Strengthening the evidence base for a learning health system - Inspirations from good practice for capacity building in health services research and public health research

摘要

Background and aims WHO published its “World Report on Knowledge for better Health – Strenghtening Health Systems” in 2004. The EU’s 6th Framework Program for Research analyzed the status quo of public health research. The current 7th Program looks at health services research. Always of central importance is the question of how to translate theoretical knowledge into practical action. To stimulate the debate on enablers of high-quality health services research and public health research, LBI-HTA initiated a report on organization and governance of health services research and public health research. A successful system (organization and governance) of health services research and public health research enables institutional and human resources capacity building, which are foundations of high-quality research. Research questions and methods The report starts off by touching upon some of the conceptual and theoretical issues relating to knowledge gaps in health systems, capacity building for research and the interface of research and policy. Then concrete examples for good practice from the Netherlands, Denmark, Norway and the UK are presented to gain ideas and draw inspiration. The starting points for (unsystematic) literature searches were reports on the topic funded by international organizations (WHO, EU). In a snowballing system the literature sources of interest listed in these reports where further explored. To explore organizational examples of good practice, information about institutions relevant for health services research and public health research in a range of countries was gathered on the internet. Building on the information available on the websites, institutions were chosen to conduct in-depth expert interviews on. Senior experts in these organizations were asked to participate in person in a semi structured interview via telephone. Eventually 13 such interviews with durations of between 45 and 90 minutes were conducted with experts from organizations showing elements of good practice in the Netherlands, Denmark, Norway and the UK. Results Not least due to a long standing and well funded research tradition and a culture open to evidence based policy debate, model organizations in the field of health services research and public health research are found in particular in the Netherlands and in the UK. Transparent processes of prioritizing research questions, of communicating research results and of evaluating research and its implementation are necessary to establish a research system positively impacting the practice of political decision making. Trust between decision makers and researchers, characterized by intensive interaction along the entire research process, is a prerequisite for ultimate user relevance of research. Scientific competence in the narrow sense on the part of the research organization needs to be coupled with the ability to actively communicate with decision makers and with network building skills. This can be enhanced by organizational structures in research commissioning, academia and independent research organizations. In addition to political will, organizational leadership and sustainable funding commitments, capacity building requires time for a culture of problem solving in mutual respect to develop between decision makers and researchers. A perspective on research that takes organizational and systemic perspectives on board, that understands the production of evidence as a shared process and that is sensitive to context offers the most promising way forward.