The Blue Cottage Blog

The Challenge & Promise of Turning Effort into Impact

by on February 21, 2019

Research. Evidence. Action. Earlier this month, I had the opportunity to deliver a keynote in Ireland at the Health Research Board’s (HRB) Grant Holders Conference (link to keynote video is below). HRB’s vision is Healthy people through excellent research and applied knowledge and their mission is To improve people’s health and to enhance healthcare delivery. As a major funder, supporter, and leader in the creation and dissemination of health research in Ireland, HRB supports excellent research to generate relevant knowledge and promote its application in policy and practice.

Four emerging investigators with HRB-funded grants were invited to give 5-7 minute “elevator pitches” designed to provide overviews of their research, covering everything from the problem statement to research design to early findings. All four pitches were thought-provoking, inspiring, challenging, and relevant. Each investigator highlighted her or his project’s potential to drive practical impact on one of more aspects of care delivery. Practical impact is measurable, delivers real benefits to people’s health or communities within months of completion (versus the average of many years), and has potential to transform the healthcare system. At the end of each pitch, the investigators took a question or two from the audience of their peers, along with health managers, clinicians, and policy advocates in the room. Dr. Darrin Morrissey, HRB CEO, closed each of these pitch sessions with a critically important question for each of the emerging investigators: “Are policy makers listening to you?”

Dr. Morrissey’s question really made me think about the effort that all of us put into our work every day. We think it’s important – we hope it matters. But true impact cannot be measured by the creators, developers, designers, and leaders within the system. Value and impact in the healthcare system often relies on a myriad of stakeholders whose attention we need to constantly seek; patients and communities who we need to reach with solutions that matter and programs that provide assistance to the real and daily issues that they face. “Are policy makers listening to you?” is such an important question not only to health researchers in Ireland, but possibly even more so in the United States where policy makers are influenced by lobbyists and corporate interests that have priorities that may or may not align with patient-centered ideals or goals for health system accessibility, affordability, and availability that many of us advocate.

So… are policy makers listening? Are other key stakeholders listening? If not, it may be that our impact isn’t as great as we’d like, or perhaps we need to work harder to ensure widespread knowledge sharing, collaboration, and communication of ideas that work.

In healthcare, many of us still rely on Avedis Donabedian’s pioneering approach to assessing quality of care. We begin with understanding structure, process, and outcome, and dive deep into the intersections and interdependence of all three (along with other factors that have been added to the quality assessment framework since its original publication in 1966). The probability of success of any endeavor to assess, evaluate, improve, innovate, or transform something important is the ability to understand the motivations, interests, hopes, fears, desires, values, and unique attributes of the group that we are trying to impact.

To maximize the impacts of our efforts – whatever they may be – we need to first cultivate a deep understanding of the individuals, communities, or countries (in this case) that we want our transformational and innovative solutions to impact. We have many tools to help us: ethnographic research, quantitative analyses, qualitative methods, strategic inquiry, design thinking, and more. So what else can we do to promote deeper understanding, empathy, and creativity to facilitate a shortening of the path from idea to implementation to impact?

  • Spend quality time with the people, organizations, and communities that we are trying to understand – see them in their own space, authentically, and without pretense or filters.
  • Invite a wider circle of stakeholders to be part of our work processes and be transparent with them about what we are doing, including our understanding of the problem that we are trying to solve (and risk the possibility that they may tell us that it’s the wrong problem).
  • Share the data that we’ve collected and consider allowing others a chance to analyze it or interpret it differently than we did (while following data use agreements and confidentiality rules, of course).
  • Check-in regularly with a group of people assembled to “fact check” and “logic check” our findings and ideas along the way.
  • Prototype solutions and test them on real people and in real communities versus exclusively relying upon proxies, representatives, or personas.
  • Share our observations, learnings, ideas, successes, and failures with a wider audience or a completely different group of people than our norm. Collaborating with new people and working in new environments spurs innovation and creativity because it forces us out of our comfort zone. With heightened awareness, we are able to see things that we otherwise might have missed or apply a new perspective.
  • Finally, ask “Are policy makers listening to us?” If not, take the initiative to engage a wider circle of stakeholders in your work efforts and make sure that open collaboration and information sharing is part of the engagement.

Please add other ideas to the list. And if you have your own story to share, please feel free to do so in the comments on this post!

Sincere thanks to Dr. Morrissey and the HRB for inviting me to join them in exploring these topics and creating opportunities for new collaborations that further both of our efforts to transform healthcare.


  1. For more information on the Health Research Board headquartered in Dublin, Ireland, please visit:
  2. The research investigators who delivered the elevator pitches are: Dr James O’Mahony – Trinity College Dublin, Dr Jane English – University College Cork, Dr John Ferguson -National University of Ireland Galway, and Dr Niamh Humphries – Royal College of Physicians in Ireland. You can watch their pitches here:
  3. For more information on Dr. Avedis Donabedian, do a literature or Google search and you will find plenty. Better yet, go get a master’s at the University of Michigan School of Public Health and you will learn all about Dr. Donabedian and his impact, much of which was made during his years on faculty on there.

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