What are the barriers and facilitators in implementing the findings from health services research?

Question

What will be an ideal response?

Answer 1

The inherent barriers to implementing health services research include a lack of immediate or obvious policy significance, the type of study performed, conflicts between policy and research priorities, differing timetables, poor communication, differences between policy and research scopes, differences in values between researchers and decision makers, a lack of leadership, poor rapport between researchers and decision makers, and a lack of collaboration.

Sometimes a scientifically significant study may not have immediate or obvious policy significance. To make this type of study more relevant clinically and with respect to health policy, another round of investigation, called transitional research, may be necessary. The objective of transitional research is to produce and apply knowledge to improve human health. The adoption of research findings in policy and practice also depends on the type of study and its likely impact. Research that focuses on clinical practices usually sees quicker adoption because clinical policy is more sensitive to research evidence. Studies that focus on organizational practices usually see slower adoption because changing organizational practices requires more time, and because more entities are involved. The emphasis on continual quality improvement provides a good impetus for organizations to improve. Research that focuses on national policies takes much longer to influence policy because national policies are formulated through political processes in which stakeholders advocate their own interests through their influence on lawmakers. Even though research does not have decisive influence on policy, it does affect policy in the long run.

There is a potential conflict between policy and research priorities. Decision makers are generally concerned about the most pressing problems, which are those that hinder the progress of their work. One of the limiting factors in the production of useful HSR is the failure by researchers to study problems that are of most concern to decision makers. Similarly, the failure of decision makers to clearly communicate their problems and concerns to health services investigators often impedes the production of useful and relevant research. To overcome this barrier, the policy and research committees need to have frequent dialogues to help in the understanding and appreciating of policy priorities, after which research could be planned accordingly to address these priorities. Regular face-to-face communication enables interprofessional team meetings and contributes to an enhanced sense of solidarity. Ensuring that decision makers are present in the governing or consultative bodies of research institutions or teams can also help.

Another potential conflict is the different timetables expected of research. Decision makers facing a pressing problem expect the research to be completed immediately, while researchers are concerned with the validity of the study design and findings, and often demand more time than decision makers envision. Strategies for reducing this gap include involving decision makers in the planning of the proposed research so that the two sides may come to an agreement as to the timetable for the project, and creating a series of useful progress reports and intermediate results from the study. These intermediate reports can be useful for decision making even before the project is completed.

Decision makers and researchers often do not share a common vocabulary, even though they need to discuss projects that have been developed before choosing the best plans and decisions. For decision makers, research results must be expressed in understandable vocabulary and be free of technical jargon. For investigators, as dictated by the publishing guidelines of scientific journals, results must be communicated in precise scientific terms after a detailed description of the research design and analysis has been provided. Investigators can help overcome this barrier by, in addition to preparing technical reports for scientific journals, writing nontechnical reports for decision makers that summarize the most pertinent results. Researchers can also meet with decision makers to help interpret research findings and answer questions. Decision makers can improve their knowledge of scientific research by taking research-related courses and seminars and by reading scientific journals related to their areas.

Another barrier is differences between policy and research scopes. Decision makers require useful and relevant research to provide broad, integrated information that assesses all the dimensions of a problem and reflects all the relevant factors. Investigators are trained to focus on a well-defined, narrow subject matter in order to yield conclusive results. To overcome this barrier, it is critical that researchers be knowledgeable about the institution or problem under investigation, fully aware of the dimensions and related issues their research will affect, and able to design an integrated project that takes into account all important policy concerns. Effective research should provide information and analysis that take into account the multiplicity of interests that exist in both the political system and the health care system. If there are research constraints, decision makers need to be informed and their expectations directed accordingly.

Researchers and decision makers may place different values on research. The value of research to investigators may be getting published in prestigious scientific journals contributing to existing literature, while the value of research to decision makers is its immediate application to problem-solving. In addition, personal values or ideological preferences may influence decision makers’ acceptance of research based on scientific evidence. To narrow the gap in values, decision makers should have a proper and realistic expectation of the value of research, and should be better educated and informed. For their part, the scientific community should place a higher premium on efforts toward research applications, and should recognize their personal biases and predilections and guard against these in the process of research.

Health services research is not a substitute for leadership in implementing research. Leadership is required to translate the knowledge derived from HSR into politically acceptable policy. The development and implementation of health care policy fundamentally depends on the leadership and initiatives of decision makers at various levels and sectors of society. It is also important for researchers and decision makers to build a close rapport so that research details can be more easily shared with each other. Collaboration with other specialists is also crucial to time-sensitive investigations and decision making. The collaboration of HSR can be supported through research institutions, universities, medical centers, government agencies, and professional associations. Successful and sustainable collaboration requires well-explicated processes, structure, and capacity building; the development of mutually beneficial relationships and effective participation without overloading the time and attention of members; and common goals to work together and carry out activities related to those goals.