Strengthening the links between researchers and clinicians is an important aim of many health policies and programs but is often difficult to achieve in practice. In the following piece, Lesley Barclay AO, Professor and Director, University Centre for Rural Health outlines the key elements of successful translational research and provides some useful tips for the new Translation Research Institute in Brisbane. Lesley writes…..
It’s great news that we have established a Translation Research Institute in Brisbane to combine biopharmaceutical manufacture, vaccine development and the intellects from a number of universities and research bodies. Australia and the world will benefit. However let’s think about knowledge translation in health services research (HSR). This does not occur in a building or in one location but when we engage in health services researchers with industry. The processes are different and we need to recognise and encourage this too.
For too long health services researchers have stood apart from policy and practice. We are too often seen by our industry colleagues or policymakers as an esoteric species somehow divorced from the business of improving health care. Partnerships that engage health system leaders and health services researchers through shared goals and endeavours can generate knowledge that quickly and directly improves health systems. Doing this builds ‘translation’ in, requires little effort, no additional personnel or ‘brokering’ and does not require a building! This process however requires rethinking about the conduct of HSR.
Where does research begin?
Commercial imperatives and investment often underpin our biopharmaceutical or vaccine research. Investigations designed to develop solutions to health service delivery problems however are often best initiated by those responsible for services. They have limited capacity to invest and no expectation of earning an income as a result which are freely shared. This type of research does not necessarily fit with current investigator or university imperatives. Nor does this fit with the current slow and expensive NHMRC grant awarding process. We need systems that enable investigators to respond rapidly and generate results by involving stakeholders much earlier in the process.
Good communication and credibility of researchers with policy makers, clinicians and planners is the first step in building engagement. Researchers or health leaders can initiate this relationship.
Researchers also need to respond rapidly to requests from health system leaders to provide evidence. This could be, for example, research synthesis skills for the rapid decision making sometimes required by leaders.
Australia has an agency (https://www.saxinstitute.org.au/) that promotes the use of research evidence in health policy by providing tools, such rapid research synthesis through commissioned reviews of evidence, for this purpose. It is important that we understand whether these kinds of strategies make a difference in increasing the use of research in policy with few tests of impact to this point. A more rigorous evaluations such as the SPIRIT trial will illuminate this in the future (https://www.saxinstitute.org.au/).
How do we measure quality and productivity?
Current indices of research productivity, predominantly through publications or research grant are essentially ‘counts’. They neither reflect nor do they create incentives for ‘co-production’ of knowledge or its application. Effective translation is easier to demonstrate clinically or in biopharmaceutical research where results may be applied in clinical guidelines or manufacture of vaccines respectively. Additional measures need to be developed to demonstrate application of research within improved health services.
The National Health and Medical Research Council (http://www.nhmrc.gov.au/) has instituted a recent reform in grant funding, the NHMRC Partnership Centres that create partnerships among decision makers, policy makers, managers, clinicians and researchers. Partners work together to refine research questions and are involved in the research process through governance. They then implement the findings. This appears to be a major step in the right direction.
How does this work and where do we start?
Researchers who succeed in these grants meet conventional measures of skills and productivity but also need to be able to work to and with industry leaders trying to improve health services. They are characterised by pragmatism and team work and often combine qualitative and qualitative techniques to investigate complex problems and syntheses across studies that explain complex systems.
Decision makers should initiate research that provides timely answers to urgent problems. They need to be part of teams that produce ‘evidence informed’ solutions. This approach conceptualises HSR and researchers as a ‘service’ industry. Investigators lose their esoteric species status and become colleagues. The process is independent of our NHMRC funding cycles, does not need institutes or buildings and this way stakeholder themselves become the ‘translators’ of the work they initiated.
Congratulations to the TRI; great move forward in discovering vaccines but let’s be equally committed to the option. That is stronger engagement of health services research with industry. The results could be even more profound.
Disclosure: Lesley Barclay was a foundational board member of the Sax Institute and has recently been re elected to this board. She has also served as a council member for the National Health and Medical Research Council ( NHMRC) and a grant awarding panel member for NHMRC, review grants regularly for NHMRC and the Australian Research Council (ARC) and has been in receipt of grants awarded by NHMRC and ARC.