During the summer of 2003, the Canadian Institutes of Health Research (CIHR) conducted a national consultation process with its various stakeholder groups to gain input on its draft Strategic Plan - Investing In Canada's Future: CIHR's Blueprint For Health Research And Innovation (Blueprint 2007). Blueprint is built on the extensive work of CIHR's 13 Institutes in developing their individual strategic plans, which included wide-ranging consultations with a variety of stakeholders.

The Blueprint consultation was a three-pronged approach, which included: town hall meetings; direct input from stakeholder groups and individuals; and a web-based survey.  Two key stakeholder groups were consulted - the research community, the men and women across Canada who develop the ideas and daily conduct groundbreaking research that benefits Canadians--and non-government organizations and governments-primarily the funders and users of health research.

Over 8000 individuals and organizations were invited to participate in the consultation over the summer of 2003, and approximately 800 people took part--650 in town hall meetings; the remainder provided direct feedback or responded through the web-survey.  Overall, participants in the consultation were very positive about the contents of Blueprint, as well as CIHR's achievements since 2000.  The identified strengths were Blueprint's vision and values, and proposed strategic directions.    Participants identified the following key areas as critical to ensuring that CIHR achieves its vision.  The themes are listed in order of importance, identified by each group.  Not surprisingly, some themes were common to both groups, while others were not.  A number of other common themes were also identified.

The Research Community

• The role of the individual researcher and curiosity-based research
• Supporting nvestigators through salary awards
• Enhancing peer review
• The resources required to sustain the health research enterprise
• Better coordination and alignment with government programs
• Programs - nature and sustainability
• Supporting the competitiveness of new CIHR investigators
• The role of the CIHR Institutes
• Regional development 
• Commercialization
• Measuring success
• Knowledge translation

Non-Government Organizations and Government

• Knowledge translation
• Importance of partnerships
• Measuring success
• The resources required to sustain the health research enterprise
• The role of the CIHR Institutes and strategic research

In summary, CIHR has a broad mandate and a broad stakeholder constituency. Through this national consultation process, CIHR heard their needs and perspectives. This confirmed the general themes of the draft Blueprint and specifically highlighted the following priorities outlined in Blueprint:

• Fundamental research is foundational;
• Strategic research is imperative;
• Alignment with other Government research programs is imperative;
• Knowledge translation is integral;
• Partners are critical to our success;
• CIHR programs and processes, including peer review and evaluation activities, will be strengthened; and
• The role of the institutes will continue to be clarified, as CIHR evolves.

Introduction

Since its creation in June 2000, CIHR has been building an energized and innovative health research enterprise for the 21st century. In June 2003, CIHR developed its first draft strategic plan-a plan to guide the organization, over the next four years, through its next stage of evolution.

The draft plan titled, Investing In Canada's Future: CIHR's Blueprint For Health Research And Innovation articulates CIHR's vision, mandate, strategic outcomes and objectives. Blueprint is built on the extensive work of CIHR's 13 Institutes in developing their individual strategic plans, which included wide-ranging consultations with a variety of stakeholders, including the research community, to identify their individual research priorities and to develop a national health research agenda.

The Consultation Process

During the summer of 2003 CIHR launched a three-pronged inclusive national consultative process to give stakeholders an opportunity to provide input to the draft Blueprint. This included: town hall meetings; direct input from stakeholder groups and individuals; and a web-based survey.

Two key stakeholder groups were consulted - the research community, the men and women across Canada who develop the ideas and daily conduct groundbreaking research that benefits Canadians--and non-government organizations and governments-primarily the funders and users of health research. The town hall meetings (16 in total) targeted the research community (11 in-person sessions and 1 teleconference); non-government organizations (2 sessions); and government departments and agencies (2 sessions). (A detailed listing of the meetings is provided in Appendix A.) In addition, CIHR Institute Advisory Boards provided their input to Blueprint through their Institute Scientific Directors. In all, over 8000 individuals and organizations were invited to participate.

Approximately 800 people participated in the consultation-650 in town hall meetings; the remainder provided direct feedback or responded through the web-survey. Over 30 non-government organizations attended specific NGO sessions and 12 federal government departments/agencies participated in the process. In addition, a number of provincial NGOs and provincial governments attended regional sessions or submitted individual briefs. These organizations are listed in Appendix B.

All input received from the various sources of input was logged and grouped into key themes. These results are reported in the following section, along with representative quotes.

What They Said

Overall Reaction to the Blueprint:

Overall, participants in the consultation were very positive about progress achieved to date by CIHR and the contents of the draft Blueprint. They viewed the consultation as an opportunity to receive an update on CIHR and appreciated being consulted. Blueprint's identified strengths were its vision and values and proposed strategic directions.

"The plan lays out a visionary roadmap aimed at enhancing basic and translational research relating to the healthcare of Canadians.the document is a laudable broad statement...

University Researcher

"...I think the Blueprint looks great. It will really create the research environment needed to help Canadians and others."

University Researcher

"The Blueprint is a tremendously valuable and well-designed document that rightfully positions CIHR in terms of leadership, outcome and benefits to Canadians and Canadian society."

Administrator

Further, several participants encouraged CIHR to highlight in Blueprint its achievements to date in transforming health research - fostering a problem-based, multidisciplinary focus to health and disease, that includes a wide range of disciplines and focuses on health challenges and research opportunities.

"What you've accomplished (to date) is truly extraordinary. We need to understand how better to help you."

-V.P. Research

"It is important to note the progress CIHR has made .in embracing the four pillars of research. CIHR has a critical role to play in building understanding of all the factors that pertain to health and disease."

NGO Forum participant

Key Themes for Achieving the Vision

The stakeholder groups identified the following key themes as critical to ensuring that CIHR achieves its vision. The themes are listed according to the frequency with which they were identified throughout the consultation.

What They Said: The Research Community

1. The Role of the Individual Researcher and Curiosity-based Research

The most repeated theme by the research community was the need for CIHR to clarify the role of the individual researcher and curiosity-based research in the health research enterprise of the future (in 9 of 11 in-person regional sessions and approximately 20 individual responses). Researchers felt that Blueprint seemed to focus almost exclusively on team-based strategic research, while the foundation for strategic research is a solid base of curiosity-based research and mature individual researchers. High qualifying scores, low success rates, and planned clawbacks on existing grants were cited as negative signals to the research community.

"...would submit that the investigator-initiated operating grants represent the cornerstone of the Canadian health research structure. We must ensure that this component of the enterprise is not threatened, but strengthened."

University Researcher

2. Supporting Investigators through Salary Awards

Through the web-survey, by direct feedback, and in the regional sessions, researchers also voiced their concern regarding CIHR's recent announcements of program cuts to career awards and the resulting impact on investigators (in 8 in-person regional sessions and 10 individual responses). They noted the apparent inconsistency between this decision and Blueprint's proposed actions to "Increase the number of outstanding new investigators and retain established researchers...page 12).

"... investigator salary support programs are a close second (to investigator-initiated operating grants) in terms of the viability of Canadian health research. We can lose our best and brightest, and particularly our youngest either to the US or to non-research career paths if we continue to lose the salary award programs."

University Researcher

3. Enhancing Peer Review

In the majority of regional sessions (8), researchers noted the need to continue to enhance peer review. CIHR's rapid budget growth, accompanied with a large increase in the number of grants and in the number of peer review panels, as well as the introduction of new disciplines and the development of strategic initiatives, have caused strains on the peer review process. In particular, peer review needs to be strengthened in its ability to adjudicate multidisciplinary applications. It was acknowledged, however, that there is a learning curve, and that the initial interdisciplinary peer review panels (e.g. gender, sex and health peer review committee) are helping to create this expertise in interdisciplinary research.

Suggestions for improvement in peer review included: evaluation of processes and policies; providing more information to applicants on the peer review process (how applications are directed to peer review panels; compulsory use of external reviews); that greater emphasis be placed on the innovative aspects and the knowledge translation components of an application during adjudication; instituting a formal appeal process; encouraging higher participation on peer review panels among established researchers, through incentives or established requirements.

4. Resources Required to Sustain Health Research Enterprise

Researchers expressed concern that the resource requirements in Blueprint ($1 B by 2007/08) were inadequate to achieve all the objectives outlined (in 7 in-person regional sessions and approximately 10 individual responses). As a result, from a researcher's perspective they thought it was important to identify specifically what increased investments will achieve (i.e. # of grants, success rates and average size of grants) and indicate how this contributes to the sustainability of the health research enterprise. In addition, CIHR should articulate the consequences of not receiving increased funding.

Researchers noted that the financial table in Blueprint could be misleading in that it indicated resource requirements would level off by 2007/08. In fact, capacity-building activities, for both infrastructure (Canada Foundation for Innovation, CFI) and human resources, will undoubtedly increase future resource requirements. Limited human resource planning activities for health research constrains CIHR's ability to identify precisely how many researchers are needed in Canada. As a result, estimated future financial requirements are speculative.

In terms of spending priorities, the research community identified funding outstanding research as the highest priority. While viewing the creation of new capacity and knowledge translation as very important to the health research enterprise, they did not want these activities to occur at the expense of sustaining existing research excellence. Although not a general consensus, some expressed the opinion that at least part of the money currently going to strategic initiatives would be better spent on funding investigator-initiated grants.

5. Better Coordination and Alignment with Government Programs

In several regional sessions (5), researchers expressed concern over the lack of alignment among the major government programs (e.g. CIHR, Canada Foundation for Innovation, Canada Research Chairs). For example, they noted that new capital investments by CFI will cause further pressure on CIHR, by increasing the demand for operating grants. As another example, high caliber CRC nominees from outside Canada are being fast tracked, yet some are not able to secure CIHR operating funds. Better coordination and clarity of program purposes needs to occur. Related to this, researchers also identified the need to ensure that CIHR's expanded mandate does not significantly overlap with that of other organizations, such as SSHRC and Health Canada.

"Increasing research capacity is difficult to reconcile with not being able to pay for today's research. At the University of Alberta new space is being built to house about 100 new investigators and I suspect that similar things are happening at other universities. I do not have faith that the CIHR budget will increase sufficiently to fund these new people."

University Researcher

6. Programs - Nature and Sustainability

While recognizing the impact of new programs in building capacity, researchers noted that the proliferation of new programs, with new nomenclature, has been difficult to navigate. They recommended that CIHR control the growth of new programs, clearly communicate the objectives of each new program, and ensure the programs are achieving their stated purpose. It was also noted that due to difficulties in assembling multidisciplinary teams, and existing program criteria, some universities have been unable to participate in these new programs (e.g. NETs, ICEs).

Concern was expressed regarding the sustainability of several programs--the multidisciplinary /collaborative/ group grants; training programs; and development grants. Several participants questioned the future of clinical trials, within the context of overall support of clinician researchers. One specific area identified was the need to review the MD/Ph.D. program.

Participants at one regional session recommended that CIHR review the criteria and methods for awarding doctoral scholarships (i.e. interpretation of the « environment » criteria appears to disadvantage students in certain universities).

Regarding "brain gain" and "regain", it was suggested that consideration be given to programs that will attract post doctoral fellows to Canada and also encourage Canadian post docs to return to Canada following completion of their studies. This included the suggestion that CIHR identify to other federal government department's contradictory immigration policies, particularly the difficulties that non-Canadian spouses of repatriated Canadians have in obtaining residency in Canada.

7. Supporting the Competitiveness of New CIHR Investigators

If CIHR is to be successful in increasing the number of outstanding new investigators, in both established and new disciplines, researchers noted it is important to develop local and national strategies to support investigators who have not previously held a CIHR grant (in 7 in-person regional sessions and 6 individual responses). Some suggested strategies included: internal institutional peer review prior to submitting to CIHR; selective investment by CIHR's Institutes; enveloping money for new investigators.

Specific issues were also identified for certain groups of researchers: social sciences researchers; researchers from small and medium-sized universities; potential community college researchers. Suggested strategies included: ongoing development of peer review panels to improve the adjudication of social sciences and interdisciplinary applications; support for release time stipends to reduce teaching commitments; enveloping money.

"...o believe, as someone who has sat on panels at the MRC and CIHR, that the higher scores reflect the better grants that are being submitted. A major problem now is that while the system is rewarding excellence, it is becoming increasingly difficult for new researchers to enter the system. They are competing with experienced large scale researchers who are proposing major projects for large amounts of money that are necessarily of high priority and get the best scores."

University Researcher

8. CIHR Institutes

A common request at many sessions was for more information on the role Institutes play in CIHR, and how individual disciplines (and researchers) can best identify and interact with CIHR and the Institutes.

In several sessions, researchers stated they were having difficulty in responding adequately to the numerous strategic initiatives from the Institutes. They also thought it was important to clarify the method that will be used to evaluate the Institutes as well as the means by which new Institutes will be identified.

Some specific policy decisions by Institutes were questioned, such as, the disparity in defining research excellence among Institutes due to differences in funding cut off points and the perceived narrow perspective used by some Institutes in setting research priorities. Others, however, noted that by limiting the number of research priorities Institutes were able to set reasonable and achievable objectives.

9. Regional Development

In some regional sessions, researchers noted that CIHR has played a critical role in regional development and that relevant programs need to be sustained. They suggested CIHR could further strengthen regional research through increased collaboration with provincial research agencies.

10. Commercialization

Some researchers thought that CIHR's role in commercialization should be more clearly described in Blueprint. Suggestions included clarification of where CIHR's strategy is situated in the commercialization pipeline.

11. Measuring Success

Many participants identified the need for CIHR to elaborate on how it will measure success by including more information on current and planned activities in this area.

12. Knowledge Translation

CIHR's role in knowledge translation (KT) was viewed as critical to fulfilling its mandate, but in general, researchers requested further clarity regarding CIHR's niche in this area. Clarification was requested on how the Centres (now called Networks) for Health Innovation would function and how they would differ from the Institutes, and other models, such as the National Centers of Excellence (NCE) and Cochrane Collaboration.

Non-Government Organizations (NGO) and Government

1. Knowledge Translation

NGOs and Government departments and agencies identified CIHR's role in knowledge translation as strength of Blueprint. They noted the extensive Government investments in health research since 1998 (CIHR, CFI, Canada Research Chairs, Indirect Costs), and indicated that the translation of research results into action is critical if Canada is to reap the benefits of those investments. CIHR was encouraged to develop further its KT role, particularly in relationship to informing public policy and practice. Participants were very interested in the Centres (now called Networks) for Health Innovation as a vehicle to promote KT, and they encouraged that there be a broader dialogue on the Centres (Networks) that included potential stakeholders.

"Knowledge translation is very important but very challenging. This needs to be a two-way street between researchers and the users of research. This is an area where leadership is required."

Federal Government Interdepartmental Meeting

They encouraged CIHR to recognize the two-way nature of effective knowledge translation and the need to engage policy makers and other users of health research early in the process--in identifying research questions. To support the culture change that is required among the research community relative to KT, CIHR was encouraged to articulate more specific actions, such as "facilitate the development of research transfer agents."

Commercialization was also identified as an area where selective increased funding for specific programs might be required-for example, regional development of clusters.

2. Importance of Partnerships

Non-Government Organizations identified partnerships as being critical to the success of both CIHR and their organizations. They also noted that partnering is a two-way street--where partners need to be included early in any processes, and acknowledged for their contributions. CIHR was encouraged to include a discussion section on partners in Blueprint, including identifying the financial commitments of CIHR partners.

"The health charities view partnerships as an integral part of what makes CIHR unique."

NGO Administrator

It was also suggested that the health professions (health managers, service providers, and governors) be more explicitly identified as potential CIHR partners. Strategies should also be identified to effectively engage professional provider organizations - both in identifying research priorities and in developing expertise for professional groups to be involved in research.

3. Measuring Success

Participants noted that Blueprint needs to include more information on what CIHR is doing and planning to do in the area of performance measurement, and evaluation.

"There is an emphasis in the document on output measures (i.e. grants awarded, etc). as opposed to the outcomes. You should include performance measures as well as indications on the direct benefits of health research to Canadians."

Federal Government Interdepartmental Meeting

4. Articulate the Resources to Sustain the Health Research Enterprise

Participants thought it was important to identify specifically what increased investments will achieve (i.e. individual projects, increased number of grants, etc.), and also recommended that CIHR clarify its priorities in the event that increased resources are not received.

5. Role of the Institutes and Strategic Research

Several participants were unclear on the role of the Institutes within CIHR and were unclear as to how much of CIHR's activities were included in Blueprint. They noted that this lack of clarity caused confusion in developing and maintaining relationships with CIHR. They suggested that a discussion on the Institutes and the CIHR operating model be included in the document. Some interest was expressed in seeing a larger portion of CIHR's budget focused on emerging health challenges and opportunities-i.e. strategic research. (This perspective was in direct contrast to the view expressed by the research community that more money be investigated in investigator-initiated research.)

Other Themes from All Stakeholder Groups

Various stakeholders identified a number of other themes in some sessions and/or through web survey/direct feedback.

1. International

Some participants, particularly in the government department sessions, noted that Blueprint should include more information on CIHR's strategy for international collaborations (e.g., strengthen national capacity; build on work occurring in other countries, while avoiding duplication of efforts; and help Canada strengthen its international stature in Research and Development. Others pointed out that CIHR should increase its presence in global health research, through increased funding for global health research and through playing a leadership role among high-income countries in promoting global health research.

2. Cross-Institute Themes

Blueprint should reference themes that cut across Institutes. Several participants noted their importance and said Blueprint should clarify the mechanisms by which these will be identified and supported.

3. Multidisciplinarity

Participants acknowledged and applauded the progress that CIHR has made in reaching out to new communities and promoting a multidisciplinary approach, particularly in the social sciences. It was suggested that Blueprint clearly identify strategies to promote further multidisciplinarity, particularly in relation to engineering, mathematics and the natural sciences, and that CIHR define its unique role in integrating disciplines vis a vis the universities and others.

4. Public Engagement

It was suggested that Blueprint identify its specific strategy with respect to public engagement (for example, providing information to the public on research findings) and dedicate appropriate resources.

Activities to engage youth were welcomed, and it was suggested their focus be on promoting critical inquiry and research awareness. Participants also suggested that CIHR partner with relevant organizations, such as "Let's Talk Science", provincial and local science fairs, Women in Science and Engineering, on these activities.

5. Language and Consistency of Blueprint:

Various opinions, sometimes conflicting and generally reflective of individual disciplinary backgrounds and perspectives, were expressed on how the language of Blueprint might be improved. These included:

• Language, including examples, needs to reflect a broad approach to health;
• Commitment to vulnerable populations identified as a key theme of Blueprint needs to be followed through in the specific objectives;
• More references should be made to the biomedical research community;
• Opportunities to use social sciences, mental health or prevention or public health examples should be capitalized on;
• The definition of health promotion used in Blueprint is outdated and should be revised;
• Improve consistency in the use of the terms "partner" and "stakeholder."

Summing Up

As Canada's lead health research agency, CIHR has a broad mandate-to create and translate new knowledge to improve the health of Canadians, support effective health products, and strengthen the health care system. CIHR also has a broad stakeholder constituency-researchers of all disciplines, funding bodies, non-government organizations and health charities, policy makers, health providers, managers, industry and individual Canadians. To be successful in leading health research in the 21st century, these perspectives and needs must be considered before a solid plan is developed.

Through the Blueprint national consultation process, CIHR heard from a large cross-section of stakeholders. CIHR thanks them for their support and for the honest feedback received. Based on what CIHR heard, its opportunities and challenges, and vision for the future, CIHR will pursue the specific themes outlined in the draft Blueprint.

In particular, CIHR confirms the following priorities that are outlined in Blueprint:

• Fundamental research is foundational to the health research enterprise. We will continue to support excellence in the open operating grants program. We will establish targets as to success rates, cutoff points and average grant size;
• Strategic research is critical. This allows us to focus on research opportunities and emerging health issues. We will continue to support a balance between fundamental and strategic research. We will continue to invest strategically in CIHR Institutes.
• Alignment with other Government research programs is imperative. CIHR plays a strong role in operating grants. With respect to salary support, we will be involved in those areas where there are gaps. There are 700 Canada Research Chairs in health, individually valued at three times higher than CIHR Investigator awards, while there are 159 CIHR Career awards. CIHR will continue to invest in New Investigators, and will honour all outstanding commitments. We will also invest in areas where increased capacity is required, for example, with special attention to clinical researchers through the Multi-stakeholder Task Force (MUST).
• Knowledge translation is integral to our mandate, and we will, through our programs, contribute to the uptake of research results into policy and practice.
• Partners are critical to our success. We will expand our partner base and continue to work at being a good partner in pursuit of common objectives.
• CIHR programs and processes, including peer review and evaluation activities, will be strengthened and enhanced to support these priorities.
• The role of the Institutes will continue to be strengthened as CIHR evolves from a granting council to a world-class Institute-centred health research agency.

Appendix A

Blueprint National Consultation Schedule

Appendix B

Participating Organizations