3-Os/Operations Research Capacity Building

Project Overview
'''Health Care Workers/Programmers/Managers investigate the impact of their programmes:

Improving patient health outcomes through health workers’ professional development in Implementation Research (IR) by developing an inter-agency community of practice for curriculum design through participatory action research'''

Background
Despite a large amount of investment in health professionals’ development, few models have proven effective in implementing latest research findings to clinical practice (Davis et al. 1995; Oxman et al. 1995; Davis et al. 1999; Bero et al. 1998; Farmer et al. 2008). A new and more effective approach is needed to realise the benefits of evidence-based medicine for better public health. It must also explain why change happens the way it does during an intervention. To overcome existing ineffective models based on limited theories of change, a curriculum for IR must consider examine changing clinical practice as emergent, situated, social action (Orlikowski 2002) in a community of practice (Wenger, 1998) that manages and generates its own knowledge and social capital (Bourdieu, 1977). For capacity building to be effective, health professionals need opportunities to be continuously engaged throughout the implementation of new research evidence (Thomson O’Brien et al. 2004) until it becomes routine, especially if an intervention is to result in behaviour change that improves their practice and patient care outcomes.

The need to improve health programme effectiveness is most serious in resource-limited settings. There is growing international recognition that greater investment in comprehensive research capacity building is needed to expand our health workforce capacity to research and improve their programme operations.

While global health initiatives and international public-private partnerships have made considerable progress towards advancing the capacity of the health workforce in delivering treatment, care and support, they face considerable challenges in developing effective and sustainable models for applied clinical learning and training support. In addition, sustainable improvements in programme operations now require that health care worker’s reflective capacities, and their critical awareness to monitor and analyse their work practices in relation to the quality of care they are delivering, are continuously developed so as to make a difference to patient health outcomes and, concurrently, strengthen health systems.

Implementation Research
The objective of Implementation Research is to significantly improve access to efficacious interventions by developing practical solutions to common, critical problems in the implementation of these interventions. Implementation Research is therefore defined as research that:

Defined in this way, Implementation Research falls within the broader framework of health systems research.
 * identifies common implementation problems and their main determinants which hinder effective access to interventions
 * develops and tests practical solutions to these problems that are either specific to particular health systems and environments or that address a problem common to several countries in a region, and
 * determines the best way of introducing these practical solutions into the health system and facilitates their full scale implementation, evaluation and modification as required.

Despite the [http://apps.who.int/tdr/publications/training-guideline-publications/framework-operation-research/pdf/framework-operation-research.pdf. Operations Research Framework] produced by The Global Fund to Fight AIDS Tuberculosis and Malaria (The Global Fund), the World Health Organisation Tropical Diseases Research Centre (WHO TDR) and associated agencies in 2008, no standardized curriculum yet exists to harmonise, develop and implement best practices in training those at the frontline – health care workers/program managers – to do IR which investigates and identifies:


 * the impact of their health programmes,
 * which approaches are effective in the field, which are not, and their associated rationales,
 * the number and quality of services and programme outputs and outcomes, and
 * the ways in which to optimize programme inputs and processes.

Purpose
The purpose of this proposal is to ultimately improve patient health outcomes, across diseases, by developing the professionalism of the health workforce of resource-limited countries in conducting IR. The rational for the proposed 3-Os learning model itself is the growing recognition that realizing this ambition will require not the mere provision of small-scale direct training on the ground by various independent actors, but first reconceptualising capacity building as continuous professional development (CPD). This will require leading the design of a flexible open curricular package for IR education, and its’ accompanying open access educational resources, through a series of action research cycles for pilot testing, revision and refinement, guided by an active online research community of participants, mentors and facilitators who will also monitor and evaluate the ongoing mainstreaming of the curriculum they develop over the next three to five years.

To accomplish this goal, rather than deploying a one-off project team, this proposal will create an inter-agency collaborative community of practice of programmers, scientists, educators, and public health resource persons to steward the knowledge creation and dissemination processes, thereby sustaining professional and institutional learning across leading international actors in IR and health systems strengthening that have - and continue to - successfully collaborate on a variety of policy and programming initiatives: (list agencies).

Professional and Curriculum Development Innovation
This proposal presents a unique opportunity for an educational intervention that directly addresses and combines both international public health training and research agendas for improving patient health outcomes in several innovative ways. The intervention will:


 * Develop an IR curriculum specific to the identified needs of practitioners, that combines conceptual knowledge and skills building in analytic tools for the measurement and optimization of impact, drawing on case-studies of Best Practices, and the communication of research findings in journals and fora;
 * Deliver the curriculum through a blended learning approach (face-to-face trainings with online communities), around the 3-Os model, complemented by collaboratively produced open educational resources, thus drawing on the latest advances in continuous professional distance education conceptual frameworks, and resulting in increased productivity and a greater return on investment, as well as allowing the opportunity for customizing to local situations;
 * Make practicing health care workers, programmers and the communities they serve central to researching their work by applying what they learn to investigate their practice, with the goal of continuously improving the operational efficacy of their own clinical programmes specifically, and the quality of health research from resource-constrained settings broadly;
 * Fill a knowledge gap in the theory and practice of health professionals’ education by conducting action research and cultivating a living professional and curriculum development community of practice that reflects and nurtures inter-agency, multi-region and multi-disease fertilization of perspectives on the issues and challenges of health care worker training during the scale up of health systems research.

Strengthening contribution to health systems strengthening
This proposal builds on strategic shifts in global health, and leverages on a growing body of training, research, policy and programming developments in health and education internationally, which are exploring the best ways to develop and translate new insights and evidence on pervasive public health problems by building the research capacity of health care workers, so as to be able to promote and instill an IR culture and the wider application of its’ results. Relevant recent developments include, inter-alia:

International Commitment

 * There is increasing international commitment to health systems strengthening, as witnessed by support of initiatives led by the Rockefeller Foundation.

Coordination of Training and Research Under Joint Leadership

 * Coordination of Training and Research under (list agencies), a consensus statement in 2008 underscored the importance of building an enabling professional environment and training staff to conduct research into the operation of health programmes to address existing knowledge gap.

Alignment of Research Priorities with Capacity Building Programmes

 * Recent announcements in the health sector reveal that stakeholders increasingly are demanding value for money for capacity building. The added-value to the response will increase by building a sustainable inter-disciplinary community of educators and health professionals across agencies and sectors, improving their skills in - and knowledge of - what and how they do what they do.

Synergizing IR for policy change and Intensifying Inter-Agency Partnership
This proposal presents a unique opportunity to respond to the call made at the recent Vancouver 2nd Global Experts Summit and at IAS 2009 for key actions by leading agencies. An inter-agency community of practice in IR curriculum development will break new ground in strategies to accelerating inter-agency partnerships for global health collaboration, joint problem solving and knowledge sharing, through embedding a long-term, high-impact project, and by mobilizing human and financial investment for capacity-building initiatives and the implementation of a robust IR agenda simultaneously.

Expertise and Experience in Professional Development
Agenices conduct targeted professional development (mainly in the form of didactic workshops) on IR around conferences and in-country, with on-site clinical mentoring. Over the years, agencies have built in-house capacity by applying the lessons from the evaluation of past educational programmes, and developing a model of practice that integrates topical seminars, conference mentoring, scientific writing training and mentoring, and online discussion groups. It is time to bring all these various approaches together and identify effective strategies for curriculum implementation that lead to changes in clinical practice. Building on this, the learning experience of participants to be trained in this proposal will be enriched and facilitated through intervening at a prior stage of professional development, namely the design of a standardized curriculum, implemented at trainings in conjunction with future conferences and by partner agencies in country, and monitoring and evaluating its effects, thus deepening our understanding of, and contribution to, the practice, transferability and scalability of all health workers professional development.

Sustainable Capacity Building Ethic

 * With the approaching target for achieving the goals of universal access, agencies are responding by pro-actively initiating learning approaches that pay attention to the gaps in early career health professionals’ skills and knowledge, employing experiential and adult learning methodologies with leading faculty and speakers.

IR training will enable health care workers to learn as they practice, giving them voice and respecting local and particular knowledge, rather than imposing additional ineffective one-off training burdens. The partnership of international agencies in this proposal will ensure professional development programming is sustained as the curriculum is scaled up and continuously improved.

Mentoring by the first batch of trainees of new ones will induct more and more health care workers into a growing IR professional learning community, supported with an online social network, enhancing their identity and commitment to improving global health. Enabling such processes can also equip health care workers to contribute to improving the IR aspects of their country’s proposals for The Global Fund, and to requesting for support to apply what they learn about IR, by developing their research writing and publishing dispositions.

Summary
The 3-Os team invites you to join us in backing this innovative proposal, and dedicating funding to ensure the proposal meets its vision of training 25,000 health care workers over 5 years. With our innovative 3-Os learning model, there is a potential to cost-effectively reach an additional 20% or more learners. By jointly developing a community of practice to produce, test, trial, and mainstream a curriculum in OR education, this proposal will sustain the next generation of health care professionals’ learning, having been equipped with research capacities to investigate the impact of their HIV/disease programmes, thus continuously improving the health of all people we aim to serve.

ToRs for CoP
TORs for Operations Research Community of Practice