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The Island

Island partners

Internal VIHA factors

WHAT’S SPECIAL ABOUT US?

STAKEHOLDER ENGAGEMENT

We asked

1. Importance of regional health research capacity?

2. Top priorities?

3. Services/resources to develop?

4. Suitable collaborators?

5. Strategic supports required?

A robust, self-sustaining health research

community on Vancouver Island, playing an

essential role in the delivery of health services,

and improving health status and health care for

the Island’s population

VISION

Building capacity and/or sustainability

Key strategic areas for Island Health

Seniors health

First Nations health

Mental health and addictions

Creative opportunism

FOCUS

Yr 1 – 2 Yr 3 – 4 Yr 5+

Compliance +++ ++ +

Capacity +++ ++ +

Collaboration + ++ +++

Granting Program + ++ TBD

Patient/public

engagement

+

++ +++

ACTIVITY TRACKS

Research ethics review process

Institutional review

Research governance

Privacy and information access

Research collaboration & skills development

INTERNAL SYSTEMS

Permission to Contact (PtC)

Partnership with BC Biolibrary

Asking capable patients for permission

Genome Canada funding competition

Collaborative, Dr. Andrew Penn as PI

Early diagnosis of stroke

EARLY WINS

Initial seed funding $4.9m, through the Michael

Smith Foundation for Health Research

Transition to sustainable funding

Grant searching and supported applications

Matching with partners

Charitable donations

BUSINESS IMPERATIVE

$1.7m (over 4y) in individual grants

To support new research, research skills

development and knowledge translation

Able to respond to funding opportunities

GRANT FUNDING FOR RESEARCH

Collaboration and

partnerships increase

The research

environment has been

enhanced

Skills to conduct and

use research increase

Health and health

services improve

Sharing and use of

evidence increase

Short term

1 – 2 years

Medium term

3 – 4 years

Long term

5+ years

Starting by building a sound foundation

Defining a niche

Seeking to co-operate, not to compete

WHAT’S DIFFERENT THIS TIME?

HOW WE SEE OUR HEALTH SYSTEM AND

ORGANIZATIONS MATTERS

Lenses (metaphors) we use:

(Morgan, 1997)

Machines

Organisms

Brains

Cultures

Political systems

Psychic prisons

Flux and transformation

Instruments of domination

HOW WE SEE PROBLEMS MATTERS

“…the world does not issue problems in neat disciplinary

packages. Problems come up as complex,

multidimensional, and often confusing congeries of

issues. To deal with them, their multiple dimensions

must be understood, as well as what holds them

together as problems...” (Greenwood & Levin, 2005)

This is the “Humpty Dumpty” problem

(Waddock & Spangler, 2000, as cited by Greenwood & Levin, 2005)

KNOWING HOW WE COME TO KNOW MATTERS

Representational epistemology

Temporal epistemology

“Twisting the lion’s tail”

(Osberg & Biesta, 2003)

PHILOSOPHICAL CONSIDERATIONS

Practical/immediate

- actions

- decisions

- evidence

- procedures

- methods

- methodologies

- rhetoric

- axiologies

- epistemologies

- ontologies

Philosophical/research-oriented

ARISTOTLE REVISITED

Aristotle’s three Intellectual Virtues (Flyvbjerg, 2004; Greenwood & Levin, 2005; Van de Ven & Johnson, 2006)

Episteme

Techne

Phronesis

IN ALIGNMENT WITH THE VISION AND MISSION

OF RRU AND SOLS, TO ADVANCE THE STUDY

AND PRACTICE OF LEADERSHIP IN HEALTH

SYSTEMS AND SERVICES TO IMPROVE

POPULATION HEALTH.

RRU – CENTRE FOR HEALTH

LEADERSHIP AND RESEARCH (CHLR)

CREATE PARTNERSHIPS

DEVELOP A PROGRAM OF APPLIED RESEARCH

CONDUCT APPLIED RESEARCH

ORGANIZE KNOWLEDGE MOBILIZATION

ACTIVITIES

GROW AND BUILD STABILITY

CHLR’S FIVE PRIORITIES

ROYAL ROADS UNIVERSITY – ISLAND HEALTH

MEMORANDUM OF UNDERSTANDING

Health Leadership Research:

creation of a joint applied research agenda pertaining to health

leadership;

sharing of RRU and VIHA expertise in the development of high

quality health leadership research programs;

pursuit of funds to support a joint applied research agenda;

support for further collaborations with other relevant parties to

design and conduct applied research where additional content

expertise will be beneficial;

sharing of research findings and information that is of interest

toward improving the quality of health leadership.

ROYAL ROADS UNIVERSITY – ISLAND HEALTH

MEMORANDUM OF UNDERSTANDING

Health Leadership Programming:

sharing of RRU and VIHA expertise in the design and delivery of high

quality health leadership educational programs, including VIHA

participating on pertinent RRU Advisory Committees to help guide

programming;

exploration of the most appropriate face-to-face, blended, and fully online

learning models for health leadership development;

exploring means by which RRU and VIHA resources might complement

each other in the pursuit of joint health leadership educational programs;

engaging VIHA leaders to develop health leadership skills through active

participation in leadership development programs at RRU;

exploring the potential of VIHA to sponsor students in RRU health

leadership educational programs;

recognizing both Parties’ approval policies and procedures.

ACTION RESEARCH (AR)

“AR is social research carried out by a team encompassing a

professional action researcher and members of an

organization or community seeking to improve their

situation…

Together, the professional researcher and the stakeholders

define the problems to be examined, cogenerate relevant

knowledge about them, learn and execute social research

techniques, take actions, and interpret the results of actions

based on what they have learned.”

(Greenwood & Levin, 1998, p. 4)

HOW CAN AR BE APPLIED TO BUILD CAPACITY

IN PARTNERSHIP WITH A HEALTH AUTHORITY?

(GREENWOOD & LEVIN, 1998; KEMMIS, 1982, AS CITED IN HERR & ANDERSON, 2005)

Co-generate the problems to be solved

Co-generate the questions to be asked

Determine limitations and delimitations of the study

Communicate intent with stakeholders

Identify, invite, inform all study participants

Conduct data gathering using qualitative (and quantitative if

appropriate) methods

Conduct data analysis

HOW CAN AR WITH AN EVALUATION LENS BE

APPLIED IN IHEALTH

IMPLEMENTATION? (continued)

Co-generate knowledge from the findings

Ensure authenticity: fairness; ontological; educative; catalytic;

tactical

Take action based on this new knowledge

Co-observe in local context

Co-reflect

Undertake further cycles of AR as appropriate

WHAT KINDS OF THINGS CAN BE LEARNED?

e.g., from the perspectives of the users:

What kinds of questions we should be asking, especially those that

haven’t been thought of or asked yet

Voice about what and where are the real in situ frustrations,

problems, issues that are being faced during implementation, and

what is working well

How the implementation process could be improved

New knowledge that can be applied

WHAT KINDS OF THINGS CAN BE LEARNED?

(continued) e.g., from the perspectives of the users:

Improved implementation processes that could be incorporated and

re-assessed over time

Ability to scale up successes in other jurisdictions based on what

demonstrably addressed concerns

Actively engaging the user ‘community’ early saves time, energy and

money in the long run, and increases satisfaction

REFERENCES

Flyvbjerg, B. (2004). Phronetic planning research: Theoretical and methodological reflections.

Planning Theory & Practice, 5, 283-306. Retrieved March 27, 2006, from

http://www.metapress.com/media/2ljgrwvyyr8226vrfl1y/contributions/d/7/6/p/d76pbhv4531

1wj4w.pdf

Greenwood, D.J. & Levin, M. (2005). Reform of the social sciences and of universities through

action research. In N. K. Denzin & Y. S. Lincoln (Eds.). The Sage handbook of qualitative

research (3rd

ed.). (pp. 43-64). Thousand Oaks, CA: Sage.

Greenwood, D.J. & Levin, M. (1998). Introduction to action research: Social research for social

change. Thousand Oaks, CA: Sage.

Herr, K., & Anderson, G.L. (2005). The action research dissertation: A guide for students and

faculty. Thousand Oaks, CA: Sage.

Morgan, G. (1997). Images of organization. (2nd

ed.). Thousand Oaks, CA: Sage.

Osberg, D. and Biesta, G. (2003). October. Complexity, representation and the epistemology of

schooling. Paper presented at the invitational conference of Complexity Science and

Educational Research, Edmonton, AB.

Van de Ven, A. H. & Johnson, P. E. (2006). Knowledge for theory and practice. Academy of

Management Review (31), 802-821. Retrieved October 22, 2007, from EBSCOHost database:

Business Source Premier Publications.

ISLAND HEALTH’S PURPOSE

To provide superior healthcare through innovation,

teaching and RESEARCH and a commitment to

quality and safety, creating healthier, stronger

communities and a better quality of life for those

whose lives we touch.

2012

Capacity Funding Collaboration Patient/public engagement Compliance

BUSINESS PLAN DEVELOPMENT

MSFHR

Partnership

Stakeholder

Engagement

Information

Gathering

SWOT Analysis Researcher

Survey

BUSINESS PLAN

Executive

Review/Support

Board (s)

review/support Approval

BUILD

* Michael Smith Foundation for Health Research

Capacity Funding Collaboration Patient/public engagement Compliance

ANNUAL REFRESH

ALIGNMENT – MOVING TARGETS

Island Health Service Plan

Ministry of Health: Setting

Priorities for the BC Health

Care System

Strategy for Patient Orientated

Research

Emerging Academic Health

Sciences Network

HealthCareCAN

Capacity Funding Collaboration Patient/public engagement Compliance

VANCOUVER ISLAND – DIVERSE NEEDS

Collaboration

Capacity

Patient/Public Engagement

Funding

Compliance

Capacity Funding Collaboration Patient/public engagement Compliance

THE BUILD: 2012 TO 2015

Capacity Funding Collaboration Patient/public engagement Compliance

1. CAPACITY

Supports and Services

Data Management

Biostats Consulting

Granting Support

Research Facilitation

Knowledge Translation

Participant Recruitment

Training/Skills

Study Personnel (clinical trials)

Student Placements

The Business End

Contracts

Budgets

Grant management

Capacity Funding Collaboration Patient/public engagement Compliance

CAPACITY (CON’T): RESEARCH

FACILITATION

Services

Collaborators

Knowledge

translation

strategies

Operational Feasibility

Capacity Funding Collaboration Patient/public engagement Compliance

Students Grant Applications

RESEARCH SUPPORTS AND SERVICES –

THEN AND NOW

2 0 1 2

Excel

Nursing research facilitation

Scant training opportunities

2 0 1 5

REDCap

Research Facilitation

Events/Workshops/On-Line Training

Start up to Close Out

Biostats Consulting

Granting Programs, Grant Facilitation

Permission to Contact for Research

Research Privacy Tools/Facilitation

Capacity Funding Collaboration Patient/public engagement Compliance

Clinical Research support limited

2. FUNDING

I N T E R N A L

G R A N T S

1. Seed Grants

2. Research Support Grants

3. Research Catalyst Grants

4. Collaborative Research

Grants

5. Summer Student

Research Grants

6. Investigator Training

Grants

G R A N T

F A C I L I T A T I O N

• Funding opportunities

• Letters of support

• Institutional Sign Off

• Contacts granting

agencies for clarifications

• Reviews and edits

applications

Capacity Funding Collaboration Patient/public engagement Compliance

3. COLLABORATION

Capacity Funding Collaboration Patient/public engagement Compliance

4. PATIENT/PUBLIC ENGAGEMENT

Capacity Funding Collaboration Patient/public engagement Compliance

5. COMPLIANCE

Ethics & Ethics Harmonization

Institutional Review

IM IT research security assessments

Policies and Standard Operating Procedures

“Quality System” for research

Capacity Funding Collaboration Patient/public engagement Compliance

INFRASTRUCTURE – KNOWLEDGE CAPITAL

Contracts/Finance Research Business Manager

Research Finance Coordinator

Part time clerk (Finance)

Grant Facilitation

Education/Skills/

Communication

0.5 Grant Facilitator

0.5 Education Coordinator

Collaboration Research Liaison Officer

Knowledge Translation

Research Facilitation

0.5 KT Coordinator

0.5 Research Facilitator

Data Management

Biostatistics

Manager, Research Bioinformatics

Clinical Research Manager & Contract funded team

Patient/Public Engagement 0.6 FTE Project Manager

Compliance

Ethics

Institutional Review

Manager/Coordinators(2)/Admin

Research Privacy Specialist (PT)

EVALUATION PLAN

Have we increased:

• # researchers

• Volume and quality of research

• Research in Senior’s, Aboriginal and Mental Health/Substance

Use

Have we:

• Strengthened dissemination and uptake of research evidence

• Made research more equitable across Vancouver Island

• Contributed to the self-sustainability of research

And:

• Have there been unanticipated benefits?

Capacity Funding Collaboration Patient/public engagement Compliance

“Unless we can generate and use all types of research and

innovation in care and educational settings, we diminish our

potential for alleviating the burdens of disease and disability”

Bill Tholl

Genevieve Moineau

Our Vision Excellent health and care for everyone, everywhere, every time.

RESEARCH IN THE ISLAND HEALTH CONTEXT

WHY ENGAGE THE PUBLIC?

7/10 British Columbians are interested in participating in health research

But… only 33% are familiar with health & medical research conducted in their province and 24% are aware of opportunities to do so Canada Speaks 2015 Poll. Research Canada. http://www.rc-rc.ca/polling/2015-poll

WHY ENGAGE THE PUBLIC?

Canada Speaks 2015 Poll. Research Canada. http://www.rc-rc.ca/polling/2015-poll

ISLAND HEALTH’S ‘PUBLICS’

Population served: >765,000 people (17% of BC)

Region covered: Vancouver Island, the islands of the Georgia Strait, and

the mainland communities north of Powell River and south of Rivers

Inlet

Facilities: >150 (hospitals, clinics, health units, and residential facilities)

Health services provided:

Acute interventional

services

Medicine

Emergency

Diagnostics

Pharmacy

Home and community

care

Residential services

Seniors health

Population health

Aboriginal health

Primary health care

Mental health

Addictions services

Child, youth and family

health

Public health

• Increase research

awareness

Public

Patients

Participants

• Provide study

opportunities to patients

as a part of their care

• Optimize the research

participant experience

WHO ARE WE ENGAGING WITH?

PATIENT ENGAGEMENT IS A CONTINUUM

More impact

Less control, slower process

Public Patients Participants

HIGHLIGHTS OF INITIATIVES

Public Patients Participants

HIGHLIGHTS OF INITIATIVES

Public Patients Participants

HIGHLIGHTS OF INITIATIVES

WHY ‘PERMISSION TO CONTACT’?

Patients as research partners

Research-readiness

Improved quality

Staff engagement

CIHR Strategy for Patient Oriented Research

CLINIC PROCESS

Step 1: Eligibility assessed and form provided

Patient (or LAR if applicable) is able to speak and

understand English

A reasonable assessment of the patient (or LAR if

applicable) would find that they have the capacity

to understand the purpose of the PTC Program

and what participation involves

Step 2: Trained staff member oversees

documentation of PTC decision

Step 3: PTC info form is labelled (PPID) if ‘yes’ and

decision is recorded

RESEARCH UTILIZATION PROCESS

Step 1: Research Program processes application

and performs pre-screening

Step 2: Study Notification is distributed

Email, mail, phone

% PTC with email address is ~65%

Step 3: Interested people connect with study

contact person

Step 4: Study personnel determine eligibility and

informed consent process commences

EVALUATION AND SUSTAINABILITY

0

1000

2000

3000

4000

5000

6000

7000

8000

Number of PTC participants cumulative - inception to date

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

PTC acceptance rate (cumulative - all participating clinics)

0

1

2

3

4

5

6

Consultation Study Notification

Research projects supported

WHAT IS NEXT…

THE PATIENT PERSPECTIVE

“Health research has the potential to

really impact the patient journey.

One of the biggest impacts of being

involved in research is the

satisfaction that you get knowing

that you are participating in

something that can help not only

yourself but other people down the

road. I think that is the biggest

impact it has had for me.”

Colleen McGavin, Patient Partner

THANK YOU

rebecca.barnes@viha.ca

Research and Capacity Building website:

http://www.viha.ca/rnd/

Partners

INTERACTIVE PANEL DISCUSSION