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Section IV: Other Items Of Interest

Year 5 - International Review Panel Report, 2000-2005
June 2006

Executive Summary¹⁹

Canada has embarked on a bold journey to change its approach to the funding of health research and ultimately to influence its breadth, its quality and its impact on the health of Canadians and the delivery of health care. The creation of the Canadian Institutes of Health Research (CIHR) six years ago was an experiment to establish whether a single agency for health research funding and leadership in Canada could sustain the excellence in Canadian basic and clinical biomedical research but also expand more effectively into areas such as population-based research, health policy research, health services research and research using social sciences and humanities to address important health issues. A successful outcome would be indicated by an expanded capacity and increased output in research reaching into previously undeveloped areas, improved interactions between disciplines undertaking health research, effective knowledge transfer and, most importantly, a retention of excellence in all areas of health research.

The International Review Panel (IRP) was impressed by the progress made in developing a more unified model of health research funding. The capacity to fund research across all health related disciplines has clearly been enhanced and new strategic initiatives have strengthened multidisciplinary research and training. Together, these changes have all occurred in a remarkably short timeframe, evidence of the commitment and success of the management team. The IRP feels now that CIHR should take stock and ensure that it has the necessary governance and management structures in place to further progress its mandate and vision.

A key component of the CIHR vision was a set of virtual Institutes, funded modestly but with responsibility for providing leadership and focus to a range of subjects at a national level. The selection of these Institutes and their leadership has been an important part of the first five years of CIHR development and was a major focus of our review. Also important, however, are the panels responsible for allocating much of the response mode research funding. We have therefore also attempted to consider the current state of the panel system in CIHR.

Our impressions of the CIHR at this moment of its evolution are intended to provide insights into its structure and function that will allow the successful development of this novel vision. The challenges in achieving objective evaluation of the outputs of the CIHR so early in its expansion and transition has led us to make comments on some of the key components of a successful organization, particularly sound governance and management. The success of the CIHR in rapidly implementing many aspects of the new mandate over the last five years has led to a much larger and more diverse organization. The speed at which this transformation has occurred is remarkable and clearly has required extraordinary effort and energy. The CIHR is in our view now at an important inflexion point in its development. New structures need now to be imbedded, transparency in decision making and process is crucial and sound governance becomes increasingly important. We believe that this represents a natural progression in the growth of this new entity but nevertheless a crucial one for the long-term viability of the organization.

We have intentionally avoided interventions around the detailed operational management of the CIHR. We do not believe it is our role to judge the balance of funding priorities, the distribution or the appropriate size of the CIHR budget. The comments we make provide some reassurance that the CIHR model is one well worth pursuing but that crucial aspects of its structure and governance need now to be reconsidered in light of its recent growth and expansion. If addressed, these suggestions will ensure that internal structures in CIHR are accountable and that CIHR remains responsive to the key stakeholders, including the policy-makers and scientific community.

Our review has resulted in the following observations:

• The CIHR is clearly in a state of rapid evolution and has already transformed the face of health research in Canada. Evidence of the benefits of a more strategic approach to health research is apparent and multidisciplinary activity is widespread. Canada is beginning to enter into health research activities that have been previously inadequately resourced and underdeveloped.
• The CIHR has clearly made progress in delivering leadership in the Canadian research community fostering collaborations, creating an environment for capacity building, forging an integrated health agenda, creating multidisciplinary Health Research Institutes, developing Knowledge Transfer and a sound ethical environment for research.
• It is too early to make conclusive judgments as to the effectiveness of this model of health research funding based on currently available objective outputs.
• All 13 Institutes appear to be functioning well, providing leadership in their fields and providing a focus for strategic activities. The Scientific Directors are all clearly contributing significantly to the success of the Institutes which are now fulfilling a crucial function in the health research community in Canada.
• Rapid growth, particularly of new strategic initiatives and panels, has led to excessive complexity. This complexity needs now to be reduced to enable opportunities and activities to be both focused and manageable.
• The panel system that is responsible for handling most of the research funding is currently under strain. It requires more academic leadership, and a review of process and structure for this system is necessary.
• A major outstanding challenge for the CIHR and health research in Canada is the apparent lack of coordination at the federal and provincial levels of the many different types and sources for funding for different aspects of health research. Support for infrastructure and research posts are welcome but must be aligned with the operating grants that are necessary to keep the research enterprise running.
• Governance will be crucial in the next phase of CIHR evolution. Accountability and transparency need to be reinforced at all levels of the organization. Governing Council should consider its position as a main board of the organization and the executive team needs expanding and strengthening. A single research committee should be established to account for all research expenditure in the CIHR, and to agree on the balance of strategic and response mode funding in each research area.
• To formally provide scientific leadership across their disciplines, Scientific Directors should now be given oversight of their Institutes and their associated panels. Each should be responsible for ensuring the balance of strategic and response mode funding is appropriate and that the panel system functions more efficiently. It is likely that Scientific Directors (SDs) would participate in a central research committee.
• Rapid growth and the challenges associated with matrix management across the Institutes and Ottawa have created management challenges within the CIHR. The most appropriate structure for handling these issues should be considered after an organizational review.
• Knowledge Transfer (KT) has been accepted as an important part of the CIHR mandate. Progress has already been made in some areas of knowledge translation particularly in infectious disease, public health and some areas of health services research. There remains lack of clarity about the definition of KT across the organization. More attention should be directed at providing leadership in the area of technology commercialization.
• CIHR should increase its emphasis on research in ethics as well as its governance responsibilities to ensure that the research it funds meets the highest ethical standards. Leadership in this area across Canada could come from the CIHR.
• It is important to determine and to collect the objective data for each research activity that needs to be collected to allow an effective review of CIHR activities in the future. In particular, terminal reports from all grant holders would be an essential part of this process. This will be crucial if the next review committee is to provide a judgment on the success of the CIHR model.
• Communication remains an important and challenging activity for the CIHR. The range of potential audiences, including funding partners, provincial and federal governments, universities, health researchers, international agencies and the citizens of Canada, make this particularly challenging. CIHR management needs to consider creative approaches to the utilization of a wide range of communication sources and resources including effective use of electronic and web-based dissemination, and should continue to improve its communication with key stakeholders.

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19. The final full report of the panel was published in June 2006 and is available at http://www.cihr-irsc.gc.ca/e/31680.html. The major findings of the review as well as CIHR's response are referred to in various sections of this report.

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