Table 3

Challenges and Changes for Routine Implementation of 5 R’s

ChallengesChanges to Address Challenges
Accelerating the pace and iterative nature of the research enterprise
Decision-maker needs outpace current speed of review cycles: grant review; funding decision; IRB approval and modification processes
Study implementation time frames
Publication cycles not amenable to “just in time” decisions; slow review and release of findings (see more below on dissemination)
Low priority assigned to designs that can speed research
Harness stakeholder interest in timeliness to drive a cultural shift to shorten what is considered “rapid” or “timely” compared with present custom
Implement a variety of technical changes to research processes already suggested in literature19,21,26,27,54
Use rapid-cycle testing of hypotheses, allowing ineffective ideas to “fail fast” and successful innovations to spread quickly
Link social media with traditional communications vehicles
Expanding limited concepts of rigor (eg, preference for, confidence in, or insistence on certain designs such as RCTs) by:
Funding agencies offering calls for proposals
Grant application reviewers
“Customers” of research (stakeholders who use the findings)
Among all parties, build awareness of and comfort with a broader “palette” of research designs, so that research design is driven by the questions, rather than research questions driven by designs
Use professional meetings/training events to more clearly articulate features, pros/cons of different designs—their appropriate or promising scope of application
Ensuring a blend of research team skills and interests
Skill and interest in stakeholder involvement in generating questions, articulating ultimate use of study findings, study design, implementation, reporting, and dissemination
Awareness of and respect for political as well as scientific concerns of stakeholders such as policy makers
Skill and comfort in building relationships with clinicians and clinics—consultative, cooperative, problem solving
Experience and confidence with the broader “palette” of research designs, including rapid learning in real-world experiments
Propose an enhanced “job description” for research teams—a checklist of skills, interests, and relationships required for specific studies
Beyond essential methodologic, data-gathering, and analytic skills, include “softer” skills and methods such as shown in left column
Build up those skills through examples, conferences, and training among both existing and new researchers
Increasing clinician familiarity with being active research partners
Negative experiences or preconceptions about feasibility or practical value of doing research in the practice
Few or no current relationships with researchers
Unfamiliarity of working with researchers to turn practice concerns and curiosity into researchable questions
Unfamiliarity with building research data gathering into routine clinic systems rather than being an effortful “add on”
Not connecting research with more familiar quality improvement, rapid-cycle learning
Provide examples and assistance through professional venues and practice facilitation or technical assistance that help clinicians and researchers adjust mindset, methods, and interactions to create practical research partnerships along the lines described in the literature15,16,25
Raising priority on collection and reporting on context and resources
Limited researcher and reviewer expectation that data on resource use of interventions or on context information relevant to transportability or reinvention in new settings be gathered systematically or reported
Space limitations and/or customary priorities in journals that reduce additional context and resource data reporting
Adjust research announcements and grant review guidelines to ask for greater reporting on context and resources required; accompany by explanation of why
For publication in limited space, consider other methods such as web supplements to access detailed context and resource use data if not in standard published article
More powerfully bringing publication and dissemination to practical decision making
Limited readiness to publish replications of key findings in original or new contexts or to publish negative results of replication
Reaching those stakeholders who want to make research-based decisions at the time and place decisions are made
Limited dissemination in publications or forms in which stakeholders are already engaged, knowing that different forms of publication/dissemination reach different stakeholders
Publish replications (successful or not) in places where stakeholders will find them
Reward researchers via funding and career paths for key replications, not only for new positive results
Create a stakeholder map—which stakeholders need what information from the study, in what form, and where it is most likely to be read
Create stakeholder-specific versions of core journal publications to increase reach of the information
  • IRB = institutional review board; RCT = randomized controlled trial.