AcademyHealth has spent the last two years envisioning and innovating for the future of health services research through our Paradigm Project. From the very start, members of the field came together around the need to address long-standing concerns about whether researchers are creating the right evidence and getting it to decision-makers in a timely, accessible way. This ambitious initiative has also allowed us to consider the relevance of larger, emerging trends in the way we do research, including open science, community-based participatory research, new “real world” sources of data, and the urgent need to address inequities and structural biases in the field.
A previous post focuses on innovations developed and tested as part of the most exciting and novel part of the Paradigm Project, our use of human-centered design to address challenges that fall into six broad categories. Based on a session from AcademyHealth’s 2021 Annual Research Meeting, the post reflects on this part of the project through the eyes of four individuals who have been intimately involved in this process.
Beginning this fall, we’re looking to build on this foundation and work to-date to assure a diverse, inclusive, and equitable field to create a social movement for widespread, meaningful, and sustained change. At the urging of the Paradigm Project’s Steering Council, we are learning about the elements of success associated with the leadership of past social movements. While actual change must come from members of the field themselves, history points to the key role AcademyHealth can play as an organization in catalyzing change. In the months to come, we will have more to say about how we make this movement for change a part of all of AcademyHealth’s work, but this juncture provides a good opportunity to take a look at how we got here. In particular, we see five lessons from our Paradigm work that have important implications for how we undertake our catalyzing role:
- Health services researchers are motivated to make a difference for others. Our initial invitations to potential volunteers to guide this work and design innovations were met with an enthusiasm that has persisted through the whole project. What comes through in all of our conversations with our volunteers is the reason we all committed ourselves to this field in the first place – a desire to make a difference – to improve health. This enthusiasm has bolstered staff enthusiasm for such a wide-ranging ambitious project, even during a world-wide pandemic. This energized volunteer base is perhaps the most important result of the project and becomes the foundation for turning the work done to-date into meaningful, sustained change for HSR.
- Change is possible. We also found a willingness, even among the most senior members of our field, to try new things to bolster the relevance of HSR. At times, that willingness has been tempered by the realities of research university finances and governance, but our most promising innovations are scaling and spreading. A prime example is the Day of Impact and Action, which uses personal lived experiences of underrepresented parts of the HSR workforce to motivate immediate actions that participants can take in their own institutions to create greater diversity and inclusion.. Even a recent expert meeting exploring whether incentives and rewards for academic researchers can be better aligned with our desire for greater social impact was able to identify a series of concrete, immediate actions that different stakeholders in the HSR ecosystem can take. A forthcoming issue brief will highlight these opportunities. The bottom line? Paradigm has established that we can improve the way we do science while preserving all that makes HSR strong and rigorous.
- We don’t have to reinvent the wheel. At the outset of the Paradigm Project, we noted that the challenges facing HSR are not unique and sought to benefit from the experience of those in other fields of study, outside the research sphere, and from other countries. We commissioned seven “horizon scans” to be written by non-health services researchers and convened a series of expert meetings to review innovations from other fields that could hold promise for our work. These outward-looking efforts have highlighted new approaches to rewarding university faculty, allocating research funds, creating a more diverse, inclusive workforce, and assuring ethical data governance. One paper even looked a fields as different as musicology and the digital humanities for lessons about change in academia happens.
- New ideas come from new tools. Our use of human centered design is probably the best example of this lesson. We were skeptical about how comfortable researchers would be to using an approach drawn from the world of visual and consumer product design. For example, “testing” ideas in human centered design looks very different from testing hypotheses in a rigorous research design. To the best of our knowledge, Paradigm is also the first attempt to apply human centered design to innovating a scientific field. We went ahead with this new approach because the challenges to HSR’s impact are so significant and longstanding. For us, human centered design was a high risk, high reward proposition. From the very first meeting of our volunteers, we saw how this approach captured people’s imaginations. Enthusiasm for design thinking has only increased as our volunteers have seen evidence that human centered design results in insights and ideas that have previously escaped notice. We have learned a lot of lessons about how best to use this tool for challenges like those that HSR faces, but that’s an important topic for another day – Paradigm shows we shouldn’t be limited to our traditional toolbox.
- A diverse, equitable and inclusive field is key to all other changes. The events of 2020 reshaped the Paradigm Project mid-course. Beyond the work of many of our volunteers on the front lines of care, both COVID-19 and the increased attention to racial violence exacted a psychic and emotional toll on everyone, including our volunteers. Last year did not so much force us to scale back our efforts as it highlighted the most important ways in which HSR falls short of the mark and insufficient diversity, equity, and inclusion in the field was at the top of that list. Participants raised the urgency of these issues in every expert meeting and human centered design session. Paradigm became an opportunity for many to share their personal and often painful lived experiences of exclusion and racism in academia and the other institutions of HSR. We soon came to see that none of the 17 specific challenges to the Paradigm Project aims to address will be solved without serious action to eliminate the inequities in our field and in health care. The five promising innovations we are now testing reflect this reality, and it is the starting place for what comes after Paradigm.
The Paradigm Project will end this fall, but it is only the start of our efforts to create real and lasting change in how we do, communicate, and use HSR. Social movements are collectively owned by all who have stake in them. While we want to be a catalyst, the real effort must come from the field We will continue to rely on volunteers from the Paradigm Project’s Steering Council, Learning Community and Reactor Panel, but we need you. We invite your ideas as we craft our next steps and hope you will join us in this important work. Please reach out to us at firstname.lastname@example.org.