The Canadian Health Services and Policy Research Alliance brings together organizations and individuals from across the health system community to collaborate on specific and common priority initiatives. Initially envisioned as an effector arm stemming from the IHSPR Pan Canadian Vision and Strategy in 2014 (Executive Summary | Full Report), the Alliance has successfully developed a number of health system enabling assets that have served our collective community over the past several years.
Using a voluntary workgroup structure, the Alliance provides leadership and the enabling infrastructure to: build a shared workgroup outcome; project plan; and support the development of the planned products to support the broader constituencies. The Training Modernization working group gave rise to the development of alternate career paths for HSPR PhD students and the establishment of the successful Impact Fellowship program. The Impact Assessment working group has successfully extended the Canadian Academy of Health Sciences impact framework to begin to articulate the value of HSPR research to the health system beyond a transactional traditional bibliometric approach.
Through its focused “shared objective and outcome” based approach the Alliance has demonstrated the value of a pan-Canadian forum for output and outcome-based collaboration. By providing the leadership and the necessary discipline and infrastructure, CHSPRA aspires to support the development of the enablers needed to translate science into practice.
The Future of CHSPRA
CHSPRA recently undertook a reflective exercise to help shape our plans for the future. The CHSPRA: Assessment and Options report reinforces the value of CHSPRA’s work and provides some ideas that are helping to shape CHSPRA’s plans for the future.
Training Modernization Working Group
Pan-Canadian Strategy for Training Modernization
The Training Modernization Working Group (TMWG) came together at the start of CHSPRA to consider ways to support impact-oriented career paths within and beyond the traditional university setting and to harness the full talents of PhD-trained individuals for continuous health system improvement. Their work began with an examination of career paths and career outcomes of HSPR doctoral graduates. They articulated the challenges and opportunities for health services and policy research training in Canada and produced a report, white paper, strategy and a full supplement of publications in Healthcare Policy:
- Report from the Working Group on Training (Dec, 2015), including a map of potential career pathways outside the traditional university setting for PhD graduates of HSPR training programs
- Challenges, Opportunities, and Future Directions for Health Services and Policy Research Training in Canada: A White Paper (May 2015)
- Modernizing Health Services and Policy Research Training: A pan-Canadian Strategy (Dec 2015)
- The Healthcare Policy special issue on training for impact is available open-access online.
The Health System Impact Fellowship
The Training Modernization Working Group’s pan-Canadian Strategy for Training Modernization informed IHSPR’s creation of the Health System Impact (HSI) Fellowship, which launched in 2016. The HSI Fellowship provides highly-qualified doctoral trainees and post-doctoral fellows studying HSPR or related fields a unique opportunity to apply their research and analytic skills and talents to help address critical health care challenges facing the system. The program seeks to support impact-oriented career paths, expand and enrich the traditional training environment and embed research talent within health organizations to advance Learning Health Systems (LHS) and prepare the workforce of the future. To-date, CIHR-IHSPR and its many partners have funded more than 200 fellows embedded within over 100 health system organizations connected to 24 university training programs across the country to accelerate evidence-informed health system improvement.
National Cohort Training Program
Starting in 2017, IHSPR held annual meetings to provide enhanced training and networking opportunities for fellows, mentors and alum and in 2020 in collaboration with CHSPRA started an HSIF community of practice.
These efforts to build a strong national cohort of engaged fellows has led to numerous collaborative publications and efforts to consider the value of the program including:
- S. Sim, J. Lai, K. Aubrecht, I. Cheng, M. Embrett, E. Ghandour, M. Highet, R. Liu, C. Casteli, M. Saari, S. Ouédraogo, H. Williams-Roberts. CIHR Health System Impact Fellows: Reflections on “Driving Change” Within the Health System. International Journal of Health Policy and Management, 2019; 8(6): 325-328. doi: 10.15171/ijhpm.2018.124 — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600016/
- M. Menear, M-A. Blanchette, O. Demers-Payette, Denis Roy. A framework for value-creating learning health systems. Health Res Policy Sys 17, 79 (2019) — https://doi.org/10.1186/s12961-019-0477-3
- C. Weijs, J. McConnell-Nzunga, S. A. Prince, S. M. Sim. Strengthening the health system through novel population and public health fellowships in Canada. Can J Public Health. 2019 Jun;110(3):323-326. doi: 10.17269/s41997-019-00195-3. Epub 2019 Mar 7. PMID: 30847802; PMCID: PMC6964419 — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964419/
- M. Embrett, R. Liu, K. Aubrecht, A. Koval, J. Lai. Thinking Together, Working Apart: Leveraging a Community of Practice to Facilitate Productive and Meaningful Remote Collaboration. International Journal of Health Policy and Management, 2021; 10(9): 528-533. doi: 10.34172/ijhpm.2020.122 — https://www.ijhpm.com/article_3854.html
To further promote cross-cohort collaboration and growth, CIHR announced the awardees of the HSIF National Cohort Training Program (NCTP) grant in 2021. The NCTP recipients are led by a national consortium consisting of 65 members, 22 of which were previous HSI Fellows and 14 of which were HSI Fellow mentors. The consortium includes representation from eight provinces and brings together a diverse set of perspectives with health system leaders and emerging leaders across academia and the health care delivery, public, not-for-profit, and private sectors. Overall, their unique insight into the HSI Fellowship program, as well as connection to health system organizations and decision-makers, will provide a strong basis for advancing HSI Fellow cohort development and more broadly, learning health systems across Canada.
In 2021, CIHR-IHSPR and CHSPRA joined forces to produce the first HSI Fellowship Embedded Research Impact Casebook. Jointly written by the fellows and their supervisors, an Impact Narrative highlights the most notable and consequential impacts that arose from the fellowship, including the fellow’s contributions to capacity-building, translatable research evidence, evidence-informed decision-making, and health system improvement. This casebook includes 18 Impact Narratives submitted by HSI Fellows from the 2017, 2018 and 2019 cohorts, who were embedded in 15 different health system organizations spanning several sectors and five provinces.
Next Steps – Advancing Early Training Modernization Efforts
The TMWG recently launched a survey to revisit the enriched core competencies originally published in 2018. The purpose of this work is two-fold: 1) to refine and modernize the Framework to ensure it prepares doctoral trainees and post-doctoral fellows studying HSPR and population and public health with the skills needed to tackle the multifaceted, complex health system challenges of today and tomorrow and further advance LHS; and 2) to work towards developing a strategy for implementation of the competencies beyond the HSI fellowship program and into doctoral training programs across the country.
Impact Analysis and Assessment
Canada has a long tradition of providing leadership in the area of impact analysis. In 2009, the Canadian Academy of Health Sciences published Making an Impact: A Preferred Framework and Indicators to Measure Return on Investment in Health Research. This was followed by a collaborative effort with the National Alliance of Provincial Health Research Organizations (NAPHRO) to examine investments in health research. This work supported the development of the pan-Canadian HSPR strategy.
CHSPRA Framework Development
The Impact Assessment Working Group (IAWG) was formed in 2015 in response to one of the Pan-Canadian Strategy’s foundational strategic directions which called on the HSPR community to “integrate innovative thinking and best practices in impact and its assessment, in addition, to develop new metrics that capture the true value and impact of HSPR and HSPR investments.” (Executive Summary | Full Report)
The IAWG identified the need to go beyond reporting investment data to include understanding the effect or impact those investments had on the health system. This group of organizational leaders in HSPR, impact assessment and evaluation completed a literature review and then developed an impact assessment framework and indicators specific to decision-making in health services and policy research. The CHSPRA Informing Decision-making Impact Framework (‘the CHSRPA Framework’) addresses an assessment void by clarifying key impacts along the pathway between health services and policy knowledge production and the downstream effect on health and societal outcomes and impacts.
CHSPRA Framework How-to Guide and Case Illustrations
Following the publication of the CHSPRA Framework and indicators, the IAWG considered opportunities to advance impact assessment practice by supporting and understanding the use of frameworks. This resulted in two initiatives.
The first involved a number of diverse organizations across Canada implementing the framework to inform impact assessments. Based on their real-world experiences, these organizations developed a ‘how-to guide’ (Executive Summary, French translation) that provides practical guidance for using research impact assessment frameworks, as well as case illustrations (English, French) that bring the successes, challenges and lessons learned to life. The guide was also introduced during a workshop at Virtually CAHSPR in 2021.
The second initiative involved guiding organizations and CIHR Health System Impact Fellows in using the CHSPRA Framework to writing impact narratives. CHSPRA and the Institute for Health Services and Policy Research – Canadian Institutes of Health Research (IHSPR-CIHR) partnered to develop and disseminate impact narratives in the HSI Fellows Impact Narratives Casebook.
During COVID, the organization of the IAWG evolved into two groups, the working group that completed the development of the ‘how-to-guide’ and a community of practice called the Impact Assessment Collaborative.
Impact Assessment Collaborative
The Impact Assessment Collaborative (IAC) brings together leaders in areas such as impact assessment, performance measurement and evaluation from various organizations, including funders, government, universities, and not-for-profits, to share experiences and information on what’s happening in their respective organizational contexts and to identify areas where collaboration is needed. The group meets monthly to engage in dialogue on topics such as defining and measuring value, building common language and highlighting systems approaches to impact assessment.
Learning Health Systems Working Group
Much of the work undertaken by the members of CHSPRA could be characterized as contributing to building learning health systems in Canada. The TMWG examined the evidence to date that suggested that embedded fellowships are an effective approach to building more “learning” into the many varied systems that support health. This work led to the HSIF program.
Advancing the practice of impact assessment and analysis is also core to building learning into health systems.
In 2017, CHSPRA leaders also started further conversation about learning health systems in Canada with an assessment conducted by the McMaster Health Forum to synthesize the evidence about rapid-learning health systems and to scan the country for related initiaitives.
Further dialogue specific to learning health systems gave way to other priorities over the course of the pandemic.
Many in the health services and policy research community have contributed to CHSPRA since its inception in 2015. Some have filled roles as founders and visionaries, organizers, planners and/or working group members. Collectively these contributors make up the “members” of CHSPRA.
Here we try to acknowledge those who have contributed to CHSPRA’s efforts, though we know the lists may be incomplete.