Written by Dr Elizabeth Fradgley, CINSW Early Career Fellow, School of Medicine and Public Health, The University of Newcastle.
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In 2016, the Health Services Research Association of Australia and New Zealand (HSRAANZ) commissioned a University of Newcastle team led by Dr Elizabeth Fradgley to explore the funding and impact of the health services research community. Over 400 health services researchers provided details on their projects, the barriers experienced in conducting multidisciplinary health services research, and their views on how to enhance the impact of their work. The study findings have just been published in the Australian Health Review.
The study results showed a passionate health services research community who, despite limited funding and variable access to different skillsets, are committed to conducting impact-rich research, says Dr Fradgley. There has not been a similar audit of the community since 2005 despite the tremendous push to demonstrate research value across all fields of research.
Thanks to the many respondents, the study produced a rich dataset and collated qualitative feedback. The data will be used by HSRAANZ to advocate for the health services research community in the coming years.
But, what is critical for HSRAANZ members to know now?
Firstly, there was consistent feedback from survey respondents that the priorities of policy makers, research funders, health services and universities were often conflicting. The general impression from reviewing the qualitative feedback of over 300 respondents was a ‘clash of agendas’ as summarised by Dr Fradgley. In the respondents’ own words:
“I think we sometimes have a 'cultural' issue where health services want answers to questions quickly and cheaply but robust research takes time...”
“…There is definitely a cultural divide… Policy makers feel that research is too slow, not timely, too detailed, and too specific. To publish and survive in academia demands skills and a specific focus (detailed, methodical, explicitness) that is considered a barrier and problematic to government and policy makers.”
This ‘clash of agendas’ may, in part, be caused by the way in which health services researchers engage with research end-users. For example, of the 344 projects described, only half involved a consumer advocate (146/344) and a third involved a policy stakeholder (103/344). As a community, we must continue to engage with research end-users and think of creative ways to provide ongoing value whilst conducting robust long-term research, says Fradgley.
Secondly, the composition of the health services research community is shifting. Relative to the 2005 audit, there is now a greater proportion of healthcare professionals participating in research. Clinician researchers have tremendous potential to conduct pragmatic and service-relevant research; however, this skillset must be encouraged within a supportive workplace, with easy access to specialised expertise, such as trial design, economic analysis, and practice change.
“Clinicians have great ideas and often know where the gaps are, but don't have the skills, experience or resources to answer these questions using rigorous methods”
“We have a lot of junior doctors willing to drive research but it is very difficult to consistently find people willing and able to review a design and then to help evaluate and do statistics on results. It can become incredibly time consuming and sometimes expensive.”
Thirdly, 15% of respondents felt that a limited or inadequate dissemination plan reduced the impact of their work. Interestingly, less than half of the respondents reported there was evidence of research findings being adopted (42%) or that they had discussed how a health service could maintain the program after study conclusion (39%). To maximise the impact and value of health services research, research should be designed alongside plans to support the sustainable implementation of positive study outcomes. There is limited evidence on planning for sustainability and this could be a priority area for development. Dissemination plans are also important to raise awareness of health services research that could be translated to other areas of the healthcare system.
Finally, quantifying the impact of research outcomes and translation of new knowledge in improved health services delivery is challenging. Unfortunately, as one participant stated, ‘Health services research is still seen as a “luxury”’. We need to continue to demonstrate the value of our work and demonstrate health services research’s invaluable contribution to improving the wellbeing of the Australian and New Zealand peoples.
Read the full paper at: https://www.publish.csiro.au/AH/AH18213
View our full infographic of the key findings https://infograph.venngage.com/ps/vo4N6pM74pw/state-of-hsr-research