My interest in better understanding what works for who and why stretches back to dissertation work … uhh, 50 years ago. At the time, as a PhD student in clinical psychology, the interest was in individual therapy – different kinds of therapy work better for different people and different problems. These days, the focus is on health system improvement – how do we make transformative change in complex health systems?
Ten years ago we formed the InSource Research Group, to better bridge from CIHR-funded grant work to the kinds of rapid action research our community partners said they needed. We quickly adopted a complex adaptive systems lens to frame the challenges health authorities and others faced making transformative change. We developed a rapid realist review methodology to provide high quality knowledge synthesis quickly, and combined that cornerstone with a mixed method approach to making and studying change. Knowledge integration is central to most of our work.
Two CIHR-funded rapid reviews for the Province of Saskatchewan:
- the first review of the role of government policy in coordinating large system transformation, to support the Saskatchewan Ministry of Health’s mandate to implement a significant transformation of the provincial health system, and
- the second to identify and synthesize evidence about how organizational culture is assessed in health systems, and the ways in which leadership and management factors are included as part of these assessments.
- Rapid review for such topics as community services for mental health, provincial tobacco strategy, health literacy, and typologies and hierarchies supporting health promotion/public health evidence.
- A major review and progress assessment for WHO of its strategy for strengthening health human resources.
Two studies funded through the Michael Smith Foundation for Health Research:
- the first to identify facilitators and barriers to province-wide implementation of clinical care management, and
- the second just completed to study international best practices to address the opiod crisis.
Sample publications include:
- Saul, J.E., Willis, C.D., Bitz, J., & Best, A. (2013). A time-responsive tool for informing policy making: Rapid Realist Review. Implementation Science, 8, 103-117. http://www.implementationscience.com/content/8/1/103
- Best, A., Greenhalgh, T., Saul, J., Lewis, S., Carroll, S., & Bitz, J. (2012). Large system transformation in health care: A realist review and evaluation of its usefulness in a policy context. Milbank Quarterly, 90(3), 421–456. http://www.milbank.org/publications/the-milbank-quarterly/featured-articles/article/3893/large-system-transformation-in-health-care-a-realist-review
- Best, A., Berland, A., Herbert, C., Bitz, J, van Dijk, M, Krause, C., Cochrane, D., Noel, K., Marsden, J., McKeown, S. (2016). Using systems thinking to support clinical system transformation. Journal of Health Organization and Management, 30(3), 302-323.
- Holmes, B., Best, A., Davies, H., Hunter, D., Kelly, M., Marshall, M., & Rycroft-Malone, J. (2016). Mobilising knowledge in complex health systems: a call to action. Evidence and Policy, https://doi.org/10.1332/174426416X14712553750311
- Best. A., Saul, J.E., & Willis, C. (2013). Doing the dance of culture change: Complexity, evidence, and leadership. Healthcare Papers, 13(1), 64-68.
C2E2 Rounds are presented Mondays from 12:00 pm to 1:00 pm in room 700 of the VGH Research Pavilion, 828 West 10th Avenue, Vancouver, BC.
Oct 16, 2023 // Matthew Kwok
Nov 20, 2023 // Don Griesdale, Elisa LloydSmith & Michael Li