Top level navigation

Breadcrumb to current page

Main content

Rapporteur report

Dr Tony Holohan

30 January 2017

Health research into practice: complexity that needs participation

Watch Dr Holohan's presentation on You Tube at the link below

Quick summary: 

  • Bringing health research into practice is complex 
  • Healthcare delivery is a key area for research, and requires active participation from providers and patients
  • Healthy Ireland provides a framework for engagement and its surveys will fuel research
  • Technology can enable healthcare but needs evidence to support it 
  • Patient safety requires a culture of listening to patients, and gathering and using information to minimise risk. 

Putting health research and evidence into practice is a complex task, and requires us to have wide engagement and vision across the health system. That was the standout message from a keynote address delivered by Dr Tony Holohan, Chief Medical Officer of the Department of Health at the HRB 30 Conference in Dublin Castle.

‘Medical and healthcare progress is linked to a strong health research community’, said Dr Holonan. ‘Nevertheless, the traditional model of laboratory to bedside to patient to population in a linear fashion seems limited. A wider appreciation of health and the factors that influence it such as social determinants, which go way beyond the reach of traditional healthcare, is needed’. 

Research into practice: water into limestone

The notion that scientific research moves in a linear fashion to impact practice is unusual in the ‘real world’ of policy making, noted Dr Holohan, who compared the process to water falling on limestone:

‘It is absorbed but there is no way of knowing what route it will follow through the stone or where it will come out’, he said.   Instead, we need to look at a model of ‘enlightenment’ where information is exchanged and challenged, where knowledge accumulates and infiltrates thinking and research has a cumulative effect rather than immediate and direct influence on public policy.

Dr Holohan also emphasised how the process of healthcare delivery is a key area for research, and that bringing about change is complex and requires all involved to play an active role. 

‘Implementation is a social process that is difficult and slow and demands collective action’, he said. ‘[It] is essential that all participants in the health system work together to create a culture of research throughout our health services and to ensure that it can absorb and apply research results and innovations’.

A systemic approach to a healthier Ireland  

A truly systematic, life course approach to health starts at or before birth and continues throughout the life course, Dr Holohan told the conference. Dr Holohan stressed that protecting, promoting and improving the health of the population need a cross-sectoral approach, and he described how the Healthy Ireland initiative driven by the Department of Health provides architecture for engagement across Government departments and with the whole of society.

Healthy Ireland now conducts an annual survey and we will soon have a final Outcomes Framework to measure and monitor not only health outcomes but also the key determinants of health in a more integrated way, he added.

‘In keeping with the Government’s Open Data policy, we make the anonymised data from the Survey available for further and more in-depth analyses by interested researchers, so that we - and by we I mean you [the audience]- can further explore and understand the many relationships between health determinants and behaviours, and personal and environmental characteristics’. 

Evidence for tech 

Good healthcare practice and outcomes need the timely flow of information, and recent years have seen a ‘wave of innovation’ in technology that can support healthcare. ‘Technological advances have revolutionised the practice of medicine, made commonplace interventions that were high risk, saved lives, and supported a significant increase life expectancy’, he said. ‘These are major achievements in anyone’s language’. 

But again it is a complex environment and we need evidence to support technology and its application, noted Dr Holohan: 

‘Over the next three years, we plan to review and develop the decision-making processes which support policy development and prioritisation in a number of key areas, including for example, immunisation policy, screening and other population based preventive programmes, policies relating to the use of blood, organs and other tissues, health promotion and improvement guidelines, for example exercise, healthy eating, alcohol consumption and the use of medications - new and existing’. 

Patient safety 

Patient safety was another area of focus in Dr Holohan’s speech – he described how there is inherent risk in the delivery of healthcare and the risk cannot be fully eliminated. 

‘The science is not perfect, the technology is not perfect, the people are not perfect and the systems are not perfect’, he said. ‘In hospitals, alone, preventable adverse events may kill more than 400,000 people per year in the US….In Ireland, a number of high-profile cases, in relation to blood-borne virus transmission, vaginal hysterectomy and breast cancer, and other high profile cases relating to patient safety have impacted on society’s trust. In more recent times, concern has focused on maternity services’. 

We must strive to develop a culture where we profile risks to patient safety, learn lessons and apply those learnings to minimise reoccurrence, he stressed. 

Building intelligence and knowledge through ‘patient safety surveillance’ would open up new understandings and insights and guide research in the area, he noted. ‘We can no longer leave the definition of quality and safety and what matters to patients only to professionals. We have to listen to patients’, said Dr Holohan. 

‘The Department, HIQA and the HSE will jointly establish the First National Patient Experience survey in 2017.  For the first time, we will get a broad input from patients that will inform planning and delivery of a better health service’.      

Search the HRB website

Other information and links