Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships

Partnership-building considerations for implementation science in learning health systems: a case study of the Implementation Science Collaborative in Alberta, Canada

Introduction

Implementation of health innovations is inherently collaborative, requiring trans-sectoral partnerships between implementation researchers, innovation teams, and implementation practitioners. Implementation science has been shown to improve implementation successes; however, challenges that hinder partnerships to advance implementation science continue to persist. Using a whole-system approach to assess and respond to implementation science partnership barriers may shed light on effective responses.

Methods

We conducted a case study of Alberta's learning health system, using semi-structured group and individual interviews to create a nuanced understanding of the considerations required for implementation research collaborations. We interviewed 53 participants representing 21 offices in the health system, academia, professional associations, and government who regularly plan, evaluate, and/or study health system implementation initiatives in Alberta. Using the Partnership Model for Research Capacity Building, we identified current facilitators and challenges for partnerships for conducting and using implementation science, at different levels of Alberta's health-research ecosystem.

Results

Alberta's healthcare system is well set up to readily embed intervention effectiveness and efficacy research. Infrastructure was also in place to strengthen implementation practice. However, weaknesses around exchanging knowledge and skills, providing feedback and mentoring, and accommodating diversity affected the ability of both individuals and teams to build implementation science capacity. Without this capacity, teams could not participate in embedded implementation research collaborations. We report the response of the Alberta Strategy for Patient-Oriented Research SUPPORT Unit to these barriers to provide practical guidance on various program options to strengthen individual- and organization-level implementation science capacity.

Discussion

This study applied a whole-system approach to assess factors across Alberta's health-research ecosystem, which affect partnerships to advance implementation science. Our findings illustrated that partnership considerations go beyond interpersonal factors and include system-wide considerations. With the results, health organization leaders have (1) a method for assessing organizational capability to readily embed implementation research and (2) a catalog of potential responses to create conditions to readily engage with implementation science in their day-to-day implementation processes.

Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program

BACKGROUND

This descriptive study reports the early career outcomes of postdoctoral fellows who completed a novel embedded fellowship training program, the Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship. The program was designed to support impact-oriented career paths of doctoral graduates, build research capacity within health system organizations, and help to advance learning health systems in Canada.

METHODS

Employment of fellowship alumni upon completion of the program were tracked using internet searches of publicly accessible online sources and complemented with program survey data.

RESULTS

Descriptive analyses show that all 87 eligible alumni included in the study are currently employed (100% of 87), with 92% employed in Canada. Their employment spans several sectors, including in academic (37%), public (29%), healthcare delivery (17%), and private (14%) sectors. Altogether, 32% of alumni held hybrid roles with an affiliation in academia and another sector. The most common position types were senior scientist (42%), professorships (18%), and director, manager or administrator roles (12%). Program reporting data indicate that these employment outcomes are generally consistent with the group's career aspirations reported at the start of the fellowship program, and that the program receives high ratings from fellows in the extent it is believed to support their career preparedness and readiness (4.49 out of 5).

CONCLUSION

We find that HSI Fellow alumni are employed mostly in research-related roles in a range of sectors including, but not limited to academia, that they positively perceive the program's success in elevating their career readiness and potential to make an impact - suggesting that the program may help equip fellows with the skills, readiness and networks for a broad array of employment sectors and roles. The findings are a promising signal of the demand for research talent and the growing capacity for learning health systems in Canada.

Changing Care: Applying the Transtheoretical Model of Change to Embed Equity, Diversity, and Inclusion in Long-Term Care Research in Canada

Healthcare policy reform is evident when considering the past, present and future of long-term care (LTC) in Canada. Some of the most pressing issues facing the LTC sector include the changing demographic composition in Canadian LTC homes, minimal consideration for the role of intersectionality in LTC data collection and analysis, and the expanding need to engage diverse participants and knowledge users. Using the Transtheoretical Model of Change (TTMC) as a framework, we consider opportunities to address intersectionality in LTC research. Engaging diverse knowledge users in LTC (e.g., unpaid caregivers, paid care staff), community (e.g., advocacy groups, service providers) and policy decision-makers (e.g., provincial government) is crucial. Empowering individuals to participate, modifying environments to support engagement, and facilitating ongoing partnerships with knowledge users are critical aspects of change efforts. Addressing structural barriers (e.g., accessibility, capacity, jurisdictional policies, and mandates) to research in LTC is also essential. The TTMC offers a framework for planning and enacting individual, organizational, and system-level changes for the future of LTC.

Trainee-led research using an integrated knowledge translation or other research partnership approaches: a scoping reviews

BACKGROUND

There are increasing expectations for researchers and knowledge users in the health system to use a research partnership approach, such as integrated knowledge translation, to increase the relevance and use of research findings in health practice, programmes and policies. However, little is known about how health research trainees engage in research partnership approaches such as IKT. In response, the purpose of this scoping review was to map and characterize the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees in thesis and/or postdoctoral work.

METHODS

We conducted this scoping review following the Joanna Briggs Institute methodology and Arksey and O'Malley's framework. We searched the following databases in June 2020: MEDLINE, Embase, CINAHL and PsycINFO. We also searched sources of unpublished studies and grey literature. We reported our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

We included 74 records that described trainees' experiences using an IKT or other research partnership approach to health research. The majority of studies involved collaboration with knowledge users in the research question development, recruitment and data collection stages of the research process. Intersecting barriers to IKT or other research partnerships at the individual, interpersonal and organizational levels were reported, including lack of skills in partnership research, competing priorities and trainees' "outsider" status. We also identified studies that evaluated their IKT approach and reported impacts on partnership formation, such as valuing different perspectives, and enhanced relevance of research.

CONCLUSION

Our review provides insights for trainees interested in IKT or other research partnership approaches and offers guidance on how to apply an IKT approach to their research. The review findings can serve as a basis for future reviews and primary research focused on IKT principles, strategies and evaluation. The findings can also inform IKT training efforts such as guideline development and academic programme development.

The Promise of Science, Knowledge Mobilization, and Rapid Learning Systems for COVID-19 Recovery

The health, economic, and social crises created by the coronavirus disease 2019 (COVID-19) pandemic have been global in scope and inequitable in impact. The global road to recovery can be enhanced with robust, relevant, and timely scientific evidence. This commentary seeks to illustrate the power of science, scientific collaboration, and innovative research funding programs to inform pandemic recovery and inspire transformational changes for a more equitable, resilient, and sustainable future. Specifically, this commentary provides an introduction to the United Nations (UN) Research Roadmap for the COVID-19 Recovery that was published in November 2020. It introduces 5 scoping reviews that helped inform the UN Research Roadmap and that are now available open access within this series of special papers, and it provides an overview of an innovative research funding program that facilitated rapid mobilization and collaboration to produce the scoping reviews. The publication of the scoping reviews in this journal series will help complement and amplify the UN Research Roadmap by furthering knowledge mobilization efforts and informing COVID-19 recovery around the world, to ensure a more equitable, resilient, and sustainable postpandemic future.

Exploring Mentorship as a Strategy to Build Capacity and Optimize the Embedded Scientist Workforce

Background:

Mentorship plays a significant role in career development in academic and applied settings, but little is documented about its role in the experiential learning of academic trainees embedded in health system organizations. The experiences of the first cohort of Canada's Health System Impact (HSI) Fellowship program can provide insights into how mentorship in this innovative type of training can work.

Objectives:

To understand the mentorship strategies that were used and to explore fellows' and supervisors' perspectives and experiences on the effectiveness and value of those strategies.

Methods:

Data from the surveys of fellows and their supervisors and a panel rooted in the lived experience of the first HSI Fellowship cohort were used.

Results:

Health system and academic supervisors developed a range of innovative, individualized and effective approaches for guiding their fellows, such as providing the fellow with a committee of mentors within the organization, holding regular meetings with the fellow and both the health system and the academic supervisor and leveraging their own network to expand the network and resources available to the fellow.

Conclusion:

The results suggest that engaging senior leadership in health system settings has provided positive experiences for both fellows and their mentors.

The Career Outcomes of Health Services and Policy Research Doctoral Graduates

OBJECTIVE

To examine the career outcomes of 20 years of PhD graduates from Canadian health services and policy research (HSPR) doctoral training programs.

METHODS

The deans of the doctoral training programs were invited to participate in this national cohort study. A standardized career-tracking template was developed. Internet searches of publicly accessible sources were used to track graduates' employment. Descriptive analyses summarized PhD program characteristics and current employment.

RESULTS

Of the 1,208 trainees who graduated during our study period, 884 (73.2% of 1,208, or 90.3% of the 979 with complete data) could be successfully tracked. HSPR PhD graduates are highly employable, but employment trends have changed over time. Today's graduates are more likely to enter careers in a wider variety of sectors and roles and are less likely to be employed in academia than previous graduates. However, over 50% of graduates are currently employed in professorial positions within the academic sector or in research roles or departments within healthcare delivery organizations.

CONCLUSIONS

This article provides an initial descriptive profile of the career outcomes of HSPR PhD graduates in Canada from 10 university-based doctoral training programs. To ensure that PhD graduates are prepared to contribute fully within diverse sectors and roles, doctoral training must evolve to keep pace with employment trends and encompass, in addition to research skills, the professional skills demanded in the public, private, not-for-profit and healthcare delivery sectors.

Developing Competencies for Health System Impact: Early Lessons Learned from the Health System Impact Fellows

Background:

The Health System Impact (HSI) Fellowship program provides highly qualified post-doctoral fellows studying health services and policy research (HSPR) with opportunities for experiential learning, enriched core competency development and mentorship from senior-level leaders within health system organizations. Its overall aim is to prepare post-doctoral fellows with the research and professional skills, experiences and networks to make meaningful and impactful contributions in careers in academic and applied health system settings.

Objective:

This study examined whether this HSI Fellowship program has contributed to the development of enriched core competencies in HSPR.

Methods:

A competency assessment tool was developed and administered to the 46 fellows and their health system and academic supervisors from the inaugural HSI Fellowship cohort. Fellows' self-assessments at baseline, three months and 12 months were analyzed, along with supervisors' assessments at three and 12 months. Descriptive analyses were used to examine competency development over time. Differences by gender and between supervisor and fellow ratings were analyzed.

Results:

HSI fellows' self-assessments indicate that they strengthened their skills in all 10 enriched core competencies. Supervisors' assessments of the fellows' competencies also improved from baseline to 12 months. Gender differences at baseline disappeared by the 12-month assessment.

Conclusion:

The HSI Fellowship provides an opportunity to develop the full suite of enriched core competencies, particularly in competency domains that are not currently emphasized in HSPR doctoral curriculum.