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Allan Best, PhD
Allan Best is Managing Partner for InSource, a Vancouver-based health services and population health research group with expertise in knowledge translation and exchange, systems thinking, and communications. InSource serves health systems decision makers at the regional, provincial and national levels, offering innovative “whole systems” research, planning, and evaluation tools to support large-scale organizational change. Services include:
- rapid reviews for putting evidence into policy and practice,
- concept mapping
- network analysis, and
- system dynamics modeling.
Allan also is Associate Scientist in the Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute in Vancouver, British Columbia, Canada. His research focuses on systems thinking and organizational change - creating the teams, models, structures and tools that foster effective knowledge to action for health policy and programs that improve the health of the population.
Allan served as the founding Chair of the Department of Health Studies at the University of Waterloo in Canada, the world's first interdisciplinary department integrating the biological and behavioral sciences to study health promotion. He has been elected Fellow for outstanding research contribution by the Canadian Academy of Health Sciences, Canadian Psychological Association, Society of Behavioral Medicine, American Psychological Association, and American Academy for Health Behavior. Allan was awarded the 1996 O. Harold Warwick prize by the National Cancer Institute of Canada for outstanding contributions to cancer control. Allan served on the inaugural Board of the Canadian Association for Health Services and Policy Research as President-Elect and was President from 2005-2007.
Questions and Answers
The InSource Research Group is focused on harnessing best available evidence to help health system leaders achieve transformational change within their organizations. To guide our efforts, we use what we’ve learned about implementation science, interdisciplinarity, systems thinking and how to partner with knowledge users. More generally, we provide our clients with the knowledge synthesis and evaluation tools they need to inform their decision-making.
A recent example of InSource’s efforts along these lines is the work we’ve done with the Ministry of Health for the province of Saskatchewan in Canada. Our first project was a rapid systematic realist review of what the Ministry called “large system transformation.” Saskatchewan is engaged in several major initiatives, all of which are intended to be transformative by breaking down silos, developing new interdisciplinary ways of working, and integrating routine measurement for feedback, learning, and evaluation. Our first systematic review provided the synthesis of research, theory and practice knowledge needed for understanding and applying the broad, cross-cutting system transformation principles required.
Our continuing work with Saskatchewan includes providing: a focused review of systems thinking tools for quality improvement; strategies for the leadership development necessary for sustaining transformative change; and mixed method, “real time” evaluation of the processes for “scaling up” from some 90 pilot quality improvement projects to province-wide transformation of health system culture and practice.
The most significant initiative along those lines that I’ve been involved in was the task force I chaired for the National Cancer Institute of Canada. Our charge was to reflect on how implementation science models have evolved over the past several decades, and to distill a framework that would resonate for all stakeholders involved in cancer control. This includes all streams of cancer control research (i.e. basic, clinical and population science), the program leaders of the Canadian Cancer Society who provide services, and the tens of thousands of volunteers who raise public donations to support cancer control research. The resulting report reviewed linear, relationship and systems models with regard to how they approach bridging evidence and policy/practice – i.e. turning knowledge into action (Best, A., Hiatt, R.A., & Norman, C.D. (2008). Knowledge integration: Conceptualizing communications in cancer control systems. Patient Education and Counseling, 71, 319-327).
What stands out about the project is how critical it becomes when collaborating across diverse perspectives to use a systems lens that both frames implementation tools and processes within the broader context of organizations, and allows each stakeholder to see their piece of the action and contribution to the larger whole.
Living on the bridge between the ivory tower and where the rubber hits the road for policy makers, we’re constantly learning. Here are three illustrative lessons:
- Relying on grant funding can get in the way of doing what decision makers need. Priorities, resources, incentives, timelines, work processes, capacities and culture all create tensions that challenge effective partnership between those in organizations who produce research and those who use it. Granting mechanisms rarely take these differences into account. We need a broader range of funding mechanisms to support implementation research. At times, perhaps often, the solution that works best for decision makers will not be a formal research grant.
- Most priority challenges for policy makers are the “wicked” problems of complex adaptive systems. The profound axiom is that reductionist science, and in particular randomized controlled trials, is less well suited to the implementation questions that arise than more ecological or “whole system” approaches. We need investment in the development of better designs and measures.
- Effective implementation strategy in complex systems almost always demands integrated multilevel intervention. Complex problems demand complex solutions. Therefore, not only do we need better designs and methods but also more sophisticated implementation strategies that are context sensitive, inclusive of the full range of key stakeholders, multilevel, coordinated, and able to adapt to dynamic changes over time.
Ed Trickett and his colleagues recently outlined a framework for advancing the science of community-level interventions. Their powerful argument is that the complexity of the challenge really demands a new paradigm highlighting collaborative, multilevel, culturally situated interventions. Implementation science can and must rise to the challenge! Trickett EJ, Beehler S, Deutsch C, Green LW, Hawe P, McLeroy K, Miller RL, Rapkin BD, Schensul JJ, Schulz AJ, Trimble JE. (2011). Advancing the science of community-level interventions. AJPH ;101:1410-1419.
Mary Ann Scheirer and Jim Dearing tackled an equally critical challenge for implementation science – the question of sustainability. They provide a definition and analytic framework that will serve us well as we increasingly succeed in crafting more effective implementation strategies and start to tackle the quite separate but equally daunting questions around sustainability. Scheirer MA, Dearing JW. (2011). An agenda for research on the sustainability of public health programs. AJPH . http://ajph.aphapublications.org/cgi/doi/10.2105/AJPH.2010.300113