Experience of Health Leadership in Partnering With University-Based Researchers in Canada - A Call to "Re-imagine" Research.

BACKGROUND: Emerging evidence that meaningful relationships with knowledge users are a key predictor of research use has led to promotion of partnership approaches to health research. However, little is known about health system experiences of collaborations with university-based researchers, particularly with research partnerships in the area of health system design and health service organization. The purpose of the study was to explore the experience and perspectives of senior health managers in health service organizations, with health organization-university research partnerships. METHODS: In-depth, semi-structured interviews (n = 25) were conducted with senior health personnel across Canada to explore their perspectives on health system research; experiences with health organization-university research partnerships; challenges to partnership research; and suggested actions for improving engagement with knowledge users and promoting research utilization. Participants, recruited from organizations with regional responsibilities, were responsible for system-wide planning and support functions. RESULTS: Research is often experienced as unhelpful or irrelevant to decision-making by many within the system. Research, quality improvement (QI) and evaluation are often viewed as separate activities and coordinated by different responsibility areas. Perspectives of senior managers on barriers to partnership differed from those identified in the literature: organizational stress and restructuring, and limitations in readiness of researchers to work in the fast-paced healthcare environment, were identified as major barriers. Although the need for strong executive leadership was emphasized, "multi-system action" is needed for effective partnerships. CONCLUSION: Common approaches to research and knowledge translation are often not appropriate for addressing issues of health service design and health services organization. Nor is the research community providing expertise to many important activities that the healthcare system is taking to improve health services. A radical rethinking of how we prepare health service researchers; position research within the health system; and fund research activities and infrastructure is needed if the potential benefits of research are to be achieved. Lack of response to health system needs may contribute to research and 'evidence-informed' practice being further marginalized from healthcare operations. Interventions to address barriers must respond to the perspectives and experience of health leadership.

The development of a practice-driven, reality-based program for rural acute care registered nurses.

Few education programs adequately prepare rural registered nurses (RNs) for "multispecialist" roles within small acute care facilities. This article describes the development of a post-RN rural acute care certificate program. To plan relevant curriculum and program delivery approaches, a series of focus groups were held with 236 rural RNs throughout British Columbia, Canada. The themes that emerged from RNs' descriptions of their everyday practice form the foundation of the new curriculum. The resulting program is practice driven and reality based, with a curriculum, teaching and learning strategies, and program delivery methods that are responsive to the learning needs of rural nurses.

Using written work to investigate stages in sixth-grade students' construction and coordination of units.

BACKGROUND: Students' ability to construct and coordinate units has been found to have far-reaching implications for their ability to develop sophisticated understandings of key middle-grade mathematical topics such as fractions, ratios, proportions, and algebra, topics that form the base of understanding for most STEM-related fields. Most of the related research on unit coordination relies on time-intensive clinical interviews and teaching experiments. In this study, we investigate the work of 93 sixth-grade students on a written assessment containing whole number and fraction contexts using both continuous and discrete quantities, and how this work can be used to assess stages in students' construction and coordination of units. Our investigation is guided by the following general research questions: (1) What forms of written work evidence the construction of and operation on composite units (units made up of other units)? (2) How does the categorization of students based on responses from a written assessment compare to written performance on a set of tasks conveying a continuous whole number multiplicative context? RESULTS: We documented the different ways students represented composite units in their written work. In particular, student written work on tasks that included figurative unit items provided the greatest variety of evidence regarding students' construction of and operation on composite units. However, written evidence from partitioning tasks did not seem as promising for distinguishing student stages. Students' performance on decontextualized bar tasks involving continuous quantities was found to be consistent with students' level of unit coordination based on written work providing evidence for the validity of stage categorizations. CONCLUSIONS: Our findings shed light on the affordances and constraints associated with particular stages in unit construction and coordination that a student brings to bear on tasks provided in a formal, written assessment. These findings provide promising evidence for scaling up the assessment of students construction and coordination of units through the use of written assessments instead of time-intensive clinical interviews.

Development of a support tool for complex decision-making in the provision of rural maternity care.

CONTEXT: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. OBJECTIVE: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. DESIGN: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. SETTING: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. PARTICIPANTS: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). RESULTS: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. CONCLUSIONS: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology.