The Field Of Health Services Research: Time To Change Its Paradigm - Health Affairs

How can health services research better ensure that high-value health care is consistently and affordably provided to different people, communities, and populations? That’s a fundamental question that this sector must answer if it’s to remain viable.

Over the past 50 years, health services research has inarguably contributed to our understanding of how health systems work and how care is most effectively and affordably delivered. For example, it has helped those responsible for the design, delivery, and financing of health care to better understand the effects of cost sharing on consumption and quality of care; how expanding Medicaid can improve health outcomes for low-income patients; and what everyone can do to reduce medical errors. 

At its core, the goal of health services research is to provide evidence that helps policy makers, clinicians, provider organizations, patients, and others make informed decisions that result in better health. When such research is well conceived, executed, shared, and acted upon, it has a real-life impact. It shapes transformative decisions about policy, from building the evidence base to support mandatory screening for post-traumatic stress disorder (PTSD) and traumatic brain injury among servicemen and -women to helping inform the majority opinion in the challenge to the Affordable Care Act brought before the Supreme Court in 2015.

The health care landscape is rapidly changing, and health services research must keep pace to ensure its promise and potential to improve health and the delivery of health care. But what happens when the very processes and methods that have reinforced the rigor of health services research stand in the way of its being effective and relevant? Rigor of the field—key to our credibility—can come at a cost in terms of timeliness. We know too well that it can take years to get funding support for, conduct, report, and publish health services research—and that translation of that research into policy and practice can take many more years. Yet the window for decision making in policy and practice can be days or weeks.

When processes and methods stand in the way, it’s time to question the established assumptions, roles, organizations, and incentives long used in the health services research community. It requires developing and adapting to a new paradigm.

The Paradigm Project

This is why we agreed to co-lead the Paradigm Project—a concerted, collaborative, multiyear initiative to redesign the way health services research is conducted and disseminated. Convened by AcademyHealth, and funded by the Robert Wood Johnson Foundation, this project is using human-centered design thinking as a creative problem-solving approach to identify, prototype, and test ways to increase the relevance, timeliness, quality, and impact of health services research.

Launched during summer 2019, the Paradigm Project consists of approximately 120 volunteers drawn from diverse backgrounds both within and outside of the health services research field. These volunteers are participating in a Learning Community to explore concerns and rethink research processes over the following year, so that concrete ideas for solving problems are identified and then tested in real-world settings. This group includes a 30-person Steering Council, which guides the overall effort.

A key aspect of the Paradigm Project is to preserve and promote what remains effective about the current health services research paradigm and the methodological rigor that guides it. And yet, to help the field evolve, the project will also explore potentially uncomfortable questions: How can health services research break through the “noise” in this era of instant information? How can it move much faster, while keeping pace with the advance of technology and a veritable flood of new and emerging data sources? And with patients and the public more engaged in evaluating and redesigning health care interventions, how can the research results be framed in a way that is far easier to understand and share than conventional channels allow?

This is indeed an exciting moment for health services research. The field has an unprecedented opportunity to disrupt and rethink how it conducts research and shares information, placing an emphasis on the needs, priorities, and values of diverse people and communities—especially those outside of traditional health care circles. Rethinking the research also requires cultivating, inspiring, and engaging a new generation of health services researchers to get them to do things differently.

Looking Ahead

The first meeting of the Paradigm Project, in Washington, D.C., brought together an impressive group of leading thinkers from a variety of disciplines—health care, open data, technology, academia, and others. Members of the Learning Community assembled into 17 groups, each focused on improving a particular challenge that the health services research field faces today—from increasing the timeliness of research so as to better meet the needs of end-users, to building upon the availability of big data and increased computing capacity.

Through spring of 2020, each group will develop and share ideas that can help the health services research field modernize. We will discuss which ideas have the most potential to improve the way health services research is conducted and disseminated and aim to test them in a variety of settings.

For people like us who have devoted their careers to gathering and assessing data that have often been compiled in lengthy research reports, this feels like a revolutionary act. We have the opportunity to completely rethink how to harness the power of information that reveals how to improve health care and make people healthier. We accept the challenge of changing the paradigm of health services research, and we hope you’ll contribute to the conversation.

The authors are cochairs of the Paradigm Project. For more information about the Paradigm Project, visit the project website.

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