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Capacity development in health systems and policy research: a survey of the Canadian context Grudniewicz, Agnes; Hedden, Lindsay; Kromm, Seija; Lavergne, Ruth; Menear, Matthew; Sivananthan, Saskia Feb 7, 2014

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RESEARCH Open AccessCapacity development in health systems andpolicy research: a survey of the Canadian contextAgnes Grudniewicz1,2*†, Lindsay Hedden3,4†, Seija Kromm1†, Ruth Lavergne3†, Matthew Menear5† andSaskia Sivananthan3† for The Canadian Association for Health Services and Policy Research (CAHSPR) StudentWorking GroupAbstractBackground: Over the past decade, substantial global investment has been made to support health systems andpolicy research (HSPR), with considerable resources allocated to training. In Canada, signs point to a larger andmore highly skilled HSPR workforce, but little is known about whether growth in HSPR human resource capacity isaligned with investments in other research infrastructure, or what happens to HSPR graduates following training.Methods: We collected data from the Canadian Institutes of Health Research, Canada’s national health researchfunding agency, and the Canadian Association for Health Services and Policy Research on recent graduates in theHSPR workforce. We also surveyed 45 Canadian HSPR training programs to determine what information they collecton the career experiences of graduates.Results: No university programs are currently engaged in systematic follow-up. Collaborative training programsfunded by the national health research funding agency report performing short-term mandated tracking activities,but whether and how data are used is unclear. No programs collected information about whether graduates wereusing skills obtained in training, though information collected by the national funding agency suggests a minority(<30%) of doctoral-level trainees moving on to academic careers.Conclusions: Significant investments have been made to increase HSPR capacity in Canada and around the worldbut no systematic attempts to evaluate the impact of these investments have been made. As a researchcommunity, we have the expertise and responsibility to evaluate our health research human resources and shouldstrive to build a stronger knowledge base to inform future investment in HSPR research capacity.Keywords: Capacity development, Health systems and policy research, Human resources, Training, WorkforceBackgroundOver the past decade, significant investments have beenmade globally to support health systems and policy re-search (HSPR) with the ultimate goal of contributing tohigh-quality, accessible, and sustainable health care systems[1,2]. These investments have taken multiple forms, sup-porting both training and development of an HSPR work-force, as well as investments in research infrastructure.The Canadian HSPR community has grown and trans-formed as a result of these investments; signs now pointto a larger, younger, and more highly skilled HSPR com-munity [3]. Developments in infrastructure, encompass-ing supportive research environments and tools (such asaccessible data) are less apparent. If growth in humanresource capacity has outpaced development of such re-search infrastructure, Canada’s transformed HSPR work-force may not be well-positioned to achieve its potential.Careful tracking of career trajectories and research outputsis required to ensure that investments in human resourcecapacity are yielding the desired growth in high-quality,relevant research [1].The importance of conducting research on health re-search systems is gaining recognition [4]. A prominent* Correspondence:†Equal contributors1Institute of Health Policy, Management and Evaluation, University ofToronto, Health Sciences Building, 155 College Street, Suite 425, Toronto,Ontario M5T 3M6, Canada2Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street,Toronto, Ontario M5B 1V8, CanadaFull list of author information is available at the end of the article© 2014 Grudniewicz et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of theCreative Commons Attribution License (, which permits unrestricted use,distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons PublicDomain Dedication waiver ( applies to the data made available in thisarticle, unless otherwise stated.Grudniewicz et al. Health Research Policy and Systems 2014, 12:9 in HSPR is the examination of health human re-source capacity, which explores whether the health careworkforce is meeting the needs of the population. Thispaper represents a first attempt to apply a similar lens toworkforce issues facing the HSPR community in Canada.Trends in the broader scientific workforceIn other scientific disciplines, large increases in thenumber of graduates with advanced training have notbeen matched with growth in work opportunities thattake advantage of trainees’ qualifications [5]. The num-ber of completed science doctorates grew by 40% inOECD countries between 1998 and 2008, yet in theUnited States (US), the proportion of PhD graduateswho received tenured academic positions within sixyears of completing their PhD fell from 55% in 1973 to15% in 2006 [5]. Of course, unemployment among thosewith advanced degrees remains low, but the proportionof doctorates taking jobs that do not require a PhD isgrowing, as is the time it takes for graduates to findstable, rewarding positions [6]. This has broader implica-tions, as it may signal that funding for training andscientific capacity development could be better directed.Whether these broad trends play out within HSPR is notknown.Knowledge of the HSPR workforceFor the purpose of this study, we use the Canadian Insti-tutes of Health Research (CIHR) definition of health ser-vices and policy research to define the broad field ofhealth systems and policy research “as research designedto improve the way health care services are organized,regulated, managed, financed, paid for, used, and deliv-ered” [1]. A 2007 AcademyHealth inventory of HealthServices Research (HSR) training programs found 124graduate programs in the US and Canada which gradu-ate approximately 4,500 Master’s and 150–300 PhDstudents per year [7]. The US HSR field has grown froman estimated 5,000 health services researchers in 1995 to11,600 in 2007 [8]. At the same time, US HSR fundingdeclined (adjusted for inflation), pointing to a potentialmisalignment between workforce growth and opportun-ities for research funding and employment [9]. Know-ledge of the HSPR workforce in the European context iseven more limited as there is no Europe-wide HSPRsociety. Some countries do have professional HSPR orga-nizations and national conferences [2,10]; however, thisfragmentation hampers efforts to measure HSPR cap-acity globally.Understanding the dynamics of the HSPR workforce iscomplicated by the diverse nature of the field, as re-searchers come from a variety of disciplines, collaborateinternationally, and work in a wide range of settings[9,11]. US AcademyHealth membership indicates thatnearly half of health services researchers were workingin universities or teaching hospitals, one third in the pri-vate sector or foundations, and 10% in governmentagencies [8]. There is a noted lack of information on theHSPR workforce in Europe, where there are large differ-ences in training opportunities among countries [10]. Areport on HSPR capacity building in Canada (based onstakeholder interviews and a document review) concludedthat good evidence is not available to capture Canada’scurrent HSPR human resource capacity; thus providingno information to direct further capacity building efforts[12]. To our knowledge, no Canadian studies have ad-dressed this gap.Capacity development efforts in CanadaThere have been considerable investments in the devel-opment of HSPR capacity in Canada over the past 10to 15 years [3]. In 1999, the Canadian Health ServicesResearch Foundation and the CIHR jointly launched theCapacity for Applied and Developmental Research andEvaluation (CADRE) program, a major 10-year capacitydevelopment initiative. CADRE supported mentoringchair awards, five Regional Training Centers (RTCs), post-doctoral awards, and career reorientation awards, with atotal of $6.5 million in funding each year [13]. The RTCsprovided students with the opportunity to collaboratewith decision makers, gain an interdisciplinary per-spective, and develop skills in research methods [13,14].Shortly thereafter, in 2001, CIHR launched the $85 millionStrategic Training in Health Research (STIHR) initiativeto increase health research capacity through training anddevelopment of researchers, in health services as well asother areas [15].These direct investments in HSPR human resourcecapacity coincide with other policies that supported in-creased opportunities for advanced training. The estab-lishment of CIHR’s Institute of Health Services andPolicy Research in 2000 marked a profound change inthe funding of HSPR research [16]. Prior to this, HSPRresearchers were dependent on highly competitive fel-lowships funded through the Natural Sciences andEngineering Research Council of Canada. CIHR nowprovides targeted funding for student traineeships tiedto operating grants, as well as master’s, doctoral, andpost-doctoral awards. Figure 1 shows the marked in-creases in the number of master’s, doctoral, and post-doctoral awards, as well as more modest growth in newinvestigator salary awards. This figure does not capture re-search traineeships through operating grants, or throughthe RTC or STIHR programs.Given these large investments in human resourcecapacity, we explored what information is collected onpost-training activities of individuals who have recentlygraduated into the HSPR workforce in Canada. This is aGrudniewicz et al. Health Research Policy and Systems 2014, 12:9 Page 2 of 7 step in determining what is known, and what remainsunknown, about the alignment between HSPR human re-source capacity and research infrastructure.Looking forward, we considered how we as both Canadianand international research communities might take stepsto ensure that we fully capitalize on investments in humanresource capacity.MethodsWe collected data on recent graduates in the HSPRworkforce from the CIHR, Canada’s national health re-search funding agency, and the Canadian Association ofHealth Services and Policy Research (CAHSPR), Canada’snational HSPR professional association. CIHR provideddata on grant funding trajectories of previous doctoralaward recipients. CAHSPR provided data on membershipand annual conference registration.These two data sources include only those young re-searchers who received CIHR doctoral funding or whowere CAHSPR members or conference attendees, and aretherefore incomplete in their ability to inform currentworkforce dynamics. To complement these sources, weconducted a survey of all Canadian university programsthat provide HSPR training. We scanned Canadian univer-sity websites for programs that self-identified as providinggraduate HSPR training, either via specific programs orwithin larger departments. The following were included:i) programs that offer research degrees in HSPR; ii) pro-grams that offer research degrees in public, population, orcommunity health, with options for HSPR specialization;and iii) graduate nursing programs that made specificreference to ‘health services or systems research’. Clinicalfellowships with a research component or other MD pre-requisite programs, executive programs, coursework-onlydegree programs, MBA or law specializations, informationsciences, and public policy without explicit mention ofhealth services or health systems were excluded. We thenasked each of the identified programs/departments toconfirm that they were in fact providing HSPR train-ing, ensuring that we were only collecting data fromrelevant programs. A total of 45 programs were iden-tified: 33 university-based programs and 12 collabora-tive and agency-based programs (RTCs and STIHRs). Anadditional file provides the list of HSPR training programswe included in our sample [Additional file 1].We collected data between April and August of 2012.The email survey was sent to program directors andcopied to assistant directors and program administratorswhere email addresses were publically available. Recipi-ents were requested to forward the survey to the appro-priate individual if misaddressed. The email included ashort preamble introducing the CAHSPR Student Work-ing Group, the survey objectives, and four open-endedquestions (see below). The survey took less than ten mi-nutes to complete and was sent in both English andFrench.The four survey open-ended questionsi.) Does [Program, School, or Department name] offerprograms that provide training related to healthservices and policy research (HSPR)? If so, pleaselist them.HSPR has been defined by CIHR as researchdesigned to improve the way health care services areorganized, regulated, managed, financed, paid for,used, and delivered. Training could include a formalstream or certification, elective course offerings, orrelevant research experience. Programs could includedegrees (e.g., MPH, MSc, PhD), certificates, orfellowships.ii.) How many students graduated from each identifiedprogram in the past three years (September2008–November 2010)?iii.) Have you collected information on the careerexperiences of previous graduates, following1002000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009020406080120140160DoctoralInvestigatorsMaster'sNew InvestigatorsPostdoctoral FellowshipsFigure 1 Number of health systems and services CIHR-funded training and salary awards, by year.Grudniewicz et al. Health Research Policy and Systems 2014, 12:9 Page 3 of 7 of these programs? For example, didthey secure employment following graduation? If so,in what field (e.g., HSPR, public health, non-health-related) and sector (e.g., academia, health servicesdelivery organization, government)?If you have collected information, please describe ina few sentences the process you used, what types ofinformation you gathered, and the years for whichthis was undertaken.iv.) How many young investigators have been hiredby your program within the past five years(July 2006–November 2010) who work in the areaof HSPR?A new investigator is defined as someone who hasheld a full-time research appointment for fewer thanfive years.A reminder email was sent two weeks after the initialemail request, followed by reminder phone calls to theprogram director or program administrator (extractedfrom contact information on program web pages) four,six, and eight weeks after the initial email request. Whenpersonal contact was not made, a voice mail message wasleft followed by another reminder email.ResultsCIHR’s Institute of Health Services and Policy Researchcollects data on whether doctoral research award holdersreceive subsequent funding through grants. On average,30% of graduated doctoral award holders receive grantfunding and are assumed to be working in academia (ingrant-tenured, tenure-track, or non-tenured academic po-sitions). This figure rises to 71.4% among post-doctoral re-search award holders. Data from the CAHSPR conferencereveal a young and growing community. Conference at-tendance grew from 443 in 2009 to 578 in 2012, with 35%of 2012 attendees registered as students. These data, how-ever, provide a very limited picture of the HSPR work-force. There is no information about doctoral awardwinners who do not end up in academia, or trainees whodid not receive CIHR awards. The question as to whethergraduates are finding opportunities that use the skills theyhave acquired remains.We sent our survey to 45 Canadian university and col-laborative/agency-based programs. Of the 33 universityprograms contacted, we had a 61% response rate of which75% confirmed provision of HSPR-specific training. Of the12 collaborative and agency-based programs contacted,83% responded, of which 58% confirmed HSPR training(Figure 2). Of these, three university programs and twoRTC/STIHRs reported not having explicit HSPR pro-grams, but provided support to students taking courses inHSPR and carrying out HSPR thesis research. Subsequentresults focus on the 15 university and 7 RTC/STIHRprograms that responded and confirmed they providedHSPR training.The majority of university HSPR program responseswere concentrated in Ontario, with a handful of pro-grams in other provinces (Table 1). Most university pro-grams (66.7%) graduated five or fewer HSPR studentsper year, likely because they are part of larger programsthat offer some opportunity for HSPR specialization. Incontrast, all but one RTC/STIHR program graduatedFigure 2 Survey responses from HSPR programs in Canada.Table 1 Tracking activities of responding programsUniversityprograms (n = 15)RTC/STIHR(n = 7)n (%) n (%)Program location*British Columbia 1 (6.7) 1 (14.3)Alberta 1 (6.7) 0 (0.0)Manitoba 0 (0.0) 0 (0.0)Ontario 10 (66.7) 5 (71.4)Quebec 2 (13.3) 1 (14.3)Nova Scotia 1 (6.7) 0 (0.0)Program size (graduates)**Small (≤ 5) 10 (66.7) 1 (14.3)Medium (>5 and ≤ 20) 2 (13.3) 3 (42.9)Large (>20) 2 (13.3) 2 (28.6)Tracking activitiesOne-time collection 1 (6.7) 3 (42.9)Ongoing follow-up 2 (13.3) 4 (57.1)None 12 (80.0) 0 (0.0)*Of the university programs that did not respond, 3 were in British Columbia,2 in Alberta, 1 in Saskatchewan, 1 in Manitoba, 3 in Ontario, 2 in Nova Scotia,and 1 in Newfoundland. Of the RTC/STIHRs that did not respond, 1 was inQuebec and 1 in the Maritimes. One STIHR supports training in Ontario andWestern provinces.**One university and one RTC program did not report the number ofgraduates over the past three years.Grudniewicz et al. Health Research Policy and Systems 2014, 12:9 Page 4 of 7 than five students per year, reflecting the focusedHSPR training provided by RTC programs.University programs do not consistently track studentsafter graduation. Eighty percent do not track their grad-uates at all, providing only anecdotal examples of posi-tions obtained (Table 1). All RTC/STIHR programs reporttracking their graduate students, as mandated in theirfunding arrangements. Whether and how these data areused remains unclear. Three RTC/STIHR programs re-ported one-time data collection and four reported ongoingfollow-up.Only two (13.3%) university programs were able toprovide information about their graduates’ careers (bothgraduating fewer than 5 trainees per year), compared toall seven RTC/STIHR program respondents. The univer-sity programs indicated that only nine (6.8%) of their re-corded graduates obtained post-doctoral fellowships orresearch staff positions. Twenty-four (8.7%) of the 283students who participated in RTC/STIHR programswere confirmed to be in HSPR faculty/teaching positionspost-graduation. However, students in the RTC/STIHRprograms come from a wide range of fields, and thusmay be in faculty positions outside of HSPR.University programs reported hiring a total of 7 young in-vestigators that work in the area of HSPR over the periodof July 2006 to November 2010. While this is not an accur-ate count of all academic hires of young HSPR investigatorsover this period, to our knowledge this information has notbeen tracked elsewhere. RTC/STIHR programs do not hirefaculty or offer teaching positions.No programs reported collecting information pertain-ing to whether their training had equipped graduateswith the skills they needed post-graduation, nor assessedwhether graduates were in positions that satisfied themor corresponded to their level of training.DiscussionThe results of our survey demonstrate that most Canadianuniversity programs do not follow their graduates in asystematic fashion, and data collected by relevant na-tional organizations is limited. While RTC/STIHRs col-lected information on positions held by their graduates,there has been no reported examination of whether thosegraduates make full use of their training, or whether it hasequipped them with relevant skills. There were also con-siderable challenges in comparing data across programsdue to differences in definitions of participating students,as well as strategies and time frames for data collection.While a midterm review in 2008 reported that the RTCswere valued by both students and decision-makers, therewere concerns about the quality of RTC’s tracking data[17]. A final evaluation of the RTCs has been commis-sioned, although at the time of writing of this paper, it hadnot yet been released.Combining our survey results with the informationcollected by CAHSPR and CIHR, it is clear that therehas been growth in HSPR training over the past decade,with a minority of trainees moving on to academic ca-reers. However, much remains unknown about gradu-ates’ career experiences and trajectories. As universities,funding bodies, government agencies, and research orga-nizations have all played roles in the development ofHSPR capacity in Canada and internationally, they alsohave roles to play in collecting information to informthis issue, and taking steps to ensure human resourcecapacity and research infrastructure are aligned.Data on graduate employment would be useful to uni-versity departments and training programs as a tool forevaluating the quality of their programs and identifyingopportunities for improvement. More specifically, thesedata could provide information on whether programsequip trainees with core competencies that match futurecareer requirements [18]. Commenting on the scientificcommunity more broadly, Kennedy et al. [6] suggestuniversity departments give applicants a detailed accountof the placement histories of recent graduates. As ourresults show, no departments surveyed currently possessthis information. More careful tracking of graduates is anecessary first step. Research funders also have a role toplay, ensuring that investments in human resource cap-acity are matched with support for research infrastruc-ture, and ensuring that available support is balancedover the course of research careers. Support for new in-vestigators has been identified as one possible gap incurrent career support funding [12]. While academic in-stitutions are responsible for hiring faculty positions,models to support research infrastructure outside of theacademic environment should also be explored.Various factors may contribute to demand for HSPRand a need for growth in the field. In the US, demand forHSPR is expected to grow with large short-term fundingincreases resulting from the recent economic stimulusand health care reforms [9,19]. Expanding health dataavailability and complexity, the need for faster and moreefficient knowledge translation, and pressures to cut costsin the health system may also continue to drive demand[7]. In Europe, the European Commission has funded‘HSR Europe’ to identify research priorities in health ser-vices research, build health services research capacity,organize the health services research community, and de-fine the relationship between research and policy [2]. Itis also important to recognize that HSPR funding is im-balanced across countries, with low income countries fur-ther challenged by weak institutional capacity and a lack ofcritical mass within institutions [20]. Canada, and otherhigh-income countries, may have a role to play in the de-velopment of the field internationally, in order to maximizeglobal health system improvement [4].Grudniewicz et al. Health Research Policy and Systems 2014, 12:9 Page 5 of 7 these forces may justify continued growth inCanada, to date, there is little information on current re-search capacity, let alone predictions of future needs.Better evidence will help to determine if continued in-vestment in human resource development is warranted,or if resources could be better spent elsewhere in orderto fulfill the objective of supporting high-quality, rele-vant research. Approaches to studying research capacitymay be adapted from other jurisdictions to provideneeded information on current research capacity and fu-ture needs specific to Canada [8,21,22].Finally, we note that our study faces limitations inher-ent to self-report surveys. Though self-report surveysare not the ideal method of data collection, no otherdata was available to triangulate our results, and we be-lieve this study is an important first step in understand-ing capacity development in Canada and identifying alack of data collection on HSPR trainees.ConclusionsOver the past few decades, significant investments havebeen made to increase HSPR capacity worldwide, particu-larly in the area of training. Evidence suggests we nowhave many young, highly-trained students and new gradu-ates. We know little, however, about the career trajectoriesof these students when they complete their advanced de-grees. In Canada, university departments, training centers,and health research funders are only minimally engagedin student follow-up. A concerted and systematic, longi-tudinal effort to build a stronger knowledge base aboutHSPR capacity development is needed to inform futureinvestment.Additional fileAdditional file 1: List of programs offering graduate HSPR training.AbbreviationsCADRE: Capacity for Applied and Developmental Research and EvaluationProgram; CAHSPR: Canadian Association for Health Services and PolicyResearch; CIHR: Canadian Institutes of Health Research; HSPR: Health systemsand policy research; HSR: Health services research; RTCs: Regional trainingcenters; STIHR: Strategic training in health research.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsAG conducted a review of the literature, drafted sections of the manuscript,commented on successive drafts, and prepared the final version. LHidentified survey participants, drafted sections of the manuscript, andcommented on successive drafts. SK collected and analyzed survey data, andcommented on successive drafts. RL collected data from CIHR and CAHSPR,drafted sections of the manuscript, and commented on successive drafts.MM drafted sections of the manuscript and commented on successivedrafts. SS collected and analyzed survey data, drafted sections of themanuscript, and commented on successive drafts. All authors contributed tothe design of the study, conception of the manuscript, and approval of thefinal version.Authors’ informationThe Canadian Association for Health Services and Policy Research (CAHSPR)Student Working Group contributing members (in alphabetical order): AgnesGrudniewicz, Institute of Health Policy, Management and Evaluation,University of Toronto & Li Ka Shing Knowledge Institute, St. Michael’sHospital, Toronto, Canada. Lindsay Hedden, MSc, BSc (hons), Canadian HealthHuman Resources Network and Centre for Health Services and PolicyResearch, University of British Columbia, Vancouver, Canada. Seija Kromm,MA, BA (hons), BSc, Institute of Health Policy, Management and Evaluation,University of Toronto, Toronto, Canada. Ruth Lavergne, MSc, BSc (hons),Centre for Health Services and Policy Research, University of British Columbia,Vancouver, Canada. Matthew Menear, MSc, BSc (hons), School of PublicHealth, Research Centre of the Centre hospitalier de l’Universté de Montréal,University of Montreal, Montreal, Canada. Saskia Sivananthan, MSc, BSc,Centre for Health Services and Policy Research, University of British Columbia,Vancouver, Canada.AcknowledgementsAuthors are listed alphabetically and should be considered co-first authors.Author details1Institute of Health Policy, Management and Evaluation, University ofToronto, Health Sciences Building, 155 College Street, Suite 425, Toronto,Ontario M5T 3M6, Canada. 2Li Ka Shing Knowledge Institute, St. Michael’sHospital, 209 Victoria Street, Toronto, Ontario M5B 1V8, Canada. 3UBC Centrefor Health Services and Policy Research, 201 - 2206 East Mall, Vancouver,British Columbia V6T 1Z3, Canada. 4Canadian Health Human ResourcesNetwork, University of Ottawa – Institute of Population Health, 1 Stewart St,Room 227, Ottawa, Ontario K1H 8M5, Canada. 5School of Public Health,Research Centre of the Centre Hospitalier de l’Universté de Montréal,University of Montreal, 7101, avenue du Parc, 3rd floor, Montreal, QuebecH3N 1X9, Canada.Received: 10 September 2013 Accepted: 20 January 2014Published: 7 February 2014References1. 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Pittman P: Health services research in 2020: data and methods needs forthe future. Health Serv Res 2010, 45(5 Pt 2):1431–1441.doi:10.1186/1478-4505-12-9Cite this article as: Grudniewicz et al.: Capacity development in healthsystems and policy research: a survey of the Canadian context. HealthResearch Policy and Systems 2014 12:9.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at et al. Health Research Policy and Systems 2014, 12:9 Page 7 of 7


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