Health Research, Development and Innovation in England from 1988 to 2013: From Research Production to Knowledge Mobilization

Walshe, K. & Davies, H. T. O. (2013). Health research, development and innovation in England from 1988 to 2013: From research production to knowledge mobilization. Journal of Health Services Research and Policy, 18(Suppl. 3), 1–12. http://journals.sagepub.com/doi/pdf/10.1177/1355819613502011
Abstract
This paper presents a critical analysis of the development of government policy and practice on health research, development and innovation over the last 25 years – starting from the publication of a seminal report from the House of Lords Science and Technology Committee in 1988. We first set out to map and analyse the trends in ideas and thinking that have shaped research policy and practice over this period, and to put the development of health research, development and innovation in the wider context of health system reforms and changes. We argue that though this has been a transformative period for health research, rather less progress has been made in the domains of development and innovation, and we offer an analysis of why this might be the case. Drawing on advances in our understanding about how research informs practice, we then make the case for a more integrative model of research, development and innovation. This leads us to conclude that recent experiments with Collaborations for Leadership in Applied Health Research and Care and Academic Health Science Centres and Networks offer some important lessons for future policy directions.
It’s not a new article but I doubt much has changed in the last five years. This is not an article that will necessarily speak to your knowledge mobilization practice but it will speak to how you locate your practice in the broader system(s) of research.
This article reviewed 13 major reports on Britain’s health research system published between 1988-2011. The basic conclusion of the first half of the article is that the primary beneficiaries of health research funding have been health researchers themselves. Despite all the calls for research to improve human health we have instead been feeding the academic research enterprise. “Overall, it can appear that the research enterprise itself is the purpose of health research, and that the long-standing and oft-stated ambition that research strategy should more closely serve the needs of the [National Health Service] has not yet been fully achieved.”
It is important to note that neither of the authors are health researchers. Both study the business of health from the perspective of faculty in business schools in Manchester and St. Andrews.
The article then looks at the role of innovation and impact – essentially getting a public return from the public investments in health research. As the authors state “how evidence from research is used, disseminated, understood, translated, mobilized or applied, and what effects are seen on how health care systems work and how health care is delivered to Patients.”
They cite two experiments in combining research and health application: the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) and Academic Health Science Centres and Networks (AHSCs and AHSNs), and point out how these offer some important lessons for future policy directions. In both experiments “for the first time, the primary mission was presented as knowledge mobilization, rather than research productionWe would point to the development of organizational capacity in knowledge mobilization; the creation of local and organizational research priorities and agendas; the explicit linking of research to knowledge mobilization; and the requirement for organizational co-investment in, and commitment to, research and knowledge mobilization.”
This is presented in an evolving health care environment where increasingly the frail elderly are presenting with multiple conditions, primarily chronic in nature, are heavy users of the health system and require attention also from social care systems. All of this in an age of austerity which demands public returns on public investments.
These problems are mostly concerned with service issues like pathway and process redesign, safety and quality; organizational issues like coordination, integration and networking; workforce issues like training and skill mix; and patient issues like experience, education and empowerment. Yet the research enterprise remains largely focused on life sciences and bio-medicine and on the development and evaluation of technologies like drugs, diagnostic tests and devices.
There is a disconnect between the research agenda (directed by researchers wanting to make technologies) and the health agenda (ideally directed by patient need wanting reduced wait times and linking of health and social care services).
Questions for brokers:
1. This is about health research. While there may not be the same number of government reviews of the broader research system do you think the conclusions will apply to natural sciences, engineering, social sciences and humanities research?
2. Read up on CLAHRCs as there have been several studies about them. They are a useful construct that don’t exist explicitly in Canada but from which many of us in the research to impact space (in any discipline) can learn.
3. Is your research to impact practice located in a system driven by researchers or by end beneficiaries? Does this make a difference to achieving your impact goals?
Research Impact Canada is producing this journal club series as a way to make evidence on KMb more accessible to knowledge brokers and to create on line discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read this open access article. Then come back to this post and join the journal club by posting your comments.

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