in Health Systems: More GPS than Self-Driving Car Sarah M. Greene, - - PowerPoint PPT Presentation

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

• perational aspects of effective D&I may

require more than a strong framework Given the myriad influential factors that support or impede D&I have we given researchers the tools to execute against these conceptual frameworks?

Content / Topic Audience Receptivity Agility/Adaptability Timeframe / Serendipity Dialect / Semantics Ease of Change Availability of Resources & Tools Workflow Considerations Incentives and Disincentives Costs (Financial & Human) 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 dissemination as an equally important line of business as doing research.” “There’s a lot of value to producing good science and not being on the hook to do more. There is an obligation to 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
• Fee-based trainings, conferences, and consultation
• Part of parent organization’s operating budget
• Venture capital backing
• Philanthropic support

Essential to determine whether there is a demand for what you’re supplying!

“Is it really dissemination if no

• ne uses it?”

Center of Excellence

• An entity with a distinct identity
• Revenue model

Build Expertise/Credibility

• Reputation becomes a

commodity Department/Independent Entity

• Embed in parent organization
• Stand-alone operating budget
• Diverse related offerings

Multiple Related Projects

• Test various related

interventions

• Build evidence base

Initial Project

• Test Hypothesis

Predominately soft money Core money, Revenue opportunity

A general model showing the possible trajectory from project to independent entity 15

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
• rganizational 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.”

Berwick, JAMA 2003

& implementation

Thank you!

sarahgreene@hcsrn.org @researchmatters @hcsrn