Wednesday, September 2, 2009

Lynne Garner on "Dealing with Scale"

A short while ago, Geoffrey Canada, President and CEO of the Harlem Children’s Zone, the award-winning comprehensive program of health, parenting and educational services, was on NPR’s Talk of the Nation, and he said something that caught my ear. Mr. Canada explained that before its founding he had been working in programs that served 100 or 200 children at a time. It was important work but didn’t come close to meeting the needs of the thousands of children that could benefit from those services. He said “dealing with scale is one of the issues we need to tackle in this nation.” A short while later, in discussing the inspiration for the Harlem Children’s Zone, he said it was “not some kind of a brilliant Eureka” but rather putting into place what is already known to be effective in a way that works.

These two issues – implementing what we already know to be effective and doing so on a scale to benefit many people – are two of the biggest challenges to creating benefit through research. After considering our own history of grantmaking and listening to the experience of others, it’s clear that there are at least three interrelated conditions at the source of this difficulty.
  • There’s lot of money for research but precious little to implement research findings.
  • It’s nobody’s “job.”
  • Most research is done in academic centers, whose incentives work against developing an idea far enough along for the findings to be put into a useable “product.”

Because these conditions are larger than Donaghue can change on its own, we are looking for opportunities to work with other funders. And although we aren’t spending a lot on new grants now, we are working to shape our grantmaking programs to be more focused on these issues. Maybe this involves starting with those who have the health care problems and then looking for research-based solutions. Maybe the research team should be a partnership with those who are ultimately the end users. And maybe, like Geoffrey Canada and the Harlem Children’s Zone, we need to be willing to stick with one issue for several years in order to make real change.

But this is only my take on the topic – what’s yours?

Lynne Garner is Trustee and President of the Donaghue Foundation

1 comment:

  1. As an RN for 38 years- my opinion follows. There are several areas of Evidence Based care that will always need addressed. Prevention of infection in wounds and vascular devices, skin breakdown, wound care, bladder control issues, medications, and other patient safety issues. The cost of followup and related issues are real to most nurses. Information is needed to be available in all healthcare settings and shared.
    Newest reimbursement issues - "Never Events" - just Goggle that one!
    Patient Safety and Quality: An Evidence-Based Handbook for Nurses 3 vol. - amazing resource- Can we get all in healthcare to use as a reference?
    One of my goals was always patient safety and comfort.