Turning research push into implementation pull for health benefit

THE traditional paradigm of health and medical research involves “pushing” discoveries out into the health care system. It is often diabolically slow – on average, the translation of innovation into health care delivery can take 17 years.

The Australian Health Research Alliance (AHRA) exists to change that by addressing and overcoming the barriers between research evidence and health benefit. There is no question that Australian researchers are good at discovery research, based on the old paradigm of excellence and competition. But it is at the other end of the research continuum – when we want to deliver what we have discovered into health care quickly, when we want to deliver a positive health outcome for the community – where we struggle and this is where AHRA focuses our efforts.

Furthermore, AHRA seeks to flip the traditional paradigm from a “push” process, appropriate in discovery research, to one that also “pulls” research and researchers into solving the problems health care providers and patient communities actually have.

AHRA was formed in 2015, soon after four Advanced Health Research and Translation Centres (AHRTCs) were accredited by the National Health and Medical Research Council (NHMRC). Those four foundation members – the Health Translation SA, Monash Partners, the Melbourne Academic Centre for Health and Sydney Health Partners – decided to come together to provide a national alliance across health care, research, translation and education. This important policy initiative was also supported by the vital Medical Research Future Fund, offering new opportunities to overcome research and translation barriers and improve health for all Australians. To date $10M has been  provided in 2018 and a further $85M announced for the next 3 years across the now nine Centres nationally.

Together we can collaborate at a whole new level. And we could do it across states, across sectors, and across entities. Large-scale collaboration such as this can move at a rapid pace and overcome key barriers to translating research into implementable strategies, delivering outcomes to patients. It was our aim to reduce those 17 years down significantly and also to reach out to stakeholders (community, health services, health professionals, state and federal governments, industry, philanthropy, and others) to determine and address their priorities through research and translation. To do this, we committed not to compete but rather, in a world first, to collaborate at many levels, across all Centres.

Since 2015, AHRA has expanded. There are now seven NHMRC-accredited AHRTCs (adding Brisbane Diamantina Heath Partners, Western Australia Health Translation Network and the Sydney Partnership for Health, Education Research and Enterprise) and two Centres for Innovation in Regional Health (CIRHs), (Central Australia Academic Health Science Centre and NSW Regional Health Partners). Together we cover over 90% of health and medical researchers funded by the government and around 80% of hospitals, with a significant community and primary health care reach. These Centres are recognised as national leaders in research-based health care and training and have been accredited by the NHMRC for excellence in health care, research and translation of evidence into patient care.

The other reason AHRA came together was the premise that we are formed to integrate research, education and health care with the purpose of bringing health benefit to the Australian community. Given that the Australian taxpayers are the funders and the beneficiaries of health care and of research, it is beholden on us to work together and collaborate for greater patient benefit. If one Centre has the best Indigenous health model of care, for example, then it makes sense to spread that across the country. If another has the best data systems that improve outcomes for patients, we need to be able to spread that across the country.

There wasn’t a platform for that kind of nationwide collaboration previously. The centres and AHRA provide that platform. Speed and responsiveness relies on collaboration, and to be able to have these AHRTCs and CIRHs not overtly competing with each other, but working together at that right-hand end of the translation pipeline has been truly transformative. Competitive tension has to exist at the discovery end (the left-hand end of the research pipeline, if you will) because we want the very best science to bubble up and move into the pipeline. But at the other end, when we have the knowledge from clinical trials to health services and public health research, we want the research to focus on what is most important and then to move that knowledge into health care quickly and easily in a flexible and collaborative manner.

Research traditionally has been about leaders with fantastic track records having great ideas and undertaking their own research through to publications or potentially guidelines. There was no imprimatur or responsibility to translate that knowledge beyond this. The AHRA is about empowering all stakeholders, especially health care providers and community – to have a strategic, prioritised say in what research we do to help them resolve their problem. They can take that solution back to their coalface and implement it, because they’ve “pulled” it into the health care system in the first place.

The AHRA has formed national steering committees to address four system-wide priorities that are supported by the transformative Medical Research Future Fund:

• data driven health care improvement
• consumer and community involvement in research and health innovation;
• Aboriginal and Torres Strait Islander capacity building — as communities and researchers — for better health; and
• health systems improvement and sustainability.

Australia lacks a skilled workforce in health services research with only 4.9% or NHMRC funding supporting this field in the past 10 years, a critical area. Here there are clear gaps, and we have set up a network nationally to link relevant groups and stakeholders together. We have developed national framework, now being implemented with a strong focus on capacity building. Likewise we are developing national data-sharing principles encompassing other relevant bodies of work nationally, to enable the use of data to improve health.

Another great example of collaboration is the community and consumer engagement framework being developed across the Centres. In a very short time, we will have a nationally agreed consumer and community engagement framework that we’re supported to implement. We are very quickly communicating and leveraging the work one or another Centre has done and spreading these nationally to promote translation into practice.

This is arguably some of the more powerful work that AHRA can do because we can leapfrog and working together learning from each other along the way.

There are other areas that we agreed to work in, workforce capacity building, particularly in health services research,and clinical research facilitation. The latter, at the moment is very piecemeal. We’re collaborating across Centres, states and stakeholders to create a clinical research system that’s much more efficient and conducive to our relatively small population having access to cutting edge treatments and to the financial benefits and jobs this industry creates.

So, what are the benefits of AHRA for the clinicians and the patients at the coalface?

This AHRA collaborative platform enables, empowers and indeed actually expects clinicians to bring their challenges from the coalface to allow researchers to work with them and support them to address their challenges and find solutions.

Other opportunities also exist. At the moment, many countries including Australia spends an extraordinary amount of money on commercial consultancies to attempt to provide solutions to challenges within health care. Yet evidence for efficacy is limited. very time there is a consultancy, there are few corporate learnings, no peer reviewed publications and little retention or leverage of that body of work and learnings. In the research context, we can bring in the experts, partner for the recommendations then implement the recommendations and continuously improve, learn and share those learnings as we go. So the learnings are captured, built on, snowballed and improved.

And it is not just health researchers who are part of this collaboration. Organisational psychology, procurement systems, legal, arts, business and commercial researchers can be brought into the process. Our Centres and AHRA allow us to bridge cross sector silos and work together in unprecedented ways.

Traditionally, health and research have been very siloed, so this new collaborative approach brings broaderadvantages to the table for physicians at the front line. It’s a brilliant opportunity to pull solutions from the incredible breadth of academic expertise we have in Australia that, up until now, has been sitting in silos.

Is it a revolution? The word suggests an adversarial process and the AHRA’s model is anything but that. It is, however, a transformation, and one that promises to deliver positive outcomes for Australians by enabling clinicians to challenge us to act collaboratively to solve their problems.

Professor Helena Teede is inaugural chair of AHRA. She is executive director of Monash Partners.

Professor Steve Wesselingh is current chair of AHRA and executive director of Health Translation SA.