Over the course of my career I have often been frustrated with the gap between the research I was conducting and the clinical operations of the health care delivery systems with which I was affiliated. As a researcher I often lacked a full understanding of the decisions facing operational leaders and the evidence that would be useful to them. Operational leaders frequently seemed to find my work esoteric and irrelevant to the challenges they faced.
The opening plenary* at the recent HMO Research Network meeting was designed to address the topic of cooperation between research and clinical operations. Much of the discussion centered on how to integrate day-to-day clinical care with research that can improve such care. Comments from three of the speakers included how their organizations pursue this integration.
In one approach, clinical care processes are established based on available information. Researchers then develop studies based on their observations of these approaches. A major benefit of this approach is that the staff and information technology that support clinical care also provide a foundation for research. This is in contrast to many experiences I have had, in which stretched clinical staff is asked to collect data beyond that needed for patient care.
A second approach emphasizes that generating public knowledge is an integral part of clinical care. There is an explicit and strong partnership between clinical operations and research staff. This partnership has multiple advantages, including: (1) identifying research questions; (2) designing feasible studies; (3) overcoming operational opposition to randomization; and (4) creating timelines in which early study results inform operations. Just as I began to wonder how such work would ever get through peer and program review at an agency like NCI, the speaker noted that funding must come from payers or administrators who will use the information for planning purposes.
A third approach assumes that creating standardized care protocols is innovative and that research is essential to creating those protocols. Projects are led by a small group of clinicians and researchers who receive guidance and financial support from operational leaders. A key element of this approach is rapid implementation and completion of studies, sometimes in as little as six months. Another key element of this approach is the ability and willingness of operational leaders to end projects that are not proceeding as planned. The concept of ending projects made sense to me given how marginally successful projects distract staff and consume funds that could be invested in more productive endeavors.
I found the plenary useful for understanding how leaders of clinical operations perceive the role of research. These approaches seem compatible with researchers whose interests lie primarily in quality improvement. I was uncertain about how these approaches would allow a researcher to establish the topical focus and sustained scientific productivity needed to obtain extramural research funding. Whether researchers outside these organizations could participate in operationally-relevant research was unclear. Hopefully this will be a topic of future discussion, including at next year’s HMO Research Network Annual Meeting, scheduled for April 13 to 15 in Atlanta, GA.
What experiences have you had working across the operational-research divide?
*The session was titled “Research-Operations Partnerships to Improve Care.” It occurred on March 11, 2015, at the HMO Research Network Meeting in Long Beach, California. The moderator was Michael Gould from the Research and Evaluation Department at Kaiser Permanente Southern California. He was joined by four panelists: (1) Jonathan Darer, MD, MPH, Director, Institute for Advanced Application Center for Clinical Innovation, Chief Innovation Officer for the Division of Clinical Innovation, Geisinger Health System; (2) Robert Reid, MD, PhD, Senior Investigator, Group Health Research Institute, Medical Director for Research Translation, Group Health Cooperative; (3) Nirav Shah, MD, MPH, Senior Vice President and Chief Operating Officer, Clinical Operations, Kaiser Permanente Southern California; and (4) Leif Solberg, MD, Associate Medical Director, HealthPartners Medical Group; Clinical Director, Care Improvement Research, HealthPartners Research Foundation.