Interview with Prof. Sabina De Geest

Sabina, in the new Shanghai Ranking Nursing Science in Basel is ranked 23^rd/300 and the Department Public Health 32^nd/500, putting them both at the top of the Swiss Universities and nursing science even in the top 10 in Europe. Congratulations to the whole team for this great result!

Thank you! I would like to acknowledge the research teams for these rankings. The interdisciplinary collaboration, team spirit, shared vision and common strategy have been instrumental in achieving this result.

Can you tell us a bit more about your current research?

The Institute of Nursing Science’s (INS) research portfolio includes three main topics: Patient Safety and Quality of Care, Innovative Care Models and Genomics in Nursing. 

We strive to develop real world solutions for real world problems. Therefore, we increasingly apply implementation science methods in our research projects. We start from the observation that there is substantial research waste: only 1/3 of evidence is ever implemented, and it takes a mean estimated time of 17 years^1,2,3 before evidence is implemented. Therefore, methodologies that make the transition from the trial to the real world faster and more effective are crucial. Implementation science combines rigorous effectiveness evaluation methodologies with contextual analysis, involvement of stakeholders (e.g., patients and families, public authorities, health insurers), and strategies for implementing, then evaluating changes (e.g., acceptability, feasibility and sustainability) and their outcomes.

This implies the use of more complex and mixed or multiple method designs (e.g., stepped wedge). The INS’s three flagship implementation science projects are INSPIRE, INTERCARE and SMILe. INSPIRE is a multi-phase project involving all partners of the interdisciplinary Department of Public Health. Its aim is to develop, implement and evaluate a community-based care program for senior citizens in the Canton of Baselland. INTERCARE implements and evaluates a nurse-led care model to reduce avoidable hospitalizations in Swiss nursing home residents. In the SMILe project, we focus on an integrated model of care for stem cell transplants facilitated by eHealth.

You just acquired a Marie Curie Innovative Training Networks (ITN) Grant together with the University of Leuven (Belgium) and other international partners. This is a highly competitive scheme with an average success rate of only 7.5%. Has the implementation science approach made the difference?

The Marie Curie ITN’s aim is to ready a new generation of creative, entrepreneurial and innovative researchers to face current and future challenges. The TRANS-SENIOR project (Tranitional Care Innovation in Seniors) focuses on training health care innovators to influence care for seniors across various settings. Of the 13 PhD positions involved, two will be here at UNIBAS. And yes, the proposal has a strong implementation science focus. Apparently, the evaluation panelists were swayed by our holistic, value-creating approach. The "Impact” section of our application achieved a very high score, as it conveyed our ultimate goal of spurring innovations that fit real life settings.

The TRANS-SENIOR training program⁴ includes many elements previously developed and implemented in the UNIBAS PhD Program² in the Health Sciences (PPHS), the Faculty of Medicine’s interdisciplinary PhD program developed under the leadership of the Department of Public Health. PPHS provided us with an excellent conceptual and strategic foundation upon which to develop our TRANS-SENIOR proposal. DPH is also looking forward to get further PhD students from around the world, funded through the GlobalP3HS PhD program  of the Swiss School of Public Health (SSPH+). This competitive program – funded by a Marie Slodowska Curie Grant as well - will bring 50 PhD students to Switzerland and with DPH being the largest constituency of SSPH+ we are confident to win some students through this competitive program.

PPHS is an example of an interdisciplinary PhD program conceptualized following international (e.g., EU, ORPHEUS, LERU) guidelines and adapted to the Basel setting. Its strength is that, as a single platform serving a number of health science disciplines in the Faculty of Medicine (i.e., economy of scale), it facilitates interdisciplinary exchange: rather than being isolated in individual scientific silos, PhD students can mingle and share ideas across departmental boundaries. They are also encouraged to attend top-level courses that deal with topic specific content while building transferable skills (also in collaboration with the University of Basel's Graduate Center GRACE). All of this prepares them to think and work as innovators, whether in academic or non-academic settings. Having received excellent evaluations from the students, PPHS is currently being developed further in a health sciences graduate school under the leadership of Professor Dr Nino Künzli of Swiss TPH and the Department of Public Health.

Implementation Science seems to correspond exactly to the goals pursued with the Top Down "Societal Challenges" Pillar under Horizon2020. This approach is likely to be further intensified under the next EU Research Framework Programme, Horizon Europe. So you are very well positioned for grants in these programs. But how do you establish these institutional contacts? How did this work for INSPIRE, for example?

Indeed, funding agencies such as the EU Research Framework Programs increasingly favor implementation science approaches. For INSPIRE I was contacted directly by the Baselland cantonal government, as they were searching for support in the development of their senior citizen care model. As a canton, Baselland has the second fastest growing aged population (after Ticino) in Switzerland. This presents a major challenge for the health care system, at least partly because Baselland has a mix of rural and urban areas that require contextually adapted solutions for community based elderly care. Recognizing this challenge, the cantonal government has taken legislative action with its “Altersbetreuungs und Pflegegesetz – APG), which was launched early this year. At their request, the Department of Public Health is supporting Canton of Baselland to develop, implement and evaluate their innovative care model for community based senior citizen care.

Once again, this project will employ implementation science methods. For example, stakeholder involvement in INSPIRE is already outstanding, as we work closely with stakeholder groups for the development, implementation and evaluation of an innovative care model. In fact, the entire project is made possible by the Department of Public Health's capacity to combine competencies in health economics, social sciences, big data analysis and geospatial modeling as part of this implementation science project. Given that implementation science and, more broadly spoken, all health sciences ultimately need large data from reference populations, Uni Basel can be most supportive in supporting the successful move of Swiss health scientists, under the lead of Prof. Nicole Probst-Hensch from Swiss TPH and our Department of Public Health, to embark on a population-based long-term study involving some 100-200’000 participants and the related biobank. Such studies are of fundamental relevance for personalized health sciences.

Can you imagine the "implementation science" approach being applied to other research areas? And can the university help to promote this development?

Implementation science is relevant to all scientific fields that work towards innovative solutions for pressing societal issues. In addition to health sciences, this can include projects in bioengineering, environmental sciences, or numerous other fields, including social sciences. Wherever it is used, implementation science offers a structure for reducing research waste by fueling early translation of high-level evidence to real world settings. Since the Lancet’s 2014 reports on the topic, research waste has received increasing attention. It can be reduced via robust, appropriately chosen research methods as well as accurate reporting of research findings.

Here at Unibas, the Clinical Trial Unit of the Faculty of Medicine’s Clinical Research Department does excellent work to support clinical researchers to develop strong research proposals, then to conduct and publish their research. This level of support is central to the reduction of research waste. Even here, though, the translation of evidence to real life settings remains a major challenge. This is where implementation science is necessary.

Researchers need to expand their competencies regarding implementation science methods. Beginning with a firm basis in quantitative, qualitative and mixed methods clinical research methodologies, performing contextual analyses, involving stakeholders meaningfully throughout the research cycle, using relevant implementation strategies and finally evaluating implementation and hard outcomes are all crucial steps to extract real benefits from research. To this end, the INS offers a summer course to prepare nursing and other health scientists in implementation science methods. In the future, it might also be valuable to add an interdisciplinary implementation science course to the PhD course offerings. 

Implementation science methods represent a mind set in research in which the ultimate goal is to develop evidence for innovative solutions that are successfully implemented in real world settings. This long-term focus makes the scientific enterprise more relevant for the broad public. Evidence that ends on the bookshelf, even in top-ranked journals, provides a very slim return on the substantial investments of time, knowledge and funding necessary for their production. In addition to each journal’s Impact Factor (IF), then, it might be useful to introduce a Real World Impact factor (RWIF) to express each research program’s value to society as a whole. In fact, the Research Excellence Framework in the UK includes ‘impact’ as one criterion to assess the performance of universities.

Last but not least: How satisfied are you with the university administration? And what can we do at the Grants Office to support you even better?

We very much appreciate the tremendous assistance we receive from the various units of the UNIBAS Rectorate. In addition to their support in identifying grant opportunities (e.g., the Research Professional website, they help us navigate the grant submission process, develop consortium agreements & contracts, manage our IP systems and coordinate our PhD programs. The Grants Office has recently been especially helpful in clarifying certain ambiguities regarding collaborative projects such as our Marie Curie ITN. This all fits well with a continuous exchange between the University’s researchers and its research support systems, encouraging both a mutual understanding of researchers’ needs and a continuous evolution of the support processes. Moreover, further improvement in research infrastructure and support can be achieved by observing ‘positive deviants’ within the Basel setting (e.g., the Swiss TPH). Nationally or internationally, I have observed how a strong, strategically developed research infrastructure can truly enhance the output, ranking and real world impact of research institutions even with limited resources. It is only through strong collaborative efforts at all levels that this can be realized.

We'll take that to heart. That was a great interview with many inspirations, dear Sabina. We wish the Institute of Nursing Science and the Department Public Health continued success and look forward to further cooperation.