- Building Better Health Care Leadership for Canada: Implementing Evidence ed. by Terrence Sullivan, Jean-Louis Denis
For over a decade, the Canadian Health Services Research Foundation (recently renamed the Canadian Foundation for Healthcare Improvement) sponsored a collaboration between scholars and decision-makers known as EXTRA—the Executive Training in Research Application. This volume is in part a meditation on the lessons learned from the initiative, with chapters written by those involved in the program—as academic advisors, students, and health-sector decision-makers. But it is also a deeper exploration of why evidence-informed leadership and administration are so critical to improving health policy and health services, and what techniques are needed to improve the use of radically different forms of evidence in decision-making.
The first chapters grapple with the imperatives for better evidence in clinical and administrative settings. For good policy and management decision-making, it is essential to have not only the best scientific evidence and knowledge available, but also knowledge of the interests of stakeholder groups as well as the knowledge that comes from direct experience. Only when all three types of knowledge are combined is it possible to exercise the type of judgment that has the potential to improve health services, health outcomes, and, ultimately, health systems and the public policies in which they are embedded.
For health decision-makers, this involves a continuous and virtuous cycle of planning, experimenting with a change, studying the results, and then spreading the change. Of course, in the real world, this is all done within budget and time constraints. In his chapter on the support of the research enterprise within health organizations, John Lavis peels the planning onion to explore how evidence is used to define the problem and establish the principal options open to decision-makers. Of course, as he points out, “action-oriented managers and policy-makers” will “often have a solution in mind and find it hard to stand back and ask what problem it is that they are trying to solve.” Thus, “[k]nowing how to define a problem using data and research evidence is often the biggest challenge” facing the proponents of more evidence-informed decision-making (p. 49).
This is an enormous challenge for decision-makers who have limited experience with the research methods used by clinical and social scientists. To address this gap, another chapter summarizes the research-literacy course—appropriately entitled “Demystifying the Research World”—that was designed to make managers good consumers (as opposed to producers) of health research. The course was made up of six modules, three on research methods, two on statistics, and one on the critical evaluation of systematic reviews and meta-analyses. Although the modules’ content requires fine-tuning over time, and there continues to be conflicting evidence on the perceived usefulness of health economics, the course appears to have made a real difference in terms of improving the ability of decision-makers to more effectively use clinical and social scientific evidence.
Further chapters are devoted to the essential question of leadership and change management. Although difficult to define, leadership is a key ingredient in any major reform of health services or health systems. In fact, leadership is required simply to change the culture and build the capacity of health organizations so that they use evidence more effectively. Although a distinction is drawn between episodic (“big bang”) change and more incremental change, both types of change require long-term commitment and perseverance to be sustained. The remaining chapters deal with the mentoring of EXTRA fellows, the systematic evaluation of the [End Page 194] EXTRA program, and examples of the EXTRA experience at various sites in Canada, including the Winnipeg Regional Health Authority, the Montérégie health and social services region in Quebec, and the Capital Health region in Nova Scotia.
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