At the recent HRSA Workforce Meeting in DC, Edward O’Neil from UCSF described the life-cycle of paradigms: beginning as effective tools, peaking by making things work and providing coherence, then limiting possibilities, and eventually, failing completely. The paradigm of university-based academic research has reached, and perhaps surpassed, the limiting stage for health systems/policy research.

Factor 1: Timeline

Academic or university-based research now has a project timeline of 3-6 years from inception of a project through the bureacracy of department approval, IRB review, then grant application and receipt, data analysis, production of manuscript, review of manuscript, then eventual publication and release of findings. This prolonged timeline ensures that findings will no longer be policy-relevant. The policy or political timeline is often on the order of days (!!), or at best one legislative cycle, which explains why academic research is typically trailing instead of informing policy. Informal guesses, back-of-napkin calculations, and stakeholder promotion push policy formation more than academic research.

Factor 2:  NIH Funding

Universities want their researchers to secure NIH funding, and as much of it as possible. NIH money dominates university ranking, funds infrastructure cost…and who can argue with a 51% indirect fee on every NIH dollar that the university is able to garner?  University-based researchers are encouraged (through promotion criteria) to pursue NIH/federal funding above other private sources, which typically allow for only a 10% indirect fee.  The problem is that NIH has no “health systems” or “health policy” institute (and in fact, no primary care institute), and AHRQ (and HRSA) have been woefully unable financially to provide sufficient funding to support health services research. So some health services researchers are stuck trying to mash their research to fit with an NIH institute (aging, kidney, cancer, etc.) or be marginalized within their institution.

Factor 3: Job Structure and Security

If health systems researchers are lucky enough to obtain federal (NIH or AHRQ) funding, their careers are put onto the hamster-wheel: complete enough of the grant objectives to satisfy requirements, then build a new grant application off of the findings to submit to the next funding rung up, and continue on. Job time structure is strictly controlled by funding: grants dictate a % of research time, and predictable clinical revenues demand a set schedule of clinic duties. Researchers tend to evolve into experts in one specific micro-silo of research, which becomes less and less understandable to the general public (and our legislators). The goal of the researcher may become furthering a research career and obtaining the next grant, rather than examining current policy issues, brainstorming new inquiry directions, and having the time to creatively collaborate with others.

Factor 4: Collaboration and Communication

Academic researchers are busy, often too busy to mentor or network. In the academic setting, channels of communication may be limited to other academicians. Collaboration with the business community, health industry, private citizens, and government is difficult. Communication of findings is focused on journal editors, and possibly a few reporters. There is little outreach to the general public, or solicitation of community input on priorities of health systems research. The new Clinical and Translational Science Awards attempt to engage the community but the structure is still based on university to community directionality.

Factor 5: Independence and Innovation

Academic medical centers have an agenda which is often dominated by maintaining and growing the funding status quo. Research that challenges current health system structures and funding streams is unlikely to be supported by the university. And unsanctioned communication of unconventional research findings–often a necessary step to spur innovation of ideas–is discouraged.

A New Path:

The Center for Researching Health Outcomes aims to produce policy-relevant research in the most timely manner possible, to solicit project funding from all sources (from individuals to the federal government), to generate projects through collaborative input from an extremely diverse group of contributors, to perform research in a transparent manner, to communicate results broadly (from social networking sites to traditional academic channels), and to emphasize the primacy of collaboration, innovation, research relevance, and non-traditional thinking.

“Never be afraid to try something new. Remember, amateurs built the ark; professionals built the Titanic.”

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This entry was posted on Thursday, October 1st, 2009 at 9:28 pm and is filed under Philosophy and Musings. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.