How has health services research made a difference?

Health services research (HSR) is commonly conceived as an applied discipline whose success is defined by its tangible impact on policy, practice or both. In Canada there has been a concerted effort to engage decision-makers in informing the research agenda. While it is admirable to aspire to practical utility, the HSR community has no control over the ultimate disposition of its work. Furthermore, the conditions for change must be present if the pathway from relevant, high-quality research to application is to be relatively smooth and immediate. In such cases, the changes may have occurred regardless of whether the research to support them took place. An examination of some widely renowned HSR reveals that timely and significant impact is relatively rare. Moreover, research that fundamentally changes how we view the world plays out over decades; it would be impossible to act on it in the short term, and in some cases it is not clear what ought to be done. The implications are that the first duty of HSR is to seek truth, and that funding and decision-making communities should define "useful" broadly, from a longer-term perspective. Taking the wide and the long view will in the end generate a greater return on investment in HSR than focusing too narrowly on contemporary preoccupations.