Developing an Organization in Response to Urgent Need

by Kevin J. Leonard, MBA, Ph.D., CMA

Background

As external pressures mount in healthcare, organizations are being forced to be more efficient with their resources while improving performance. These pressures emanate from a variety of sources, such as rising costs and lower budgets, changes in hospital practices with a greater reliance on community resources as an alternative to hospital care, rapidly growing population and growing demand for complex care and new medical technologies.

The result of these pressures is that more patients are being served with more and wide-ranging services, thereby placing even greater demands on delivery support mechanisms.

These growing needs are not limited to in-hospital services but rather are evident throughout the community care delivery system. (It should be emphasized that our use of the term “community care” herein is meant to describe all care delivered outside hospitals and not just the traditional perspective of only “home care” or services delivered in “long term care centers”, for example.)

Consequently, now more than ever, there is a demand for research into both the management and the practice of health services. Unfortunately, practitioners are often unaware of research opportunities, recent best evidence findings and the best way of putting research into practice. This is due, primarily, to the very nature of research and research organizations, as the research sector is very insular. In reality, the research agenda is often driven by only two factors: the research areas being funded and the specific interests of the research personnel. Unless there is individual interest in a particular field, funding allocation is the only way to get attention to an issue and gain an increase in research productivity.

There are few mechanisms in place that provide an opportunity for practitioners to influence research topics other than through funding. In addition, research findings are often published in areas that are often not accessible to practitioners. In fact, researchers get greater academic recognition for publishing in areas that are reviewed, and by definition, read only by other academics. As a result, much of the research productivity goes unnoticed, and thereby, non-implemented by the practitioner community – the very group that the research is intended to serve. Clearly, throughout the whole range of healthcare settings from the doctor's offices to hospitals to home care, there is a need to bring two separate stakeholders together: researchers and practitioners.

The Rationale for a Network in Community Care

Moreover, the community care sector has not received the same attention by researchers as other sectors. As such, it is even more critical to link practitioners with the research findings. In an effort to assist this entire community care sector, a group of professionals came together in 1997 to address this need. These professionals represented:

These member organizations realized that they needed to join forces to have a stronger influence on the research community. In the end, a network was created where it was indicated that it be heavily involved in both coordinating the research and the dissemination of research findings. This would be operationalized by fulfilling the following roles:

Further, it was specified that one of the most important elements for success would be that this network be visible, accessible, understood and seen to be “value-added”. Optimally, when a question of research or best practices arises, the community care sector should feel confident to contact the network. It should be the resource that informs the community care provider of that has been completed and the related findings. In the case where a new research question has been raised, the network should be a resource outlining the feasibility of getting the research done along with identifying potential funding and research partners.

Ontario Community Services Research and Evaluation Network

In the end, these provider agencies created the Ontario Community Services Research & Evaluation Network (OCSREN). The objectives of this network can be stated simply: It seeks to improve the efficiency of information transfer within and throughout the healthcare industry. It is envisioned that the OCSREN will facilitate the design and dissemination of research related to health care services.

It is probably best to describe the OCSREN by the role it will play in assisting community care delivery. Information theory concentrates on getting the right information at the right time in the right format to the right user. The essence of “information systems analysis” focuses on the root of the problem: the need for the right information. It is the mandate of the OCSREN to help community care organizations access better (and ultimately, the right) information when they need it. In this way, the OCSREN will act as a liaison or information broker between the many practitioner stakeholders in this sector and the research community. It should be emphasized that the role of OCSREN is to disseminate information emanating from research results – not conduct actual research.

In the ideal setting, the practitioner/manager and the researcher must work together to design projects that specifically address the needs of the practitioner/manager. This requires some initial investigation and literature review work that is then sent to the practitioner/manager for feedback. It is quite common for this process to incorporate four or five iterations until the structure has been fully designed. This process must be followed for the research question to be truly identified and so that the research project can be accurately designed and carried out.

To this end, OCSREN can also be viewed, in addition to the role of broker, as an important component of the overall information systems that serve our community care organizations. The specific objectives of OCSREN are:

  1. to create an integrated research community in Community Care;
  2. to support healthcare organizations in adopting and evaluating research that has already been completed and/or published; and
  3. to encourage collaborative research linking community care professionals with the academic and research community.

This association hosted its first one-day symposium in February 1999, as OCSREN began building the bridge between researchers and practitioners. Ongoing, OCSREN will work to link researcher areas and partners through symposiums, workshops and conferences.

Going forward, some areas that have been identified where more research is needed are:

The second annual symposium has now been scheduled for May 9, 2001. Some of the research presentations will focus on the following areas in an effort to guide the healthcare industry in moving forward towards improved knowledge awareness and increasing use of evidence based decision support.

  1. Investigate the types and nature of health data that should be collected. This would include the acquisition of existing healthcare data sets, linking and analyzing these data sets and determining where deficiencies might be.
  2. Evaluate current patterns of healthcare utilization and the meaningful comparison with either historic or future results. These studies will encompass the full range of the healthcare system from health promotion and prevention, to the evaluation of current healthcare services.
  3. Investigate the types of information and reports that would be useful to different disciplines and healthcare providers. The range of optimal formats and the best modes of translation of research findings into day-to-day practice should be explored.
  4. Conduct considerable testing of connectivity options of partners within a prototype integrated healthcare delivery system or health network. This may go beyond electronic records to include exchange of data, use of videoconferencing and other modes of information exchange to enhance information exchange and education of healthcare providers in an integrated system.
  5. Analyze the in-depth community care data needs, information needs and knowledge needs (evidence) depending on the style of healthcare delivery - and the format and time frame to make them meaningful. An example might be the information needs of an effective integrated healthcare delivery system versus a regional approach to healthcare delivery.
  6. Research into the creation and dissemination of useful benchmarks for healthcare and evaluate their achievement over a period of time; including identification of barriers, strategies to overcome them and the evaluation of outcomes.
  7. Explore a major area of concern in the use of electronic record information systems is security, confidentiality and privacy, all of which need to be tested and evaluated with the development of new and acceptable systems to provide for these needs.

As integrated healthcare delivery systems evolve, health professionals across the continuum of care need to be able to measure what resources they are using to provide quality of care, at what cost, and to what end—and the effectiveness of that care. Moreover, the eventual design and structure of a more efficient and effective delivery system itself needs to be investigated, tested, implemented and evaluated. It is hoped that OCSREN will assist in all these areas by focusing on the community care sector and how it can increase operational efficiencies and effectiveness and by providing a link between the research and practitioner communities.

In conclusion, we invite researchers and practitioners to contact OCSREN to learn more about the benefits of such an organization and to add to the diverse group of stakeholders that now comprise this network. Further, we challenge other regions throughout Canada to start building the linkages between health practitioners and the research community. In the end, the move to improvement of community care practice and effectiveness is not discrete but rather continuous and can be best achieved through the iterative process of defining research needs and integrating feedback with the involvement of both groups so as to manage both the overall research strategy and practitioner objectives.