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Monday, January 16, 2017
Move health research
out of the academy and into the community
Health changes require greater input by
people trained to create a difference - and that's not happening in
By Stephen Bornstein with Adalsteinn
TORONTO, Ont./Troy Media/ - Canada has a mismatch between the
world-class health research we produce and how that research is implemented into
our health-care system.
Our doctoral graduates are among the most productive and respected
researchers in health services, health policy and health economics - and
Canadian universities are often in the global top 10 for these areas of study.
Yet our health system continues to underperform.
Where's the disconnect?
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The Commonwealth Fund ranks
comparable health systems around the world on a number of performance
indicators. It continually places Canada as one of the worst performers across a
number of categories, such as timeliness, safety and efficiency of care. Only
the United States routinely performs worse, sitting at last place
It would be easy to point to health-care funding as the culprit but
that's largely not the case.
Canada spends roughly 10.4
per cent of its gross domestic product on health, more than the United Kingdom,
New Zealand and Australia.
The truth is, we often don't manage our health system
But much can be done to lift Canadian health care out of its poor
Over the last several decades, a number
of studies from
experts inside and outside of Canada have pointed out the gap between the performance of our system and the level we
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Landmark reports from Manitoba and Ontario show that a patient's
likelihood of getting needed surgery depends heavily on where they
live. Studies also show a huge gap between what we know to be effective and
appropriate care and what people actually receive. And a study from over a
decade ago shows that nearly one in 13 hospital visits resulted in adverse
health events with nearly nine per cent of these ending in preventable
follow-up study last year shows that little has
We can do better, but how?
Health system changes require greater input by people trained to
create and use evidence to design, implement and evaluate them. That's not
happening in Canada.
Every year, more than $3.5 million is invested in the training
of health-care-related PhDs in Canada. But for the majority of them, the
likelihood of academic employment is low and declining. In fact, the
vast majority will work in health services and management fields, not
academia. Yet our doctoral programs in health sciences don't prepare them for
An extensive interview-based study found that our recent health
PhDs are not having the impact they could have on Canada's health system - the
sort of impact that many of our most advanced graduates with PhDs see as the
goal of their careers and the reason for their training. While well prepared in
academic terms, they lack preparation in the managerial and leadership skills
necessary to make tough decisions based on evidence with a relentless commitment
to evaluation and improvement across the system.
It's time to move health research out of the academy and into the
We now provide experiential learning opportunities during and after
PhD training, where individuals get the opportunity to work with hospitals,
government agencies and other health-care providers in the community - to apply
their skills and findings directly in the service of health system
We're building an open source curriculum to teach health PhDs
essential managerial and leadership skills they need to make sure their
expertise gets translated into better decisions across our health
Discussions about health funding will always be important, but we
need to make sure we have the personnel to make the system better, regardless of
the dollars transferred between levels of government.
We have a great resource in Canada's university-based training
programs in health services and PhD graduates who want to make a difference. Now
we need to make sure they have the opportunity.
Adalsteinn Brown is an
expert advisor with EvidenceNetwork.ca, the director of the
Institute of Health Policy, Management and Evaluation and the Dalla Lana Chair
in Public Health Policy at the University of Toronto. Prior roles include senior
positions in the Ontario government. Stephen Bornstein is director of the Centre
for Applied Health Research and a professor at Memorial University. Prior roles
include senior positions in the Ontario government.