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This year has been tumultuous and emotional, to say the least.

Over a quarter of a million people in the United States have died from COVID-19 and cases continue to surge in all corners of the country. Acts of police violence awakened many Americans, and indeed the world, to systemic racism resulting in a summer of Black Lives Matter protests. And the drama that ensued before, during and after the closely contested U.S. political election brought questions of civic responsibility to the fore across the ideological spectrum.

These recent events demand a major shift in how we think about ourselves, our society, and the ways in which we can stand up to the challenges of our time and in the process uncover the solutions they require.

We know from health care’s rapid pivot to telehealth that large institutions can swiftly identify and implement changes when other alternatives are unavailable. While telehealth’s success is the result of market-driven change, public health officials, activists, and health care providers require timely, actionable research to guide most action. Without it, public health emergencies like COVID-19 quickly envelope and cripple society without guidance on the path forward. To respond more effectively to challenges old and new, we need to proactively embrace the sense of urgency and innovation that makes pivots like the one to telehealth possible.

This is particularly true for the field of health services research, where I have spent the past 30 years. Some challenges for health services researchers have been clear since long before the pandemic—provider shortages, unaffordable health care costs, and racial disparities in how care is delivered, to name just a few. In recent years, many of us working in the field have come to understand that while knowledge is undoubtably good for its own sake, decision-makers require conclusions that are more targeted than the fail-safe ‘more research is needed’ approach.  

This recognition has forced our hand, expanding our beliefs about who should be involved in the research process—from patients to community advocates and activists to researchers and entrepreneurs from non-health care backgrounds—as well as our understanding and acceptance of new and non-traditional data and methods for conducting, disseminating and translating research.

Other challenges to the traditional way of doing health services research–the ones made most salient by current events – reflect larger changes in society. A general distrust of institutions and greater expectations for transparency make the idea of open science more resonant. The urgency of the pandemic highlights the need for data sharing and prompt sharing of results—especially as we hunt for a COVID-19 vaccine and the best way to deliver care during the pandemic. Similarly, incidents of racial violence highlight not only the need for health services researchers to develop strategies to eliminate structural racism in health care, they have also made us aware of the need to address these biases within the research community and the methods it uses. Indeed, we now understand the two are inextricably linked. 

When COVID-19 struck, AcademyHealth’s Paradigm Project was already at work rethinking 17 different aspects of the field to ensure its work is more timely, more actionable, and more equitable. In the ensuing months teams of volunteers—representing producers, funders, communicators, users, and subjects of health services research—have focused on five of these challenges that became particularly important in 2020.  Using the tools of human-centered design our teams test prototype innovations to take the field into a more relevant future. Each of these interventions are intended to help researchers break out of their traditional silos to engage underrepresented, often “real world” perspectives, particularly from the very people most affected by the issues we see and hear so much about. In particular, these volunteers engage the broadest spectrum of producers and users of health services research to understand:

  • Can the stories of academic researchers from underrepresented groups who struggle to find a place in academia move established members of the field to truly diversify the traditional university power?
  • Can pre-print servers and effective visualizations complement traditional publishing and peer-review platforms to shorten the gap between important research results and putting them into policy and practice? 
  • What innovative tools can help researchers identify and address structural bias in their data and methods?
  • Can funding and expertise incubate partnerships between health systems and community-based groups, paving the way for these groups to work together to implement research findings and remediate inequities in health and health care outcomes?
  • What model of health services research funding and governance could shift the locus of control from traditional research partners to the communities they seek to serve?

The answers to these questions will emerge as we continue an iterative process of prototyping and testing solutions with growing numbers of participants from within and outside of the health services research community.

In the near-term, the Paradigm Project aims to engender a wider acceptance within the health services field that the status quo isn’t okay and a belief that meaningful change to solve long-standing problems is possible. We will continue to test ideas and scale and spread those that are successful, demonstrating that our approach works and can innovate the field.

This year clarified our resolve that the Paradigm Project is the right project for the times and challenges we face -- antiracism and equity, health system improvement and resilience, and science innovation -- because the needs of society demand it.

One project, however, can’t by itself create the big, sustained change we need. Rethinking how we conduct research is a continual process–a shift in mindset that makes continuous improvement, agility, and innovation in how we do science part of our DNA and the bedrock of the health services research paradigm.

AcademyHealth’s Paradigm Project is seeking new members for its Reactor Panel to ensure that we’re engaging diverse group representative of those who produce, communicate, and use health services research. Members of the Reactor Panel provide honest feedback on the innovations the Paradigm Project is developing.   



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