Dossier n. 182/2009 [Abstract] Research as an institutional activity of the Emilia-Romagna Regional Health Care System

Research Governance: a regional policy

In July 2009 the Emilia-Romagna Region issued - with resolution no. 1066/2009 - a document outlining the research and innovation strategies for the regional health services. The document - presented in this volume - is of great importance for the future development of regional research initiatives and can be approached with different “interpretation keys”.

On the one hand, it represents a clear confirmation of the regional healthcare system’s commitment to research and innovation, commitment made particularly tangible by the amount of resources awarded to support research initiatives within the system.
On the other hand, the document explicitly shows the ambition to convey all research programmes launched in the past in a coherent and comprehensive strategy, aimed at emphasizing their potentials and implications.

In this context the Regional Research and Innovation Programme (PRI E-R), started in 2004, is re-proposed as a testing ground for the development of a successful relationship with the industry, acknowledging both the intrinsic problems and the inescapable relevance of such relations. Moreover, the PRI E-R programme confirms itself as a bedrock for systemic initiatives aimed at transferring research outputs into clinical practice, for the evaluation of the cost-effectiveness profile of health care technologies, for the strengthening of the regional research capacity (i.e. through the development of clinical databases).

The Region-University Research Programme maintains its supporting role for innovative activities in teaching hospitals, by sustaining locally developed initiatives, likely to have a system-wide impact, and by addressing most relevant issues through the input of skills and competencies present in the academic environment.

The Regional Fund for Health Services Modernisations is specifically devoted to clinical and organizational innovation, an important and too often neglected area. The bold, but no longer eludible, goal is to succeed in matching the many changes, promoted at the local level by our health care organizations, to sensible forms of evaluations of their actual impact on quality of care.

A specifically appointed Committee for Research and Innovation is therefore established to assure those research programmes the necessary harmonisation and to set priorities coherent with the development of health services and their needs.

This plan has the long-term and ambitious aim to provide the regional health System with the means necessary to steer its own development through strategies embedded on the information acquired through research activities.

An important section of the document is dedicated to the governance of research and innovation processes; it offers general operational advices to health care organizations, while preserving the flexibility needed in different local setting. Both traceability of and ability to plan research activities are essential issues.

The general message underlying the whole document deserves some additional comments.

Linking the word “governance” with the theme of research and innovation may seem an oxymoron: how is it possible - and to what extent is it at all desirable - to govern activities that should be performed with creativity and full autonomy by individual researchers? Is there a risk of putting unnecessary limits to initiatives that should be simply assisted and supported rather than “governed”?

To address this question a conceptual pivotal point must be emphasised: there is an unavoidable tension between respecting conditions enabling researchers to express their creativity and ensuring that their research activities are both open to external evaluation and relevant to the policies of the health care organizations hosting them. This implies an assessment process which is bound to be intrusive for researchers’ activities, but which can become - if not seen as a mere bureaucratic apparatus - an actual means to promote a successful and constructive exchange.

If research is really to become an important part of health services’ development deserving economic, cultural and organizational support, it has to be subjected to assessment processes confirming its capacity to produce useful and usable information. In other words, if research activity is to be an investment for the future, it must be shared between researchers and end users.

Overall we have quite a challenging agenda ahead of us. Yet the complexity of the issues at stake must be appreciated and accepted. In order to evolve and be competitive in the national and international arena, biomedical and health services research must be increasingly oriented towards the interests of the system supporting them, and not just those of the researchers. As an integral part of this process, health care organizations should support and invest in professionals that are sufficiently skilled in research activities to effectively support researchers and sufficiently acquainted with features and mechanism of the organization to interpret its information needs and translate them in adequate research questions.

To conclude, this document sets the agenda for the immediate future, identifying a number of issues which require shared efforts on conceptual, methodological and policy grounds.