Examples of Listening for Direction III (LfD III) and CIHR- Institute of Health Services and Policy Research Priority Synthesis Questions
The following table contains examples of synthesis questions (developed in large part from the LfD III consultation exercise), which reflect the LfD III themes and CIHR-IHSPR's complementary and corresponding research priority areas.
Note that the questions below are illustrative only and that this is not a comprehensive or exhaustive list of synthesis topics. These questions are simply presented as a guide and stimulus to the development of questions relevant to the priorities that emerged from the LfD III consultation exercise and/or CIHR-IHSPR's three priority research areas.
| LfD III Theme | Example Synthesis Questions |
|---|---|
| 1) Workforce and the Work Environment | How do various training and education initiatives affect: the quality, safety, cost, and timeliness of healthcare services? The willingness of providers to engage in team-based care and shared decision-making?; Job satisfaction and retention in the healthcare field? |
| How do various remuneration mechanisms for providers with respect to particular organizational contexts (e.g., primary care, community-based care, hospitals), affect the type, quantity, quality, safety, cost, and timeliness of services delivered by providers? What are the effects on patient outcomes? | |
| How do various non-financial factors - such as professional governance and health system structure - interact with remuneration mechanisms and what is the impact on the type, quantity, quality, safety, cost and timeliness of services delivered by providers? Is there an effect on patient outcomes? | |
| How does the mental and/or physical health of the workforce impact on service delivery and patient outcomes? What is the impact on quality, safety, productivity and cost? | |
| What enabling factors and steps have allowed other jurisdictions to change scope of practice and what has been the impact on the type, quantity, quality, safety, cost and timeliness of services delivered by providers? What has been the effect on patient outcomes? | |
| What approaches have been shown to be effective in achieving integration of new kinds of workers - professional, paraprofessional and non-professional - into healthcare teams? | |
| 2) Change Management for Improved Practice and Improved Health | What lessons are available from other sectors that could inform how to take local or smaller successes or other positive developments and implement them more broadly in the healthcare system? |
| Are there barriers to system transformation - even in the light of clear evidence in support of change - that may be unique to health care? Are they amenable to policy influence? | |
| How can models of evidence-informed best practice in chronic disease management be disseminated and implemented across jurisdictions in the Canadian context - incorporating consideration of sensitivities related to geography and/or culture? | |
| How can we better engage healthcare professionals in policy and system change and what are the factors that result in positive participation by professional in policy change? What strategies can be applied to improve healthcare professional leadership and engagement in organizational change? What works under what circumstances? What strategies should be avoided? | |
| What is known from healthcare and other sectors about ways to cease or decommission 'old' practices, approaches and policies in favour of new, evidence-informed practices, approaches and policies? | |
| 3) Data, Information and Knowledge Management | What can we learn from Canadian and international experiences (e.g. HMOs in the US and Veterans Affairs systems in the UK) with respect to the integration of clinical and administrative information needs? Where have there been successful attempts to establish useful, timely, relevant information for users at all levels of the system including primary health care and community care? What are the pathways to and factors that determine success? What are the challenges and barriers? |
| How can health information be managed and used to improve the capacity for evidence-informed patient care and decision making in health care settings? How can it be used to improve decision-making, leadership, collaborative care, management and resource allocation processes? | |
| What are the factors within particular contexts that will influence effective implementation, data input and support of health information systems by providers, including user-friendliness, privacy and confidentiality, change management, incentives and training? | |
| What does Canadian and international experience reveal about the planning and strategies needed to ensure effective use of databases and data residing within electronic health records by decision makers and researchers? | |
| 4) Values-Based Decision-Making and Public Engagement | What does Canadian and international experience show about promising practices in terms of models and frameworks for public participation and engagement in priority-setting processes? How is success measured and what evidence is there regarding the impact of different processes on citizen satisfaction with the health care system, cost savings, improved decision making, etc.? What are the barriers preventing more widespread adoption of validated approaches in Canada and what strategies are required to overcome these barriers? |
| What is known from health and other disciplines (e.g. education, business, social marketing) about effective mechanisms for translating facts and evidence about specific services and the healthcare system to the general public? | |
| What is known about the interplay between the media and health policy? What proven strategies should be adopted by policy makers to work positively with the media as a form of engagement with the public? | |
| 5) Patient-Centred Care | What is meant by patient-centred care? Is there a common definition suitable for the Canadian context? |
| What outcomes are observed or achievable through patient-centred care approaches, including costs and benefits to patients and the healthcare system? | |
| How can the electronic health record be a vehicle for supporting patient-centred care? What are the costs and benefits and how does the implementation of electronic health records need to be adapted to support it? | |
| What evidence and promising practice exists for the involvement of patients in the design of programs of care throughout the system? What are the implications for evolving provider-patient partnerships, models of 'shared' care, and clinical practice? | |
| How, and under what conditions, can families and informal care providers be optimally involved in supporting patient-centred care? | |
| 6) Patient Flow & System Integration | What does international and Canadian experience demonstrate in terms of the costs and benefits of different approaches or models of promoting integrated patient care across the health system, e.g. care pathways, patient navigators or care co-coordinators? What navigational tools exist? |
| How do we systematically measure and evaluate service integration, access and patient flow at different levels of the healthcare system? What does integrated care mean from a patient perspective? | |
| What are promising practices and solutions related to challenges associated with access and health service integration for vulnerable groups, including Aboriginals, rural/remote populations and immigrants? | |
| What evidence supports promising practices for managers and clinicians to effectively manage wait lists and times? | |
| 7) Chronic disease prevention & management | What are promising practices, nationally and internationally, for funding and delivery models for chronic disease prevention and management across different settings? Are innovations in other countries or jurisdictions relevant to our geographical and resource contexts? To what extent do different models address the need to integrate health and social care for certain chronic diseases? |
| Which strategies for chronic disease management contribute to improvements in health outcomes and/or experience of care and/or performance of the healthcare system in terms of efficiencies or effectiveness? | |
| In what ways and at what cost are various primary healthcare and community-based providers effectively involved in chronic disease management? | |
| How should chronic disease services (e.g., diabetes and mental health) be organized and delivered in the Canadian context to maximize the effectiveness of proven interventions? | |
| 8) Health System Financing and Sustainability | How can our healthcare system be described such that the different components and the degree to which they are sustainable are uncovered? What are the threats and supports to a sustainable healthcare system in Canada? How can decision makers and the public be effectively engaged in the determination of solutions? |
| What is the role for private financing in Canadian healthcare? What is the role for different forms of private delivery in Canadian healthcare? What are the limits, values, models and regulatory interventions that might apply in ensuring an appropriate balance between private interests and public objectives and constraints? | |
| What are national and international promising practices and models with respect to providing end-of-life care? | |
| 9) Emerging Technologies and Drugs | What is the impact of various models and policies for financing prescription drugs across the country, in terms of access to necessary medicines and equity within and between jurisdictions and sustainability? What does international experience reveal with respect to access, equity and financing of prescription drugs and how and to what extent are these experiences relevant to Canada? |
| Are there models, tools or techniques for harmonizing policies across jurisdictions? | |
| What evidence exists to support promising practices for adopting and excluding new technologies? | |
| What are effective strategies for engaging members of the public and broadening their knowledge about the trade-offs and options considered in decisions about inclusion or exclusion of drugs and technologies within a publicly-funded system? | |
| 10) Quality and Patient Safety | What are the methods and measures for assessing patient safety outside acute care environments? This work should build on the World Health Organization and other syntheses on this topic to include comparative evidence for the Canadian context. |
| What are the effective interventions for improving safety in non-acute environments? | |
| What research strategies and study designs are appropriate for the assessment of quality and safety under different circumstances, (e.g., across different settings, jurisdictions and types of health problems or client groups)? | |
| How can decision makers and clinical leaders access and use effective information about safety and quality at different levels of the healthcare system? | |
| 11) Linking Population and Public Health to Health Services | Where and in what ways does the public health system interface with healthcare services? Where are the opportunities to make improvements in health and healthcare through coordinated action at the organizational-systems level? |
| Where, in what ways, and with what effects has the healthcare sector effectively partnered with non-health sectors/government (e.g., environment, transportation, housing) to improve health status for disadvantaged groups? | |
| What evidence is available to support the design of a healthcare system that is more responsive to communities, such as Aboriginal people, who face particular challenges in their socio-economic and physical environment? | |
| How does the healthcare system help to mitigate the effects of social disadvantage? |
