Alberta Innovates- Health Solutions

Health Research Agenda

The Health Research Agenda was developed by the Health Research Advisory Committee with the intention of advising AHFMR's programs, the Health Collaborative Agreement with Alberta Health and other partners with a stake in health research. The Agenda specifically focuses on health services and community and population health while the overall purpose of the Agenda is to describe overall directions and important guiding principles and priorities which should be addressed in the provincial plan for health research. Overall, the Agenda is broad as it is intended to guide and prioritize the provincial plan. The Agenda and a plan for implementation over 1997-1998 were released in the Spring of 1997.

The vision of the ideal health research environment in Alberta includes highly trained health researchers, research relevant to individual Albertans and those making decisions, continuous improvement through education and peer review, positive changes, successful linkages and partnerships (e.g. researchers and practitioners), tools to put research into practice, evidence-based decision making and the recognition of the importance of health research by the public. The principles which will guide the process to attaining this vision include an emphasis on the importance of the application of health research; the importance of the research itself and the necessary infrastructure to facilitate it; and the necessity of linkages and alliances between the providers and users of research, including mechanisms for the dissemination and implementation of the research.

The goals stated in the Agenda include: high quality research and development; joining partners in a common vision and set of values; developing a more effective knowledge-based health system; increasing awareness and appreciation of research by users and the general public; providing a rationale for long-term investment in research; improving the scope, relevance and quality of research to inform policy and practice; increasing capacity of research to address provincial challenges; ensuring that the benefits of research are disseminated and applied; and improving linkages between delivery sectors and research areas.

The plan for implementation includes:

• Capacity building - The ability of system to conduct research and use it in evidence-based decision making at all levels is to be facilitated through peer review; training, personnel support and infrastructure, and developing the capacity to use research information.

• Structures - Alliances and partnerships at international, national, provincial and community levels are recommended as is funding from primary public sources to kickstart continued funding or matching funding from other public and private sources.

• Engagement - Attention is to be given to the knowledge diffusion process, which includes dissemination, adoption, implementation and maintenance.

• Priority setting - In setting priorities, a balance between broad base and responsiveness to user needs is emphasized.

The Health Research Agenda can be found at www.ahfmr.ab.ca/grants/HRF/Agenda/index.php.

Health Research Strategy

The Health Research Strategy was put together by the Working Group of the Health Research Advisory Group, established by the Alberta Science and Research Authority (ASRA). The stimulus for this project is to develop a strategy for Alberta to remain competitive in the area of health research. Our competitive position as a province and country has been weakened as a result of cutbacks and federal and provincial governments are now developing initiatives to increase support of health research. The draft plan was approved by the Advisory Group in December of 1998.

The vision of the plan is for Alberta to be an international leader in integrated health research in order to maximize the health and prosperity of Albertans by 2010. In order to develop initiatives to achieve this end, a SWOT analysis was performed with the identification of strengths, weaknesses, threats and opportunities of health research in Alberta. Strengths include AHFMR and the university programs while weaknesses focus on fragmentation, poor understanding of research on the part of the public, lack of planning and an unattractive environment. Threats identified were a poor competitive position, lack of competitive fiscal and taxation environment for start-ups and a lack of communication to the public on the value of health care.

The focus of the plan is for planning and decision making in health research sector to become more provincial in focus and more strategic in nature. A financial plan for the implementation of the strategy is also proposed. Specific strategic initiatives include:

• Build on strengths in biomedical research - Basic researchers are to collaborate with developing strength in health services and population health to bring nodes of excellence into international prominence.

• Develop a critical mass in health services and population health research of international quality - Start specific programs in these areas.

• Encourage and support the development of an integrated health information system for Alberta - This information system should serve to support clinical care and promote research.

• Develop the necessary human capacity - Competitive income, an attractive environment and infrastructure are necessary to attract quality researchers.

• Increase the ability to leverage funds from multiple sources to support the health research sector in Alberta - Leverage funds from industry, CIHR and other partnerships.

• Develop a significant health research industry in Alberta both through technology commercialization and by attracting established industry - The business environment must be attractive and skills for success in start-ups should be developed.

• Communicate the value of health research and a health research industry to Albertans

International Board of Review

An International Board of Review is convened every six years to review the operations of the Alberta Heritage Foundation for Medical Research. Such a review was completed in 1998 by an International Board of Review comprised of seven esteemed scientists. Overall, the 1998 review was positive, with specific recommendations made to AHFMR on its various operations. In response to this review, AHFMR had GPC Communications conduct a stakeholder consultation to determine the public response to the IBR report. Most stakeholders were in agreement with the report with some exceptions for certain recommendations.

In general, the IBR applauded AHFMR's continued success, specifically with respect to being on the leading edge of research, increased funding and their policies and standards of excellence. Reference was made to AHFMR's mission to create a community of researchers who improve the health of Albertans and to the goals articulated in AHFMR's 1992 Strategic Plan.

Specific recommendations were made in each of AHFMR's areas of operations:

• Financial stewardship - The plan of the trustees to maintain the real value of the endowment was endorsed.

• Personnel programs - Several specific recommendations were made, including an increase in funding to trainee programs.

• Technology commercialization program - Discontinue AHFMR's responsibility for this program and have universities assume the program with AHFMR's continued support in the areas of training and advocating government support.

• Health research - The thrust of the Health Research Agenda was endorsed.

• Health Technology Assessment - Transfer HTA to an independent entity.

• SEARCH - Continue the SEARCH community based initiative but seek partner funding, mentors, Alberta Health and RHA leadership, critical appraisal of research studies and dissemination where appropriate.

• Major equipment program - Expand this program to replace or upgrade old equipment.

• Capital construction, infrastructure support, renovation and renewal - The Opportunity Fund was approved but clearly defined policies for partnership in infrastructure funding are needed.

• Ethics and industry commercialization opportunities - Take leadership in Alberta to facilitate the development of a comprehensive structure and national policies that would enable the Research Ethics Boards to fulfill their missions.

• Management - The president should focus on presenting AHFMR externally and on new initiatives while a new Senior Administrative Officer should fulfill the other duties.

• Advisory committee structures - Have two of the advisory committees, SAC and HAC chaired by someone other than the president and work to enhance communication.

• Communications - Ensure that all user groups and interested parties are informed on fiscal matters and granting policies.

In determining the stakeholder response to the IBR report, opportunities were made for interested persons to express their views. 81 submissions in addition to formal contacts were made. The recommendations were generally supported, with the endorsement of SEARCH and the need for better communication being strongly supported. Stakeholders had mixed views over recommendations to move the Technology Commercialization and Health Technology Assessment programs out of AHFMR.

The IBR report can be accessed at www.ahfmr.ab.ca/publications/reports/IBR.

Health Summit '99

Health Summit '99 took place in Calgary in February of 1999 and provided an opportunity for 200 people from across the province to talk about health issues and explore questions posed by the Health Minister. The 200 participants invited represented a wide range of people directly involved or working in the health system combined with an equal number of randomly selected people chosen from across the province. Prior to the Summit, questionnaires were sent out, to which 1340 responses were made; mini summits were held by MLAs and public opinion research was conducted. This information was made available at the Summit to stimulate discussion, in addition to a series of speakers. Information made available as a result of the Summit include the "Final Report of Health Summit '99' as well as background reports on the specific recommendations made in group discussions and the responses to the Summit questionnaire. The Final Report is available at http://www.health.gov.ab.ca/public/document/summit/f-report.pdf.

The four questions posed by the Health Minister in December of 1998 to launch the summit process were:

• What is essential in Alberta's health system?

• What changes should be made in how health services are delivered and managed?

• What responsibility do individuals have for their own health?

• How much money is enough to sustain our publicly funded health system?

The Final Report contains 30 recommendations to government on important directions for the future of Alberta's health system. The overall themes identified are: ¨ People know what they want from the health system. Basic values and principles identified were: access, accountable, affordable and sustainable, adequately funded, publicly funded and publicly administered, consistent with the Canada Health Act, high standards, access to information, choices, cooperation, teamwork, balance, adaptable and coordinated.

• People want a comprehensive, publicly funded, publicly administered health system that is flexible and meets changing health needs.

• It is time for a clear plan for the future of Alberta's health system.

• There are priority areas where changes can and should be made: teamwork, primary health care and community health centres, information and evidence, a better balance, planning for long term care, the right people doing the right work, improving access, and accountability.

• Health is a shared responsibility with individuals and the government.

• We need to find ways to sustain Alberta's health care system.

• The public should have effective ways of participating in future directions.

Contact Information (copies of report)

Provincial Health Report Card

The Provincial Health Council of Alberta's 3rd annual report on the performance of Alberta's health system was released in 1998. The report is entitled the "1998 Annual Report Card to the Legislature: How is our Health System Performing?" The Health Council is made up of a group of citizens selected by Minister of Health to represent views of average Albertans. This concept of an independent citizen body is now recommended by the National Forum on Health for use at the national level. Note that the Report Card also makes reference to the progress on the 1996 and 1997 recommendations, which is good in some areas but mostly acceptable or below acceptable.

While the 1997 Report Card focused on the need for change and working together to find new ways of delivering services in order to meet present needs, the 1998 council focused on reform and sustainability. The goals of health reform were determined to include a wellness-based health system that was citizen-focused, integrated, appropriate, affordable and accessible. In creating the 1998 Report Card, the Council assumed that the Alberta health system was not sustainable in long run, that the integration of health services would make the system more sustainable (particular focus on primary health services, injury prevention) and that reform includes restructuring, refinancing and reform. Information was gathered via consultation with Albertans, focus groups, formal reports and targeted workshops to assess these assumptions. It was found that Albertans want to sustain universality, guiding principles, the focus on the influence of determinants, personal responsibility, the commitment of service providers, the regionalized structure, Alberta's position as leader in education and research, and increased potential for information-sharing. However, it was also found that Albertans want to change the lack of integration, fragmentation of services, structural barriers between groups, the low morale of service providers, the lack of understanding of vision, the limited ability to influence professional behavior, the inability to measure outcomes, the lack of citizen-focused health care and the lack of conflict resolution process in Alberta's health system.

Specific recommendations were for:

• Minister of Health to champion health reform in AB by taking more direct leadership role in the health reform process.

• Alberta Health to work with health authorities and professional bodies to identify barriers to further integration in health services delivery and endeavour to remove barriers.

• Minister of Health to facilitate development of effective mechanisms for linking physicians and other providers into coordinated and integrated networks of health and human services.

• Minister of Health to work with Advanced Education and other bodies to ensure all professional education programs emphasize skills for working in interdisciplinary teams, wellness approach and a focus on individual and family needs.

• Minister of Health with Ministers of Labour and Advanced Education to establish comprehensive study to determine long-term sustainability of service provider workforce.

• Minister of Health to improve financial monitoring of wellness programs and ensure sustainability where funding was reduced.

• Minister of Health to review current payment mechanisms to ensure system encourages movement towards goals of health reform.

• Minister of Health to develop a ten year strategic plan to guide the RHAs' three year operational plans.

• Alberta Health to develop evaluation framework based on provincial health goals and reform goals.

Contact Information (copies of report card)

Evaluation of Collaboration Agreement Between AHFMR and Alberta Health

The Health Research Collaboration Agreement was signed in October, 1995 when funding from Alberta Health was given to AHFMR with the transfer of the Health Services Research and Innovation Fund, the Mental Health Research Fund and the Health Technology Assessment program along with a commitment on the part of AHFMR to develop and communicate a general agenda for health research in Alberta and to provide for the dissemination of research and HTA findings.

The Agreement (Article 7) requires an evaluation framework and an independent evaluation to demonstrate the achievement of the Agreement's deliverables and to assess the impact of the Health Research Collaboration on the provincial health system. A consulting team approved by the Health Research Advisory Committee (HRAC) conducted an evaluation between October 1998 and February 1999. It's focus was: compliance with provisions, intermediate products of Collaboration, research and HTA products and the placement of the Collaboration within the context of AHFMR, Alberta Health and the government in general.

Specific findings and recommendations were:

• Health Research Agenda - When HRAC was established its first task was to undertake active role in the development of the Health Research Agenda. This Agenda and a plan for Implementation over 1997-98 were released in the Spring of 1997. The consulting team found that the HRA was more broad than Alberta Health wanted but was generally viewed as a good start which could be built on. Recommendations included revisiting the HRA and implementation strategy every two to three years, narrowing down the implementation strategy and more actively engaging the related health research committees in the HRA.

• The Health Research Fund - The goal of the fund was to support health services research, population health research and health technology assessment research. The team found that people were generally happier with AHFMR administering the fund with some concerns from Alberta Health over a lack of research that would allow them to formulate policy in health care. Recommendations were to keep HRF under AHFMR, keep funding levels generally where they are but allow for more evaluative research, look at more flexibility, keep mental health research integrated and provide explanations when review and committee decisions contradict.

• Health Technology Assessment - HTA moved from Alberta Health to AHFMR in 1995 though Alberta Health is still the primary client. It was found that awareness of HTA was limited within RHAs and with HRAC members, distribution of publications was not very good and there was limited knowledge of the HTA website. Most interviewees disagreed with the IBR recommendation to move the HTA function from the Foundation. Alberta Health established an Ad Hoc HTA Working Group to address the difficulty with access to HTA services since the evaluation began. Recommendations were to work together to improve process and relationships, keep HTA with AHFMR, develop relationships with RHAs, and for the HTA Advisory Committee to work with HRAC to set priorities.

• Communication and Dissemination of Research Findings - The establishment of the research to practice framework was noted while it was found that there was still unawareness of the Foundation's dissemination activities. There was still a long way to go in reaching the right audience in the right manner. Recommendations include more active liaisons with practitioners and AHFMR committees and a comprehensive plan for evaluation.

• Utilization Monitoring and the Development of Databases - Alberta Health and AHFMR were found to have different interpretations of AHFMR's role regarding utilization monitoring and the development of databases. Recommendations include the need for clear communication and the continuation of AHFMR's focus on skills development in the utilization analysis through SEARCH, ACHRN and student/scholar support programs rather than engaging directly in utilization analysis and data base development.

• Collaboration Committee Structure - A number of advisory committees created under Agreement - Dissemination Research Advisory Committee (DRAC), Health Technology Assessment Advisory Committee (HTAAC), Alberta Health Collaboration Advisory Committee (AHCAC) and Health Research Advisory Committee (HRAC). It was found that HRAC has had a limited role to date, members not sure what programs they represented and members were unaware of what other committees doing. Recommendations were to clearly articulate the role of HRAC, review membership, institute regular meetings, establish working groups to achieve specific goals as well as to have HRAC be the overall umbrella committee with the terms of reference and membership of the other committees to be reviewed.

Overall it was found that AHFMR was doing well in its new role. Clearer understanding was needed between parties to the agreement and more effective linkages were essential. Overall areas of improvement identified were:

• Balance between elucidatory and evaluative research

• Balance between investigator-driven and needs-driven research

• More effective liaison among committees of Foundation

• Improved liaison between Foundation and external stakeholders - RHAs, PHAs, AH, Alberta Science and Research Authority (ASRA)

• Clarification of lead / support roles of AH and AHFMR in particular areas (e.g. AHFMR leads in research, AH in utilization monitoring and database development)

National Forum on Health

The federal launched its on National Forum on Health in 1994 and completed the process in 1997. The Forum consisted of 24 members with expertise in health care as volunteers, professionals and consumers. The mandate of the form was to consult with Canadians and advise government on innovative ways to improve the health of Canadians. The four themes identified by members of the Forum were: determinants of health, evidence-based decision making, values and striking a balance.

The Final Report concludes that the public sector has demonstrated that it can effectively manage the health care system and that the role of public funding for health care is the key to successful restructuring. Recommendations include:

• Restructuring the organization, funding and delivery of primary care services; funding the care rather than the provider or site and taking steps to bring home care and medically necessary drugs under the umbrella of the publicly funded health care system.

• Investing society's resources to improve the health prospects of Canadians at a broader level. These recommendations included a broad, integrated child and family strategy involving both programs and income support; the creation of a national foundation to strengthen community action; an Aboriginal Health Institute; and help for people trying to enter the work force.

• In order to increase accountability and effectiveness, the adoption of an evidence-based system at the clinical, management and policy levels and at the public information level is recommended.

• Collaboration and partnerships between governments on other sectors.

Information on the final report, news releases and companion publications can be found at www.hc-sc.gc.ca/english/forum_e.htm.