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An Organizational Guide to Building Health Services Research Capacity

Contract Final Report


Introduction

Geographic, racial, and ethnic disparities in health and health care and the need for health care systems to accommodate increasingly diverse patient populations are a matter of national importance. As solutions are sought, it becomes more important to involve the areas and groups most affected by the disparities. They need to be empowered and equipped with the skills, tools, and funding to contribute to the development of research-based solutions. The Agency for Healthcare Research and Quality (AHRQ) sponsored the development of this guide to help research organizations and institutions improve their health services research capacity and competitiveness for grant and contract funding.

Health Services Research: A Definition

Health services research is a “multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately, our health and well-being.”i

Applied health services research provides data, evidence, and tools to make health care affordable, safe, effective, equitable, accessible, and patient-centered. For example, products stemming from health services research serve to enable providers and patients to make better decisions. They also can be used to design health care benefits and inform policy.

Health services researchers come from a variety of disciplinary backgrounds. The workforce includes an array of professionals and disciplinary perspectives, including fields such as:

  • Medicine, nursing, dentistry, pharmacy, and allied health.
  • Social and behavioral sciences.
  • Epidemiology and biostatistics.
  • Engineering.
  • Health care policy, research, administration, and management.

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Background and Purpose of the Guide

AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.a AHRQ achieves this mission by supporting the conduct, dissemination, and use of high-quality health services research and by supporting the development of researchers and research infrastructure.

AHRQ has supported health services research infrastructure development through two programs — the Minority Research Infrastructure Support Program (MRISP) and the Building Research Infrastructure and Capacity (BRIC) Program. These programs focus on improving the research capacity and competitiveness of institutions that predominantly serve racial/ethnic minorities or are located in geographic areas that have had historically low levels of AHRQ funding. Both programs were launched in FY 2001.

In 2006, AHRQ funded an evaluation of the programs by the American Institutes for Research (AIR). The evaluation was conducted to determine the extent to which, and ways in which, program grantees had strengthened their institutional research infrastructures and enhanced the capabilities of their individual faculty and staff members in relation to their ability to undertake health services research. After completing this research, AHRQ and AIR developed this guide to synthesize and share what has been learned. Our intent is to help organizations and institutions develop and enhance their ability to plan and conduct health services research and obtain funding for their research.

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Intended Audience

This guide is intended to meet the needs of a variety of organizations and institutions seeking to build their health services research capacity, including both public- and private-sector institutions. It can serve as a resource for organizations with limited experience conducting health services research and organizations that have some experience in the field but are seeking to further develop or strengthen their infrastructure. In particular, this guide may serve as a resource for:

  • Administrators and directors of organizations that would like to develop or expand their organization's health services research program.
  • Department leaders and program directors with limited research experience interested in creating or expanding a health services research program for their students or staff.
  • Individual researchers seeking to create a program or collaborative group of health services researchers.

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Organization of the Guide

This guide provides a user-friendly, step-by-step approach to planning, implementing, and sustaining a health services research infrastructure. These steps do not have to be taken in sequential order.

The guide describes six steps for establishing an effective, sustainable research infrastructure (Figure 1).

  1. Conduct an assessment.
  2. Cultivate a supportive research culture.
  3. Plan for infrastructure support.
  4. Communicate with funding agencies and other researchers and share findings.
  5. Evaluate the infrastructure.
  6. Plan for sustainability.

Figure 1. Layout of the guide

Step Detail
Step 1 Assessing Your Organization's Needs and Capabilities Identifying your organization's existing capacity and resources helps to determine your strengths and areas for improvement. This can help you set goals and target your resources.
Step 2 Fostering a Research Culture Moving an organization toward a culture of research requires dedicated leadership and support of other staff throughout the entire organization.
Step 3 Planning the Infrastructure Support

Step 3 comprises four activities for developing and expanding a research infrastructure:

Creating a research center with a thematic focus, research director or principal investigator, technical support, management support, and facilities and equipment.
Building research skills through training, mentoring, and individual research projects.
Establishing and sustaining partnerships within and outside of your organization.
Assembling an advisory group to provide technical guidance and feedback.
Step 4 Communicating and Reporting Reporting your work to the funding agency and disseminating your work to research professionals and the community can strengthen relationships and support longevity.
Step 5 Evaluating the Infrastructure Support Initiative Monitoring, evaluating, and updating your approach to building infrastructure can help to ensure success.
Step 6 Planning for Sustainability Planning for the long-term is essential to maintaining the infrastructure.

Each step concludes with a section entitled “Maximizing Success.” This section describes strategies for overcoming those challenges that organizations faced when implementing that step.

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Step 1: Assessing Your Organization’s Needs and Capabilities

The first step in determining needs is to identify the current status of your organization's overall research infrastructure. This section will provide specific issues that you will want to examine to determine your organization's needs and capabilities.

The process of assessment will depend on the availability of resources — time, staff, and data. Data may come from existing documents and databases at your organization; population data from a national online resource; surveys of staff, faculty and/or students; interviews with faculty and administrators; and even from informal conversations with others.

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Health Services Seed and Fertilizer Organization

Assessment is important for setting up a successful initiative. In order to set achievable goals, it is vital that those goals are based on current information that shows where your organization is in relationship to where you want to be in developing a health services research infrastructure.

In this guide, we classify organizations in two ways: seed organizations and fertilizer organizations. A seed organization is one that may have established research capabilities but limited health services infrastructure support. Such an organization will want to initiate the development of a health services support infrastructure. For example, seed organizations may want to acquire access to health services research journals for their libraries or establish procedures for arranging release time for staff to conduct health services research. Fertilizer organizations, on the other hand, are organizations that have an infrastructure in place for conducting health services research, but there may be little support for it. A fertilizer organization might choose to retain consultants with specific research expertise to complement the skills of existing staff or to identify colleagues to review strategic plans or provide training.

To obtain perspective on where your organization is, we suggest five areas for assessment:

  1. Contracts/grants infrastructure.
  2. Research staff expertise and experience.
  3. Research facilities and equipment.
  4. Organizational research culture.
  5. Partnerships within and outside the organization.

Contracts/Grants Infrastructure

It is important to review the resources available for both writing proposals and administering grants and contracts. Be sure to think about this information on both a departmental level and on an overall organizational level. In review of your contracts and grants infrastructure, you should consider the following questions:

  1. Do you have an office that manages your department's or organization's proposals, grants and contracts?
  2. Are staff available to:
    • Identify and disseminate information about funding opportunities.
    • Provide access to previous proposals.
    • Prepare budgets for grants and contracts.
    • Review proposals.
    • Review budgets for grants and contracts.
    • Legally commit the organization to perform the proposed work.
    • Coordinate grant and contract activities within the organization.
    • Keep track of funded project expenses and produce monthly expense reports .
    • Prepare invoices for funded projects.

Research Staff Expertise and Experience

It is invaluable to identify individuals at your organization who have the skills and interest to support the initiative. You should identify faculty and staff with the appropriate skills and abilities to help support the proposal or grant preparation process, and you should review information on faculty, staff, and students at your organization who can and will support your efforts.

  1. How many faculty, staff, and students are at your organization?
  2. What degrees are held by the faculty and staff?
  3. What types of research staff (administrative/secretarial support, student workers, and graduate research assistants) are available? How many?

Review CVs, résumés and biographies of faculty and staff to find out about:

  1. Current level of Federal research funding.
  2. Amount of Federal research funding in the past 5 years.
  3. Availability (release time) for conducting future research.
  4. Area(s) of expertise – look at both research topics and methodologies.
  5. Experience serving in the role of principal investigator.

Contact others at your institution to find out about:

  1. Interest in getting involved with health services research (for both writing grants and proposals and also for conducting research).
  2. Health services researchers with whom they have existing relationships.

Research Facilities and Equipment

In addition to staff, you will also need to consider the facilities and equipment available to conduct the work. Consider:

  1. Office space.
    1. Do you have enough space to conduct your research?
    2. Is the space conducive to teamwork? Are all staff members able to be in the same area?
  2. Information technology.
    1. Do you have the software for conducting data analyses and creating presentations and publications?
    2. Do you have the hardware—such as servers, computers, and printers—needed to conduct health services research?
    3. Are there existing data security protections and procedures to ensure privacy and prevent corruption? If not, what is necessary to develop and implement such procedures?
    4. Do you have means to access databases you need for your research? What about access to populations you plan to study?
  3. Library facilities and relevant literature.
    1. Do you have access to online databases for literature searches?
    2. Does staff have the expertise to conduct these searches?
    3. Do you have access to the medical journals likely to be identified in these searches?

In the early stages of an initiative at a seed organization, the facilities and equipment currently available may limit the kinds of research that you pursue.

Organizational Research Culture

In assessing your needs and capabilities, it is important to address these additional aspects of your organizational culture. Consider the following questions when thinking about the research culture at your organization:

  1. Research centers consist of a group of investigators who collaborate on research in a common topic area, operate as a formal entity within the structure of the organization, and generally share physical space. Do you have any research centers? How many? What is the focus of each center?
    1. Is there a potential for developing a synergy within an existing center to address health services research questions? Is it possible to form a new center to address health services/policy research questions?
  2. What research focusing on or related to health services research has been funded at your organization in the last 5 years?
    1. From where was funding obtained? (Sources of funding including Federal, State, and local governments; foundations; your organization itself.)
    2. How much research funding did the organization receive?
  3. How easily can staff access technical support in biostatistics, health services research methodologies (such as secondary data analyses, survey research, retrospective and prospective quasi-experimental observational studies, and qualitative methods), and research proposal and manuscript review within your organization? Outside of the organization?
  4. How easily can staff obtain concrete support from the organization (staff labor or time, funding) to apply for and conduct health services research?

Institutional Policies

  1. Does your organization have any formal documents (such as mission statements and strategic plans) or policies and practices that explicitly support or encourage research?
  2. Does your organization have its own Institutional Review Board (IRB) or a formal agreement to use another organization's IRB?
  3. Does your organization have staff or committees (such as a staff research council or vice president [VP] of research) that explicitly support or encourage research?
  4. How supportive are your organization's leaders of research? How supportive is fellow staff?
  5. What weight does obtaining support for, conducting, and disseminating research have in performance evaluations? What weight does research have on decisions about raises, promotions and tenure?

Personnel Policies

  1. How difficult is it to get release time to conduct research (for example, a sabbatical, reduction in teaching responsibilities, or permission to consult)?
  2. How much verbal support and encouragement does staff get from supervisors for conducting research?
  3. What kind of tangible support does staff receive from supervisors for conducting research?

Partnerships

Existing partnerships can serve as important resources for helping to find out about potential funding opportunities, guiding and mentoring research activities, and providing access to research data. Examine what kind of relationships and partnerships exist within your organization and with other organizations. One of the most common and effective strategies we found in our research was developing partnerships with top-tier academic institutions and senior researchers. Consider developing partnerships with groups and organizations that will support your goals and activities. There are different types of partners listed below; please note that these categories are not mutually exclusive.

  • Academic institutions or individuals (such as an experienced researcher at a university).
  • Non-academic research partners (such as foundations, think tanks, associations, and not-for-profit organizations).
  • Government partners (such as a State or local department of health).
  • Community and clinical partners (such as a health care delivery system or a school).

As part of your assessment make a list of your current partners.

  1. What partnerships do you already have in place?
    1. For each partner ask:
      What type of organization is the partnership with? (Use the categories above.)
      How long has the partnership been in place?
      What has the partnership already accomplished?
      How does your organization benefit from the partnership?
      How does your partner benefit from working with your organization?

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Preparing to Evaluate Your Project

It is important to monitor, evaluate, and update your organizational assessment on an ongoing basis. In this way, you will be able to revise your plans appropriately. It may be important to consider the following overall questions:

  • What are the challenges or barriers to assessing your organization’s infrastructure needs? How might you overcome these challenges?
  • How will you define the “success” of an initiative? What data or information will you use to show that your strategies are moving you along the path to your goals?
  • What information can be reassessed at a later time as part of an evaluation of your organization’s infrastructure capacity-building?

For more details on designing and conducting evaluation activities, go to Step 5 (Evaluating the Infrastructure Support Initiative).

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Conducting and Using Your Assessment

Now that you have finished reading about assessing your needs and capabilities, prepare to conduct the assessment.

  1. Create a variables list.
  2. Construct data collection tools and storage for data.
  3. Draft a summary of findings.
  4. Incorporate findings in goal-setting exercises, proposals, and promotional activities.

Create a list of variables (things you wish to measure) in your assessment. Use the numbered questions in Step 1 as a guide. Include information on potential sources for the data. Figure 2 provides an example of a variables list.

Figure 2. Example of a variables list

Variables Potential sources
Web site Phone call/email Other
Past research funded at the organization
  • National Center for Educational Statistics
  • National Science Foundation
  • Organization's web site
  • University administrators, grants management
  • Dean, department chairs
  
Organizational support of research
  • Organization's web site
  • Dean, department chair
  • Other faculty and staff
  • Announcements and press releases
  • Policy memos, vision/mission statements
Institutional Review Board (IRB)
  • Organization's web site
  • University administrators
  • Dean, department chair
  • Other faculty and staff
 

Take a closer look at your list of variables and think about the costs — time, labor, and materials — to conduct this assessment. Revise your list of variables based on the resources and time you have available. Refine the variables on the list by prioritizing the five assessment area(s), selecting key variables in each of the five areas, or eliminating variables that are too costly to measure.

Once you've finalized your variables list, begin creating data collection tools and establish methods for storing the data. After completing the data collection, create a thorough, accessible summary of your findings. This summary can be used as a reference point for tracking your progress and as a resource in procuring support and funding. Figure 3 provides a framework and example for summarizing findings.

Figure 3. Example of a summary

Health Services Research Infrastructure Assessment

Research Culture
Past research funded at the organization. In the last 5 years, we have conducted research in biology, justice, and medicine. Funding stemmed from various sources, including Federal agencies, local government, private foundations, and the organization's own overhead. On average, we received $35M/year in research funding.

Organizational support of research. Our organization is “somewhat” supportive of research. The department recently revised their strategic plan, which now includes seeking research funding. However, there are no staff positions or committees currently supporting this effort. To a limited extent, conducting and disseminating research are considered in performance evaluations.

Institutional Review Board (IRB). Our organization has a formal agreement with ABC's IRB. The IRB conducts reviews of all our federally funded research projects that involve human subjects. They charge $1,500 per review.

Contracts/Grants Infrastructure
Research Staff Expertise and Experience
Research Facilities and Equipment
Partnerships

Use this summary to highlight your organization's strengths and areas for improvement. Consider this to be a starting point for enhancing your current capabilities in health services research. Set goals and plan activities that will help you improve in weaker areas. The data can be used in proposals, marketing, and other reports.

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Maximizing Success

Assessment is a key component to infrastructure capacity development. It provides baseline information to track your progress. Further, it identifies opportunities for improvement that can be used to set achievable goals.

  1. Create a list of variables that includes the potential source(s) of information.
  2. Next, develop data collection questions for each variable and identify ways to collect these data. Use what is most readily available to you to collect data: publicly available web sites, discussions or emails with faculty and staff, email or online surveys, interviews, existing documents, and databases at your organization.
  3. Once you've identified the variables, questions, and data collection strategies, consider involving other staff, such as a research assistant, to collect the data.

a For more information about the Agency for Healthcare Research and Quality, visit the Agency's Web site at www.ahrq.gov.

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