Dissemination & Implementation in Health Systems: More GPS than Self-Driving Car Sarah M. Greene, MPH Health Care Systems Research Network D&I Conference, December 2016
Acknowledgements Michael Parchman Brian Austin Eric Larson Interview Participants
“In health care, invention is hard, but dissemination is even harder.” Don Berwick, JAMA 2003
We are fortunate — strong conceptual frameworks available to guide D&I However, execution, i.e., the tactical and Content / Topic operational aspects of effective D&I may Audience Receptivity Agility/Adaptability require more than a strong framework Timeframe / Serendipity Dialect / Semantics Ease of Change Given the myriad influential factors that Availability of Resources & Tools support or impede D&I have we given Workflow Considerations Incentives and Disincentives researchers the tools to execute against Costs (Financial & Human) these conceptual frameworks? Alignment w/Current Practice Cultural Mores Peer Influencers Change Management De-implementation
Premise: Dissemination & Implementation Require Considerable Energy • Slack for change is one dimension of this energetic state, and it applies to both individuals and organizations (i.e., target of the D&I) • But another dimension of “energy” is actually having the skill and the will to effectively disseminate or work with others to implement an intervention • To what extent do organizations need to invest in the skill and foster the will to undertake more robust dissemination and implementation?
Context: Research Center Embedded in an Integrated Health Care Delivery System • Confers advantages in that the researchers are proximate to the care delivery activities; increases potential to align research with delivery system priorities • Facilitates realization of “Learning Health Care System,” where practice informs research, and research informs practice • Research center sought to examine barriers and facilitators to more effective D&I, both within its parent health system, and more broadly • Objectives of this project were to identify challenges and opportunities and conceive a possible business model for the D&I work of a unit within the Center
Methods Key Informant Interviews (Semi-structured, ~1 hour) • Participants: research faculty, project managers, operational leaders • Willingness to engage in (more) D&I • D&I capabilities at the individual and organizational level • Moral imperative to disseminate research? • Other challenges and opportunities Environmental Scan • Exemplar entities engaged in strategic D&I as a way to sustain research activities • Business models / funding streams of these entities
Findings : Key Informant Interviews 28 interview sessions (27 individuals; one small group) Respondents expressed interest in broad range of passive and active dissemination opportunities: • Hosted symposia, training/short courses, papers, conferences, national webinars, consulting, other thought leadership Explored barriers & facilitators to implementation within parent organization and external opportunities Barriers and facilitators categorized into three themes: • Technical infrastructure to support D&I • Designing for dissemination • Business acumen
Primary Insights from Key Informants Variable desire to do more dissemination &/or implementation • For some, producing and publishing good science was enough • Numerous concerns that D&I was an “unfunded mandate” after grant was completed • Others felt that more robust D&I was mission critical • Important distinction drawn between disseminating research results and disseminating expertise and learned experiences from doing research • “Currency” is getting grants, publishing; unless consulting on implementation leads to subsequent grant funding or promotion, motivation is less compelling “If we are to achieve our mission, we have to see “There’s a lot of value to producing good science and not dissemination as an equally important line of business being on the hook to do more. There is an obligation to as doing research.” your own institution, but not necessarily beyond that.”
Closer Look at Key Challenges (1) CATEGORY: Technical Infrastructure Unable to rapidly develop and deploy websites to disseminate content with full autonomy (content vetting from parent system required) Difficult to do rapid online prototyping or A/B testing to assess effective dissemination messages Given growing importance of video as dissemination tool, research teams need videography capability that is available in more agile/on-demand fashion Impediments to holding large virtual conferences/webinars (bandwidth, firewalls, IT support) Food for Thought: Does your organization have the necessary breadth and depth of technical capabilities to support desired dissemination & implementation activities?
Closer Look at Key Challenges (2) CATEGORY: Designing for Dissemination Challenging to build enduring relationships with parent health system, given organizational complexity, size, and churn Lack strong ability to pitch research, whether to policymakers, system leaders, patients, clinicians Dissemination (beyond journal articles) often an afterthought and may not meet end-user needs — e.g., policymakers and patients need different types of synopses of research studies Social media could be deployed more strategically, but use and comfort with social media tools varied Long research studies could benefit from mid-course engagement w/patients, but this is not always routinely planned in grant proposals Food for Thought: Do we need to revisit expectations for researchers and funding agencies with respect to D&I? What if researchers were assessed based on tangible markers of impact (e.g., implementing, then sustaining an intervention)?
Closer Look at Key Challenges (3) CATEGORY: Business Acumen Need business development expertise for assessing market potential and value of a research product/intervention Need expertise to navigate issues related to intellectual property Research center unable to generate and retain its own revenue, due to restrictions in parent health system Researchers on 100% soft money may be unable to pursue certain D&I opportunities, e.g., ad hoc consulting on implementation of a program Assess how to monetize symposia , conferences, training, including the “soft ROI” derived from becoming thought leaders Food for Thought: Are we getting the maximum return on investment on our research? Could there be an analog to technology transfer offices to support behavioral, social sciences, and health services research?
Insights from Environmental Scan 15 case studies, chosen to represent breadth of different models 6 based in academic institutions • 6 based in health systems • 2 began as research projects and were subsumed into businesses • 1 freestanding health improvement organization • Environmental scan describes the trajectory, funding model, customer/market, and tailored insights for the research center that sponsored this project Funding models included: • Grants & contracts “Is it really • Fee-based trainings, conferences, and consultation dissemination if no Part of parent organization’s operating budget • one uses it?” • Venture capital backing • Philanthropic support Essential to determine whether there is a demand for what you’re supplying!
15 Predominately Initial Project soft money • Test Hypothesis Multiple Related Projects • Test various related interventions • Build evidence base A general model Build Expertise/Credibility showing the • Reputation becomes a possible trajectory commodity from project to independent entity Center of Excellence • An entity with a distinct identity • Revenue model Department/Independent Entity • Embed in parent organization Core money, • Stand-alone operating budget Revenue opportunity • Diverse related offerings
Concluding Thoughts & Implications • To realize the full ROI of our research and succeed at D&I, need (at least) three attributes: tools, training, and time • Many researchers do not receive formal training in how to effectively persuade others on the uptake of findings, hoping that the journal articles will speak for themselves provided someone finds the right article at the right time • Implementation is dependent on forming strong partnerships, but may not be top of mind when developing research proposals, many changes between time study is funded and results are ready for implementation • No one size fits all model for supporting and sustaining D&I, however organizational capabilities are a prerequisite and warrant examination
Robust D&I capabilities can drive health care learning, system-wide improvement From: Implementing the Learning Health System: From Concept to Action. Ann Intern Med. 2012;157(3):207-210.
Friendly amendment to Dr. Berwick’s quote! “In health care, invention is hard, but dissemination are even harder.” & implementation Berwick, JAMA 2003
Thank you! sarahgreene@hcsrn.org @researchmatters @hcsrn
Recommend
More recommend
