHTS OF INITIATIVES
WHY ‘PERMISSION TO CONTACT’?
Patients as research partners
Research-readiness
Improved quality
Staff engagement
CIHR Strategy for Patient Oriented Research
CLINIC PROCESS
Step 1: Eligibility assessed and form provided
Patient (or LAR if applicable) is able to speak and
understand English
A reasonable assessment of the patient (or LAR if
applicable) would find that they have the capacity
to understand the purpose of the PTC Program
and what participation involves
Step 2: Trained staff member oversees
documentation of PTC decision
Step 3: PTC info form is labelled (PPID) if ‘yes’ and
decision is recorded
RESEARCH UTILIZATION PROCESS
Step 1: Research Program processes application
and performs pre-screening
Step 2: Study Notification is distributed
Email, mail, phone
% PTC with email address is ~65%
Step 3: Interested people connect with study
contact person
Step 4: Study personnel determine eligibility and
informed consent process commences
EVALUATION AND SUSTAINABILITY
0
1000
2000
3000
4000
5000
6000
7000
8000
Number of PTC participants cumulative - inception to date
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
PTC acceptance rate (cumulative - all participating clinics)
0
1
2
3
4
5
6
Consultation Study Notification
Research projects supported
WHAT IS NEXT…
THE PATIENT PERSPECTIVE
“Health research has the potential to
really impact the patient journey.
One of the biggest impacts of being
involved in research is the
satisfaction that you get knowing
that you are participating in
something that can help not only
yourself but other people down the
road. I think that is the biggest
impact it has had for me.”
Colleen McGavin, Patient Partner
THANK YOU
Research and Capacity Building website:
http://www.viha.ca/rnd/
Partners
INTERACTIVE PANEL DISCUSSION