Developing Canada's clinical research capacity and relevance: Change management issues

Introduction: Despite significant investments in clinical research over the years, the pandemic illustrated Canada's limited ability to rapidly deploy research programs that could have generated immediately useful policy and health care information. This qualitative study aimed to identify the barriers, facilitators, and possible solutions to strengthen Canada's practice-changing clinical research enterprise (or ecosystem). Methods: Through purposive sampling, stakeholders representing various perspectives on Canada's clinical research ecosystem engaged in semi-structured interviews. We continued to gather stakeholders until reaching data sufficiency. The collected information was coded and analyzed using QDA Miner based on Lewin's force field framework. Results: Thirteen participants identified four main driving forces—dynamic scientific community, involvement of patients and clinicians, innovation capacity, and research champions—and six barriers—legal, ethical, data access, administrative inefficiencies, protectionism and regionalism, and lack of incentives—that they believe explain the current state of clinical research across the country. In light of these barriers and facilitators, they proposed six strategies to fully realize Canada's clinical research potential: nationalization of the research infrastructure, prioritization of the portfolio, enhancement of representativeness, investment in health and scientific literacy, promotion of a cultural shift, and development of human resources for research. The proposed solutions require a degree of consensus and enhanced coordination among different levels of government. Discussion: Given the numerous barriers and perceived constraints, meaningful changes to facilitate the implementation of practice-changing research within a learning health system in Canada will require both policy and cultural changes, which will also necessitate broad stakeholder support.