Bridging the gaps: Why research impact can elude us — and what we can do about it

Some years ago, BC-based clinician-scientist Dr. Robert Olson set out to understand whether one session of radiotherapy could be as effective as multiple sessions for cancer patients with painful bone metastases. It turned out the evidence existed.

So instead of conducting another expensive randomized controlled trial, his team turned to the question of why the evidence wasn’t being used, despite its significant potential to improve patient care and health system efficiency.

This story is among many that have inspired me during my tenure as President & CEO of Health Research BC. It’s a great example of what our agency is funded by government to do: support researchers to improve health and healthcare.

But more importantly, it illustrates what’s right with the research system, and what needs to improve – regardless of the type of research, where it sits on the discovery-to-application continuum, or where in the world it’s done.

As I step down from this role and into a new one with the international Impact Funders Forum, here are my takeaways:

What’s right with the research system

Dr. Olson’s team designed and implemented a multi-faceted intervention – including sharing potentially sensitive centre-specific practices and data with oncologists and clinical leaders. Their work led to a province-wide increase in adoption of single-fraction radiotherapy, the therapeutic approach supported by the evidence.

That’s one study, vastly oversimplified. But on a larger scale, it’s exactly what’s right with the research system: people collaborating to identify problems, redefine them as necessary, test and refine sometimes-uncomfortable solutions, and achieve potentially powerful results. Ultimately, it’s thinking beyond evidence to the context in which it is produced and used.

What needs to improve

In any system, tangible gaps such as funding, infrastructure, and talent collide with the more intangible elements: power, incentives, values, culture. In research, those collisions manifest in frustrating, hard-to-solve problems like resistance to innovation and lack of evidence use.

With critical advances in knowledge threatened by global events, there’s never been a more important time to increase our understanding of the scientific enterprise itself as a social, political and industrial-technological enterprise.

Fortunately, work in different fields is coalescing to help make sense of the complexities of research production and use. Health Research BC draws on this work to design programs in a system context. Public and private funders from multiple sectors are adding to it as they partner with government, universities, industry, individuals and communities to align and act on priorities. Research teams like Dr. Olson’s are pushing past simplistic notions of evidence use to explore what gets in the way of doing things differently – and better.

I have three related suggestions for those of us working in the research system:

Let’s understand research impact 

Important work has advanced research impact measurement over the last 25 years, including the International School on Research Impact Assessment guidelines, and the development of the “4A” purposes framework for reflecting on measurement of impact: accountability, analysis, advocacy, or allocation. Adjustment has been suggested as a fifth “A.” With competition for funding and attention at a high, there’s a lot of after-the-fact measurement for advocacy. It’s time to better understand the enablers and predictors of progress for yet another “A” – achievement of research impact.

Let’s support our research talent – realistically

Arizona State University emeritus professor Daniel Sarewitz notes that “university scientists are expected to produce a continual stream of startling and newsworthy findings.” Arguably, most research findings are neither – which doesn’t diminish their importance. The case is strengthening for a collective effort to set realistic expectations for research, and put in place appropriate incentives to support our talented scientists throughout their careers.

Let’s stop talking about the real world as if it’s somewhere researchers don’t live

The question “What do those research findings mean in the real world?” comes from an honest desire to understand the usefulness of evidence. But it perpetuates the very gap that needs closing. It’s not helpful to think of science existing in a separate world from the one in which it’s funded and supported and socialized. Some may say “It’s just words,” but we need to realize that words drive action.

In closing

I’m leaving Health Research BC grateful to everyone I’ve worked with and learned from in the organization, the province, the country, and beyond. I’m also hopeful, because collectively we know a lot about how to strengthen the international research system, and we have the will to put that knowledge to work.