Over a ten-month period beginning at the Institute's inaugural symposium in Montreal in 2003, IHSPR and five national partners canvassed policy-makers, managers, members of the public and researchers across the country to identify research priorities for the next two to five years. This process, Listening for Direction II, was intended to refresh a similar exercise undertaken shortly after the inception of the Institute, in early 2001. The changes and, equally, the lack of change, in the identified priorities, reflect the realities of the Canadian health care system. Periodically some new issue emerges, but for the most part, the major problems besetting Canada's health care system are soap opera-like-they remain the same, even if nuanced in slightly different ways.
Those priorities are now guiding investments in pursuit of the goals of the broad "Outstanding Research" component of our second Strategic Plan. Like the research priorities themselves, this Plan will look and sound familiar, yet has also undergone some changes. Most obviously, the major areas for investment and attention are now consistent with CIHR's own Blueprint. Other changes and consolidations reflect the experience of our early years, and the decisions taken by the Institute Advisory Board over that period.
This Strategic Plan is what guides the Advisory Board in making critical decisions about human and financial commitments, and with so many opportunities worthy of Institute support, and so many challenges and issues to attempt to respond to, to which it returns in moments of uncertainty. It provides the framework around which we organize our work, against which we evaluate ourselves, and against which others will evaluate the Institute's work over the coming year.
This also represents the Strategic Plan that we will hand to our successors. Both of our terms, as Scientific Director, and Advisory Board chair, end in 2006. While there is still much to be done in the coming year, we are confident that this document will provide important guidance to our successors and, equally important, will ensure continuity for the communities the Institute serves.
We continue to welcome feedback on our goals and objectives, as well as on the means we choose to achieve them.
| Scientific Director | Chair Institute Advisory Board |
| Morris Barer | François Champagne |
The Canadian Institutes of Health Research (CIHR) is Canada's major federal funding agency for health research. Its objective is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system.
In July 2000, CIHR launched 13 institutes, each dedicated to a domain of research. These health research institutes were created to identify, coordinate, focus and integrate health research and translation priorities for Canada, based on:
All Institutes encourage interdisciplinary, integrative health research that includes bio-medical research, clinical research, research pertaining to health systems and services, and research on the health of populations, including social and cultural dimensions of health and environmental influences on health (i.e., four domains, themes or pillars). CIHR's Institute of Health Services and Policy Research is one of the 13 institutes.
Our Vision ~ Strengthening Canada's Health Care System through Health Services and Policy Research
The vision of the Advisory Board of CIHR's Institute of Health Services and Policy Research is to enable a vibrant community of excellent researchers who conduct outstanding health services and policy research that informs Canadians about their health care system, is used by decision-makers to strengthen Canada's health care system, and influences health and social policy in Canada and abroad.
Our Mandate ~ Supporting Health Services and Policy Research and Its Timely Translation
The mandate of CIHR's Institute of Health Services and Policy Research is to support outstanding research, capacity-building and knowledge translation initiatives designed to improve the way health care services are organized, regulated, managed, financed, paid for, delivered and used in the interest of improving the health and quality of life of all Canadians.
The following fundamental and core values are promoted by CIHR's Institute of Health Services and Policy Research, and influence its decision-making, strategic activities and operations:
The Institute is guided in its strategic and operational activities by the following principles to which it is committed:
In 2002, CIHR's Institute of Health Services and Policy Research (IHSPR) published its first strategic plan, following a national consultation process to define the most important issues likely to be facing the Canadian health care system over the subsequent two to five years. That plan, entitled Health Services and Policy Research: Making the BEST of Canadian Health Care, focused IHSPR's activities on four key areas: building a community of researchers, expanding and enhancing research resources, supporting strategic research, and translating knowledge.
At that time, we knew we needed to nurture a small, but increasingly in-demand community and, at the same time, increase the size and capability of that community in whatever ways we could. The establishment of CIHR in 2000 created a vastly expanded set of expectations for health services and policy researchers, with all 13 CIHR institutes encouraging interdisciplinary, integrative research relating to health systems and services. We recognized that to enable outstanding research, we needed to make investments in developing and improving access to quality health and health services data. We also had to build our capacity to supply policy and management decision makers with timely research evidence in priority areas. And we had to support initiatives to better translate research knowledge into improved systems and services.
Over the last few years, we have made significant progress on many of the specific goals within each of those four broad areas. At the same time, while the health policy landscape in Canada may appear to stand still on some issues, on others there have been dramatic changes. This has left us with a new mix of priorities and circumstances to respond to. Health care leaders have learned far more about Canadians' preferences and expectations for their health care system through the work of federal, provincial and territorial committees, review panels and commissions. The Standing Senate Committee on Social Affairs, Science and Technology (Kirby Committee) submitted recommendations on health care renewal in April 2002 and the Commission on the Future of Health Care in Canada (Romanow Commission) completed its work in November 2002.
As a result, there have been important movements to change the organization, funding, regulation, delivery and oversight of health care in Canada. The nation now has the Health Council, with an explicit public reporting mandate, and some jurisdictions have established health quality councils. Some provinces have restructured regional health authorities and provider networks. Options for private financing of facilities and services continue to be explored across the country, and there have been some notable shifts in the organization and funding of primary health care. Public health and health system issues also came under intense scrutiny during the SARS crisis of 2003, which spurred the establishment of the Canadian Public Health Agency.
Of particular importance is the September 2003 Accord on Health Care Renewal, which gives expression to a Federal/Provincial/Territorial consensus on system reform. A ten-year plan to strengthen health care was agreed to by the First Ministers a year later, backed up by a long-term commitment to annual increases in funding from the federal government. Both the Accord and the Ten Year Plan stipulate strategic areas in which health system change is expected and recognize the vital role that applied research and knowledge translation must play in renewal efforts.
There is also heightened interest in Canada's global role in health research. In November 2004, health ministers from around the world took part in a joint summit on health research. The resulting Mexico Statement points to the crucial, but under-recognized, role that research has to play in strengthening health systems, and affirms the value of a global commitment to linking research to action in health services and policy.
How Canadians experience their health care system has remained relatively constant over the last number of years. Their major concern-timely access to high quality care-continues to dominate health services and policy debate in 2005. In a few areas there is evidence of deterioration in accessibility of services, and enhanced concern over quality. Relative to a few years ago, fewer Canadians are satisfied with access to care in the community and the timeliness of access.1 While most Canadians (86 per cent) report having a family physician, some (16 per cent) report difficulty accessing first contact care, and others (13 per cent) report difficulty accessing routine care. Many (51 per cent) now rank improvements in the quality of care as a top priority for new health care investments.2 But Canadians continue to be open to a wide variety of initiatives to improve the health care system, and strongly support the notion that health research will contribute to the pace of innovation in health care and evidence-based decision-making.3
IHSPR's overall goals and objectives remain the same, while some of the specifics have been modified to reflect this changing environment. The health services and policy research community remains small, as it was in 2000, but its growth has been expedited by investments from IHSPR and our partners. We now have a fully-fledged national association for our research and research-user community, the Canadian Association for Health Services and Policy Research (CAHSPR) to complement our community-building efforts. CIHR's (including IHSPR's) early investments in new training and team-building capacity are already beginning to bear fruit. Changes at CIHR will also create more opportunities for supporting capacity development for our community. At time of writing, a standing "Teams" competition had been added to CIHR's annual competitions, and work was underway toward developing a new "Emerging Teams" annual competition.
Over the last three years, despite our best efforts, the research landscape with respect to availability of, and access to, fundamental data resources, has remained difficult. IHSPR has backed a number of foundational initiatives to develop, and improve access to, health and health services data, including workshops designed to take the first steps towards harmonizing privacy standards for health services and policy research. We now need to put what we have learned into action, and will continue to work with key national partners to create supportive regulatory and policy environments for health systems and services research.
In 2004, we embarked on our second round of joint national consultations with users and producers of health services and policy research. The result, Listening for Direction II, outlines a revised set of national priorities for research and knowledge translation, many of which also reflect key areas of focus for the Accord and Ten Year Plan. Many of the themes identified in our 2001 consultations, Listening for Direction I, continue (not surprisingly) to be priorities, although some reformulation and consolidation were needed.
Areas for strategic research investment by IHSPR over the next few years will be informed by the Listening for Direction II agenda, but we will have additional tools for funding work in these areas at our disposal. Beginning in 2004, CIHR launched a new competition, Partnerships for Health System Improvement (PHSI), which provides expanded opportunities and eligible areas for support while retaining the basic architecture and objectives of the Canadian Health Services Research Foundation's (CHSRF) Open Grants Projects Competition (OGC).
The demand or "pull" for evidence and supply or "push" of research into decision making has, we hope, been increased by investments by IHSPR and its partners. In 2005 we are witnessing the launch of a new Canadian health services and policy research journal, Healthcare Policy, specifically designed with the system's policy-makers and managers in mind. IHSPR will also publish its first knowledge translation casebook dedicated to sharing best practices and demonstrating the potential impact of health services and policy research evidence in 2005. But the need for health services and policy research and expertise in knowledge translation is large and continues to grow at an astounding pace.
IHSPR, like CIHR more generally, is entering a second stage of evolution. The next three years will mark a shift in the way that we achieve our institutional goals, as we transition from development to a more action-oriented phase. Our portfolio will move above and beyond the focus on capacity building of our first three years to include a greater ability to respond to pressing policy and practice issues. Three early signs of this change came in 2004, with our leadership in moving CHSRF's OGC across to CIHR to create the PHSI, and with the launch of our first "synthesis" request for application (RFA), and in early 2005, when IHSPR led the development of a rapid response RFA to support the First Ministers' commitment to establish wait time benchmarks in five clinical areas.
Partnerships and public engagement have also been recognized as a key area in which IHSPR has had some key successes, but where more needs to be done. Partnerships are integral to the vision of CIHR, and in the domains supported by IHSPR, are crucial for both conducting research, and ensuring its relevance, applicability and translation into more effective health services and systems. We have introduced a number of new objectives into this strategic plan to develop and maintain relations with organizations on both domestic and international fronts.
The next three years promise to be full of new challenges for IHSPR and the community we support. CIHR is embarking on its first organization-wide comprehensive evaluation, and is itself entering a new phase of growth designed to accelerate the pace of discovery and its application to health. Over the next three years, the terms of CIHR's first cohort of Scientific Directors will come to an end: this will bring the organization both interesting transition challenges and new opportunities. IHSPR's first Scientific Director will hand over to his successor at the end of August 2006, signaling the beginning of a new phase in the life of the Institute. As always, we welcome your comments on our activities and progress, and how we can best continue to serve the health services and policy research and research-user communities in Canada.
Our GoalsThe strategic goals of CIHR's Institute of Health Services and Policy Research are built around a commitment to five key areas, corresponding to the CIHR Planning, Reporting and Accountability Structure:
A decision-maker is an individual who makes decisions or influences policies that have a direct influence on the organization, delivery, financing, management, regulation or delivery of health systems or services. Health care decision-makers carry the challenge, on behalf of all Canadians, of developing and implementing constructive change in health services and systems in Canada. The best available research evidence provided in a timely fashion should inform their decisions. The creation and synthesis of research evidence requires time, but the knowledge derived from these activities must be available and accessible when decisions requiring that evidence are being made. To ensure that health services and policy research in Canada is able to anticipate emerging issues and the information needs of health care decision-makers, we will continue to work with stakeholders and partner communities to identify gaps in knowledge, and to support strategic initiatives that address those gaps.
Accordingly, this Institute is committed to working with key partners to:
Goal 1 Identify and prioritize current and emerging information needs of health care decision-makers and the public.
Objectives:
Goal 2 Support the creation and synthesis of health services and policy research in strategic areas.
Objectives:
Even before the establishment of CIHR, Canada was faced with a shortage of individuals with the requisite skills and experience to conduct outstanding health services and policy research. With mounting pressures facing the health care system, members of this small research community are increasingly approached to undertake work of direct and immediate relevance to health care decision-makers and the public.
The establishment of CIHR has brought new challenges and new opportunities to this small community of health services and policy researchers:
To address the current research capacity deficit, and the rapidly growing demand for outstanding health services and policy research, the Institute is committed to working with key partners to build a community of outstanding researchers by setting the following goals:
Goal 3 Increase the supply, and improve the geographic distribution of excellent interdisciplinary researchers in Canada who can successfully lead, participate in and translate outstanding health services and policy research.
Objectives:
Goal 4 Encourage and facilitate the emergence of new collaborations by increasing connectivity among health services and policy researchers and with biomedical, clinical and population health researchers who engage in health services and policy research projects.
Objectives:
In order to conduct outstanding research, investigators must work within innovative, supportive research environments, and have access to the best available resources. For health services and policy researchers, this means ready access to the best available research data, whether these data are collected through survey instruments or interview approaches, located in administrative databases, or developed from other sources.
Canada is home to many internationally recognized health services and policy researchers who have generated new knowledge about health care services and system dynamics, through the use of data that are routinely collected for other purposes. Many have used this information in combination with high quality data collected specifically for the purposes of a research project. However, researchers' experiences in accessing the best available data are quite variable, and there is still no single national strategy to guide investments in data infrastructure to support scholarly health services and policy research.
Accordingly, IHSPR is committed to working with key partners to expand and enhance research resources by addressing the following goals:
Goal 5 Support the development of, and improve access to, health and health service data in Canada to enable researchers to undertake outstanding health services and policy research.
Objectives:
Outstanding health services and policy research requires continuous enhancement of theory, frameworks, and empirical methods, as well as measurement and evaluation tools. The best available data are only useful to the extent that they correspond to constructs, variables, or instruments that have been developed, tested and validated through innovative research. Such enhancements often involve collaborative, trans-disciplinary initiatives. Health services and policy researchers have much to gain from the methodological and content expertise of academics, policy-makers and practitioners from disciplines such as mathematics, law, ethics, the humanities, and a wide range of social sciences.
Goal 6 Support the development, enhancement, and use of theories, frameworks, research methods, measurement tools, and evaluation techniques, for health services, health policy and knowledge translation research.
Objectives:
Where there is a consistent body of research evidence to inform decisions, this knowledge can improve the effectiveness of health services, policies and products, improve equity in access and use of health care, and strengthen the Canadian health care system in other ways. And, when the research process is guided by the information needs of the users of research, findings are more likely to be translated into usable knowledge. The process of translating knowledge into improved services and systems, however, is not always a straightforward chain of events where knowledge is produced, distributed, received and used.
People, who could take advantage of research evidence to implement positive change, may often not know of its existence. Conversely, those generating that evidence have often taken little interest in, or do not have the skills or experience necessary for getting research findings 'into play'. Effective knowledge translation requires continuous long-term interaction between researchers and users of research, effective synthesis and communication skills for researchers, and a commitment to using relevant research results in decision-making. Yet, more research about the process of effective knowledge translation is required.
In addition to supporting researchers who will provide new understandings of best practices in knowledge translation (goal 3 above), and the development of new approaches, methods and tools to assist research on effective knowledge translation (goal 6 above), this Institute is committed to working with key partners to:
Goal 7 Support the identification of, promote the use of, and engage in, effective approaches to translating knowledge.
Objectives:
Partnerships are increasingly important for a) the creation of new knowledge and its translation, b) the development of more effective health services and products, and c) the strengthening of the Canadian health care system. This is particularly relevant for IHSPR because so much of the research within its domain is multi-disciplinary. Partnerships are essential not only for the leveraging of funds and the conduct of research, but also for enhancing the relevance, applicability and use of research products.
Goal 8 Develop and maintain relations with relevant organizations on domestic and international fronts in order to facilitate appropriate partnerships in a timely and effective manner.
Objectives:
IHSPR is committed to identifying, adopting, developing and sharing best practices for the management and operation of its programs, initiatives, and investments. The institute strives to create and maintain a work environment that supports excellence in all aspects of its mandate.
Goal 9 Encourage innovation and effectiveness in all Institute programs,initiatives, activities and structures.
Objectives:
