SPECIAL COMMENTARY
Achieving Effective Health Service Research Partnerships Rebecca Russ-Sellers, PhD,* Matthew F. Hudson, PhD, MPH,w Jerry R. Youkey, MD,z and Ronnie D. Horner, PhDy
T
here is ongoing and dynamic dialog regarding the degree to which health services research adequately addresses questions of critical importance to everyday medical practice. Central to this dialog is the issue of who should be at the proverbial “table,” or “on the bus,” and in what capacity. Increasingly, health services researchers are encouraged—by hook or by crook, that is, by funding or by willingness—to engage the health care provider, the patient, and other stakeholders in the research process. Including these nontraditional partners in the research process will certainly change the nature of investigations and, at least for some investigators, raise concern that such inclusiveness may profoundly compromise the scientific integrity of any study (ie, “damage the goods”). Health Service Researchers are not the first or only scientists challenged to balance their disciplinary perspective with that of the clinical practitioner.1 Both need to be aware of the “blind spots” inherent in their disciplines. And both need to be open to reconciling alternative perspectives with their traditional approach. So, how can we achieve a scientifically rigorous product that is also relevant, feasible, and sustainable in real-world medical practice? Or alternatively framed, how can clinical, academic, and industry partners align their respective strengths and needs to achieve meaningful results for all parties involved? Although risking hackneyed platitude, we firmly believe that effective collaboration across potential partners involved in clinically derived research is characterized by transparency and respect for views of all participants; partners must recognize that each perspective is beneficial and brings value to an effective and informed health services research enterprise. This “meeting-of-theminds” must occur before initiating any research project and optimally continues through the entire research process, involving several fundamental principles.
EARLY AND FREQUENT COMMUNICATION Early and continuing dialog among engaged parties is essential for creating a research process focused on improving care delivery and quality. Key initial communication goals include research topic agreement, establishing the project’s clinical relevance, determining the objective(s) to be achieved, and developing practical, “real-world” methodologies. Pragmatic research informed by the realities of the medical environment is not necessarily antithetical to theoretical constructs. Indeed, clinical relevance and practicality grounded in a conceptual framework strengthens process and outcome. Establishing consensus expectations regarding the nature of the research, and revising as appropriate, ensures that there are no unwarranted surprises for any of the partners as the research progresses. For example, research projects which inform both practice and theory associated with population health management of chronic disease or primary care workflow processes can determine clinical best practices, improve the delivery of care, and simultaneously inform scholarly work. From the *Care Coordination Institute; wComparative Effectiveness Office, Greenville Health System; zOffice of the Dean, University of South Carolina School of Medicine-Greenville, Greenville; and yDepartment of Health Services, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC. The authors declare no conflict of interest. Reprints: Ronnie D. Horner, PhD, Department of Health Services Policy and Management, Arnold School of Public Health, Discovery I Building-Suite 303, 915 Greene Street, Columbia, SC 29208. E-mail: [email protected]. Copyright r 2014 by Lippincott Williams & Wilkins ISSN: 0025-7079/14/5204-0289
Medical Care
Volume 52, Number 4, April 2014
www.lww-medicalcare.com |
289
Russ-Sellers et al
SHARED UNDERSTANDING OF THE FUNDAMENTAL GOAL Just as shared research priorities are an important foundation for effective clinical research collaboration, research goals and partner interests need to be aligned. The provider is particularly motivated to provide optimal health care. The health system is motivated to provide cost-effective care essential to financial stability. Payers want to minimize cost of care. Industrial partners seek patentable and marketable diagnostic and/or therapeutic products. The academician seeks to advance scientific knowledge through publication of findings and, of course, obtain grant dollars to conduct research projects. Patient-centeredness, however, is (or should be) the linchpin linking these seemingly disparate goals. The patient wants health care that positively impacts his/her health at an affordable cost, be it preventive care, chronic disease management, or curative therapy. Maintaining the patient as the central focus of the research assures clinical relevance and will likely generate outcomes of interest to each partner, whether practitioner, health system, or other stakeholder, to include the patient. Findings addressing care gaps and facilitating improved patient health at the individual and population level can incentivize academic researchers and industry. Such findings can advance the academician partner’s ability to attract further research funding, provide competitive publication opportunities, and, in addition, create novel research frontiers that junior faculty may explore. Industry partners can capitalize on these real-world findings to develop entrepreneurial health innovations such as telehealth technologies that may fill gaps in care and reach increasing volumes of patients through needed access. Health system and provider interests are served through implementation of research findings which provide clinically driven innovative solutions that lead to transformation of care. With a little creative thinking, there is no reason the involved stakeholders cannot achieve symbiotic partnerships.
HARMONIZING RESEARCH STRENGTHS Each partner contributes specific strengths to the group that, collectively, yield a multidimensional team: one that has higher likelihood of developing a feasible and sustain-
290 | www.lww-medicalcare.com
Medical Care
Volume 52, Number 4, April 2014
able improvement in health care delivery. The academic researcher contributes expertise in the design of scientifically rigorous projects that can validate a specific outcome. The industry partner brings business acumen necessary to assess and predict market interest in a product or process. The clinician can advise on the practicality of proposed research methods and approach, and guide real-world interpretation of findings. Health system leadership can advise on the realistic probability of broad implementation given the regulatory and reimbursement environments. Finally, the patient perspective indicates likelihood of individual and population acceptance of and compliance with a new care approach or product. Each partner must be open to considering the concerns of the other partner(s), and be willing to temper their standards to achieve a meaningfully impactful goal. For example, the researcher might contemplate the absolute necessity of a 90-item or even 30-item measure, particularly if the requisite data accrual time disrupts patient flow, excessively taxes the practicing clinician, and/or consequently begets patient and clinician dissatisfaction. The goal is to align the partners’ various needs and strengths to ensure that the process and product have utility and value for all.
CONCLUDING THOUGHTS Having all partners at the research table in a collaborative role can shift health services research into a transformative role in health care delivery. Sustainable change will only come through meaningful consideration of the strengths, interests, and needs of participating research partners and stakeholders, to include health care providers, as well as academic and industry researchers, and even the patient—our effort’s ultimate beneficiary. Forthright and streamlined dialog must align project processes and desired outcomes. Agreement on research priorities and process details can empower health research teams, and lead to transformation of health care. REFERENCE 1. Brandt AM, Gardner M. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century. Am J Public Health. 2000;90:707–715.
r
2014 Lippincott Williams & Wilkins
Achieving Effective Health Service Research Partnerships Rebecca Russ-Sellers, PhD,* Matthew F. Hudson, PhD, MPH,w Jerry R. Youkey, MD,z and Ronnie D. Horner, PhDy
T
here is ongoing and dynamic dialog regarding the degree to which health services research adequately addresses questions of critical importance to everyday medical practice. Central to this dialog is the issue of who should be at the proverbial “table,” or “on the bus,” and in what capacity. Increasingly, health services researchers are encouraged—by hook or by crook, that is, by funding or by willingness—to engage the health care provider, the patient, and other stakeholders in the research process. Including these nontraditional partners in the research process will certainly change the nature of investigations and, at least for some investigators, raise concern that such inclusiveness may profoundly compromise the scientific integrity of any study (ie, “damage the goods”). Health Service Researchers are not the first or only scientists challenged to balance their disciplinary perspective with that of the clinical practitioner.1 Both need to be aware of the “blind spots” inherent in their disciplines. And both need to be open to reconciling alternative perspectives with their traditional approach. So, how can we achieve a scientifically rigorous product that is also relevant, feasible, and sustainable in real-world medical practice? Or alternatively framed, how can clinical, academic, and industry partners align their respective strengths and needs to achieve meaningful results for all parties involved? Although risking hackneyed platitude, we firmly believe that effective collaboration across potential partners involved in clinically derived research is characterized by transparency and respect for views of all participants; partners must recognize that each perspective is beneficial and brings value to an effective and informed health services research enterprise. This “meeting-of-theminds” must occur before initiating any research project and optimally continues through the entire research process, involving several fundamental principles.
EARLY AND FREQUENT COMMUNICATION Early and continuing dialog among engaged parties is essential for creating a research process focused on improving care delivery and quality. Key initial communication goals include research topic agreement, establishing the project’s clinical relevance, determining the objective(s) to be achieved, and developing practical, “real-world” methodologies. Pragmatic research informed by the realities of the medical environment is not necessarily antithetical to theoretical constructs. Indeed, clinical relevance and practicality grounded in a conceptual framework strengthens process and outcome. Establishing consensus expectations regarding the nature of the research, and revising as appropriate, ensures that there are no unwarranted surprises for any of the partners as the research progresses. For example, research projects which inform both practice and theory associated with population health management of chronic disease or primary care workflow processes can determine clinical best practices, improve the delivery of care, and simultaneously inform scholarly work. From the *Care Coordination Institute; wComparative Effectiveness Office, Greenville Health System; zOffice of the Dean, University of South Carolina School of Medicine-Greenville, Greenville; and yDepartment of Health Services, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC. The authors declare no conflict of interest. Reprints: Ronnie D. Horner, PhD, Department of Health Services Policy and Management, Arnold School of Public Health, Discovery I Building-Suite 303, 915 Greene Street, Columbia, SC 29208. E-mail: [email protected]. Copyright r 2014 by Lippincott Williams & Wilkins ISSN: 0025-7079/14/5204-0289
Medical Care
Volume 52, Number 4, April 2014
www.lww-medicalcare.com |
289
Russ-Sellers et al
SHARED UNDERSTANDING OF THE FUNDAMENTAL GOAL Just as shared research priorities are an important foundation for effective clinical research collaboration, research goals and partner interests need to be aligned. The provider is particularly motivated to provide optimal health care. The health system is motivated to provide cost-effective care essential to financial stability. Payers want to minimize cost of care. Industrial partners seek patentable and marketable diagnostic and/or therapeutic products. The academician seeks to advance scientific knowledge through publication of findings and, of course, obtain grant dollars to conduct research projects. Patient-centeredness, however, is (or should be) the linchpin linking these seemingly disparate goals. The patient wants health care that positively impacts his/her health at an affordable cost, be it preventive care, chronic disease management, or curative therapy. Maintaining the patient as the central focus of the research assures clinical relevance and will likely generate outcomes of interest to each partner, whether practitioner, health system, or other stakeholder, to include the patient. Findings addressing care gaps and facilitating improved patient health at the individual and population level can incentivize academic researchers and industry. Such findings can advance the academician partner’s ability to attract further research funding, provide competitive publication opportunities, and, in addition, create novel research frontiers that junior faculty may explore. Industry partners can capitalize on these real-world findings to develop entrepreneurial health innovations such as telehealth technologies that may fill gaps in care and reach increasing volumes of patients through needed access. Health system and provider interests are served through implementation of research findings which provide clinically driven innovative solutions that lead to transformation of care. With a little creative thinking, there is no reason the involved stakeholders cannot achieve symbiotic partnerships.
HARMONIZING RESEARCH STRENGTHS Each partner contributes specific strengths to the group that, collectively, yield a multidimensional team: one that has higher likelihood of developing a feasible and sustain-
290 | www.lww-medicalcare.com
Medical Care
Volume 52, Number 4, April 2014
able improvement in health care delivery. The academic researcher contributes expertise in the design of scientifically rigorous projects that can validate a specific outcome. The industry partner brings business acumen necessary to assess and predict market interest in a product or process. The clinician can advise on the practicality of proposed research methods and approach, and guide real-world interpretation of findings. Health system leadership can advise on the realistic probability of broad implementation given the regulatory and reimbursement environments. Finally, the patient perspective indicates likelihood of individual and population acceptance of and compliance with a new care approach or product. Each partner must be open to considering the concerns of the other partner(s), and be willing to temper their standards to achieve a meaningfully impactful goal. For example, the researcher might contemplate the absolute necessity of a 90-item or even 30-item measure, particularly if the requisite data accrual time disrupts patient flow, excessively taxes the practicing clinician, and/or consequently begets patient and clinician dissatisfaction. The goal is to align the partners’ various needs and strengths to ensure that the process and product have utility and value for all.
CONCLUDING THOUGHTS Having all partners at the research table in a collaborative role can shift health services research into a transformative role in health care delivery. Sustainable change will only come through meaningful consideration of the strengths, interests, and needs of participating research partners and stakeholders, to include health care providers, as well as academic and industry researchers, and even the patient—our effort’s ultimate beneficiary. Forthright and streamlined dialog must align project processes and desired outcomes. Agreement on research priorities and process details can empower health research teams, and lead to transformation of health care. REFERENCE 1. Brandt AM, Gardner M. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century. Am J Public Health. 2000;90:707–715.
r
2014 Lippincott Williams & Wilkins
