Quadruple Aim and Equity End-of-Grant Workshop: Summary Report

Overview

On November 21-22, 2023, CIHR’s Institute of Health Services and Policy Research (IHSPR), Institute of Aging (IA), Institute of Musculoskeletal Health and Arthritis (IMHA), Institute of Population and Public Health (IPPH), Institute of Neurosciences, Mental Health and Addiction (INMHA), Strategy for Patient-Oriented Research (SPOR) and the CMA Foundation hosted an end-of-grant workshop to convene the 50 funded research teams of the Quadruple Aim & Equity funding program.

The goal of the one-year catalyst grant competition was to generate relevant and timely evidence about the impacts of innovations in how healthcare systems and services are organized, delivered, governed, held accountable, financed, and/or funded on the Quadruple Aim principles (better population health outcomes, improved care and patient experience, improved provider satisfaction, and lower costs/better value) and health equity. All projects were of high priority to the research team’s policy and/or decision maker(s) and designed to inform decision-making and identify policy/implementation considerations for the Canadian context.

The purpose of the end-of-grant workshop was to convene the funded research teams, program partners and relevant stakeholders to:

1. share progress, challenges, barriers and enablers;
2. share and learn successful strategies for incorporating the Quadruple Aim and health equity within research; and
3. provide a forum for knowledge exchange and networking.

In addition to the research teams presenting their research findings, the workshop included an open dialogue with panelists who shared their perspectives on the role of evidence and research in integrating the Quadruple Aim and equity into policy and practice, and small breakout discussions on the power and impact of partnerships and future actions after a one-year grant.

Moving from outcomes to impact: why health systems should use the Quintuple Aim framework

The workshop opened with a multi-stakeholder panel to explore the differences between clinical outcomes and impacts when striving for the Quintuple Aim principles (Quadruple Aim plus health equity). The panelists included Alex Haagaard (design researcher, patient perspective), Dr. Antoine Groulx (Full Professor, Université Laval; Scientific Director, Quebec SPOR SUPPORT Unit; Family Physician), Dr. Nakia Lee-Foon (Health Equity Research Lead, Institute for Better Health), and Dr. Verna Yiu (Provost and Vice-President (Academic), University of Alberta). The panelists reflected upon their expertise and experience and discussed how the Quintuple Aim principles can ideally be aligned to eliminate healthcare disparities and improve overall health system performance.

The panelists discussed the challenges of translating research into effective healthcare practices and policies, underscoring the necessity of involving communities in the design of services. Trust building with equity deserving and rights holding communities and stakeholders was deemed essential as was defining health equity within different contexts. Although challenging, addressing health inequities and focusing on upstream determinants of health were deemed highly important.

The panel highlighted the importance of measuring progress and outcomes in achieving healthcare goals, including rigorous evaluation of intervention implementation and quantitative measures and qualitative experiences of patients and providers. The panel stressed the need to demonstrate a return on investment, while also enhancing population health and quality of life. Questions about reconciling differences in value for money between different stakeholders and the challenges policy-makers face in allocating limited funds to various demands were also raised. Overall, the integration of the Quintuple Aim principles into policy and practice requires a multifaceted approach, with co-design, trust-building, stakeholder engagement, and measurement and evaluation all playing a crucial role in achieving success.

Research Findings

Over the course of the two days, the 50 teams presented their research which spanned several topics areas including health system organization, health workforce, equitable primary care, mental health services, models of care for older adults, specialized care, patient-centered care, virtual care, digital health innovations and population and public health.

For more information about the research projects, please download the program’s Evidence Brief Booklet [ PDF (4.1 MB) - external link ].

The Power and Impact of Partnerships

Workshop participants had the opportunity to reflect and discuss the power of partnerships in advancing research and how partnerships contribute to overall project success and impact. The following key points were discussed:

• The importance of partnerships: the need for strong and meaningful relationships with diverse stakeholders, including researchers, decision/policy-makers, patients, communities, and providers.
• Challenges in partnerships: time constraints of partners, navigating role definitions, managing power dynamics, and addressing the different priorities and perspectives of various partners.
• Feedback and knowledge mobilization: importance of providing feedback and sharing knowledge with partners and stakeholders, and the need for effective communication, co-design, and engagement processes to ensure research findings are translated into policy and practice.
• Sustainability of relationships: maintaining strong relationships over time was highlighted, especially in the context of personnel turnover and changing organizational structures.
• Virtual collaboration: the efficiency of virtual meetings and the need to balance them with in-person interactions.
• Equity and inclusivity: importance of including diverse voices, such as patients, frontline clinicians, and community representatives, in research partnerships.

Future Actions: what comes after a one-year grant

Workshop participants had the opportunity to reflect and discuss opportunities and actionable steps for sustaining momentum of research projects through effective knowledge mobilization and future Quadruple Aim and health equity research. The following key points were discussed:

• Consolidating Relationships: building and nurturing relationships formed during the projects is crucial for moving forward. This involves consolidating the partnerships and networks that were developed during the grant period. It was suggested that forums like the workshop are essential for fostering communities of practice and creating opportunities for collaboration.
• Synergizing Results: importance of synergizing and bringing together the results of the various projects. This would involve synthesizing common findings and solutions to address common problems in the health system. The idea was to create a collective knowledge base that could be accessed by different user groups, through the creation of slide decks, toolkits, and other tailored formats for specific knowledge users.
• Defining Return on Investment (ROI): importance of defining and measuring the return on investment of the research projects. Traditional metrics may not capture the full impact and value of the projects and teams should explore alternative ways of measuring and evaluating the impact, such as storytelling and tailoring knowledge mobilization products for specific users.
• Managing Expectations and Context Change: the short timeframe of the one-year grant posed challenges in terms of managing expectations and dealing with contextual changes. It was suggested that upfront discussions and consensus-building with stakeholders are necessary to align expectations and ensure feasibility within the limited time frame. Additionally, there was a recognition that the research projects need to be adaptable to changes in policies, procedures, and priorities within the organizations they are working with.
• Supporting Knowledge Mobilization: need to amplify the projects from the start to engage stakeholders and decision/policy-makers, providing opportunities for researchers to have a seat at decision/policy tables, and facilitating connections and networking among researchers and teams. Mentorship and communication/media training could be beneficial in effectively presenting research and engaging with different user groups.
• Impact and outcomes: participants mentioned the tangible impacts of their research projects, such as developing recommendations and influencing policy and practice. Many groups expressed the desire for ongoing support and funding beyond the one-year grant period and highlighted the need for continued funding opportunities and suggested the creation of a programmatic approach that allows for larger, longer-term projects and collaborations. Overall, there was a strong emphasis on collaboration, partnership building, and sharing of knowledge and resources to maximize the impact of the funded projects.

Conclusion

Thank you to all who participated in the Quadruple Aim and Equity End-of-Grant Workshop. CIHR-IHSPR is grateful to all our partners, speakers, presenters, moderators and facilitators who generously shared their time and expertise and whose involvement enriched the success of the workshop.

For more information on other research programs focused on Quadruple Aim and Equity, visit CIHR’s Institute of Health Services and Policy Research.

Date modified:

2024-01-26