From Insights to Action: Enhancing Clinical Research at The Ottawa Hospital through a Mixed-Methods Improvement Project

Abstract

The Ottawa Hospital—one of Canada’s largest academic health sciences centres—and its research arm, the Ottawa Hospital Research Institute, undertook a comprehensive review of the hospital’s clinical research ecosystem in 2022 to identify systemic challenges and opportunities to better integrate clinical research within hospital operations and patient care. Interest holders were engaged through qualitative interviews and pre- and post-review quantitative surveys. Barriers identified included limited funding access, lack of protected research time, fragmented technology infrastructure, inconsistent support for non-physician researchers, and limited access to patients for research purposes. Findings informed an action plan comprising over 30 initiatives under four strategic goals: strengthening infrastructure, building capacity and culture, enhancing patient access to research opportunities, and streamlining governance. Progress was evaluated by the 2025 post-review survey data. This performance improvement project offers a replicable roadmap and framework for healthcare and research centres seeking to build a supportive, collaborative, and patient-centred research environment.

Introduction

By definition, academic hospitals have a responsibility to advance evidence-based care, improve practice, and enable innovation through clinical research. Strong clinical research programs improve patient experience and outcomes, enable the recruitment and retention of top talent, and drive economic growth. ¹ While Canada is a global leader in the application of research to add value to health systems,^2,3 the challenges of integrating clinical research within hospital operations are widespread in academic health centres globally.^1,4–11 These include scarce and competitive funding,^5–9 a lack of protected research time for clinicians,^5–7 cumbersome administrative and ethics processes,^4,10,11 and fragmented technology infrastructure.^6–9 While frequently acknowledged, these issues are addressed in isolation; sustainable solutions require a move beyond isolated fixes to a coordinated, system-level approach. At The Ottawa Hospital (TOH), despite a long-standing commitment to research, leadership identified a need to better understand and strengthen its research infrastructure, culture, and integration with patient care. In response, a Clinical Research Review Committee was established to identify challenges, enablers, and actionable strategies to enhance the institution’s clinical research capacity and impact.

Methods

A mixed-methods approach guided this initiative. To ensure the action plan was grounded in diverse perspectives, interest holders’ groups included researchers, physicians, nurses, allied health professionals, clerks, administrators, hospital leaders, and patient/family advisors.

Qualitative Component

In early 2022, semi-structured interviews were conducted with 23 participants from TOH departments, the Ottawa Hospital Research Institute (OHRI), and patient advisory groups. Interview questions explored enablers, challenges, and opportunities for improvement. Thematic analysis was conducted using NVivo, with codes generated inductively. Rigour was maintained through iterative discussions among team members.

Quantitative Component

A structured survey assessing 10 domains of the research ecosystem was distributed at baseline in 2022 (n = 159) and in a follow-up in 2025 (n = 65). Domains included strength and weaknesses in clinical research at TOH, funding and finances, administrative support, research knowledge and training, research culture, staff roles and responsibilities, facilities and equipment, data and information technology, and governance and oversight. Descriptive statistics and comparative analyses were used to track changes over time. The quantitative survey component of this project served as one part of a broader, ongoing evaluation strategy. Its primary purpose was exploratory, to validate findings from qualitative findings and to provide a longitudinal snapshot of interest holders’ perceptions. Consequently, the survey was not powered or structured to definitively measure the causal impact of individual initiatives. This limitation was addressed through complementary operational data and the development of targeted Key Performance Indicators (KPIs) for the new initiatives developed through the action plan.

Findings

Qualitative Findings

Eight core themes were identified:

1. Challenges and Barriers to Clinical Research: Participants identified several key barriers, including limited access to internal funding (especially for non-physician researchers), lack of protected time for research, inconsistent research support across departments, and substantial administrative burden related to financing, billing, ethics and regulatory submissions, and study monitoring.

2. Technology: Participants noted that Epic, TOH’s Electronic Medical Record (EMR) system, had significant potential, but this was offset by its complexity and lack of ongoing support. Institutional restrictions on alternative data management platforms, such as REDCap, hampered multi-site research.

3. Collaboration and Communication: Research collaboration often depended on personal networks rather than formal structures. Some departments, such as Radiology, were more actively engaged in research due to the presence of established processes and support systems.

4. Research Culture and Mission Awareness: Research was not consistently viewed as part of TOH’s core mission. It was often perceived as an added burden among clinical staff (i.e., nurses).

5. Research Conduct: Ethical and regulatory processes were seen as overly bureaucratic and time-consuming. Positive experiences were linked to strong individual support (e.g., OHRI facilitators).

6. Recruitment and Access to Patients: The “permission to contact” process, along with inconsistent staff practices in approaching patients for research participation, limited patient access to active studies and hindered recruitment effort.

7. Patient Experience: Patients expressed interest in participating in research, motivated by altruism and the prospect of improved care. However, they felt inadequately informed about available research opportunities and rarely received feedback about the studies they contributed to.

8. Institutional Comparison: Participants recognized that all academic centres face similar challenges, while also identifying models that have been successful elsewhere (e.g., centralized research support, more funding, and stronger research cultures).

The interview questions and detailed results of the qualitative analyses are available upon request.

Quantitative Findings

Data analysis compared baseline and follow-up responses to assess changes over time.

Baseline survey results aligned with themes identified through the qualitative interviews. Follow-up data in 2025 revealed improvements in mentorship and coaching, information technology systems and data management, visibility and availability of research funding (particularly for non-physician staff), opportunities for professional growth in research, and a clearer understanding of staff roles and responsibilities. Persistent issues included administrative inefficiencies in ethics and regulatory processes. Despite broad agreement that research “should be part of patient care” and “enhances care,” it remained perceived as a “burden” by non-research staff (i.e., nursing staff). Moreover, there remained a lack of awareness among staff that research is a core component of TOH’s mission.

The survey questionnaire and detailed results of the quantitative analyses are available upon request.

Action Plan and Key Achievements (2022-2024)

Informed by the qualitative and quantitative findings from our institutional review, over 30 targeted initiatives were developed under four strategic goals.

Goal 1: Strengthen Research Infrastructure and Integration

Over $6 million in matched funding was made available to incentivize clinical departments to contribute to funding research. Two new roles, Clinical Research Liaison and Clinical Research Navigator, were established to support the administrative aspects of research. A dynamic listing of active clinical trials was launched on the OHRI web site and across disease-specific pages, improving accessibility for both clinicians and patients. Social media presence was expanded, elevating the visibility of ongoing research and showcasing success stories. When it comes to technology, EMR functionality was expanded to better support research workflows, and enhanced analytic platforms (e.g., Cosmos and Nebula) have been introduced to facilitate multi-centre collaboration and provide cognitive computing capability.

Survey findings suggest a meaningful shift in how researchers perceive research funding access and support. Perceived strength in research funding opportunities increased over the evaluation period. For example, awareness and visibility of TOH funding opportunities rose from 28% to 35%, while perceptions of funding-related weaknesses slightly declined. Confidence in knowing where to seek funding support grew notably, from 53% to 72%. Also, perceptions of support for grant writing improved, with agreement rising modestly from 25% to 32%.

On the technology front, access to supportive data systems (e.g., REDCap) improved significantly, with satisfaction rising from 58% to 74%. Perceptions of Epic also shifted positively: agreement that Epic is useful for research increased from 36% to 62%, along with greater trust in its accuracy and recognition of its potential to support new research opportunities.

Goal 2: Build Capacity and Culture across the Organization

To build research capacity and cultivate a supportive culture, a Research Community of Practice for health professionals was launched in 2024. Clinical Research Week was hosted with accessible, recorded training sessions to broaden staff engagement. TOH also developed grant opportunities to support non-physician-led research, increasing inclusivity and innovation in its research enterprise.

Survey data revealed encouraging shifts in training, mentorship, and access to research knowledge. Perceived strength in research training and mentorship saw a modest but positive increase, rising from 60% to 65%. Notably, staff reported significantly improved access to expertise within TOH and OHRI, with agreement jumping from 73% to 89%. More staff also indicated that they had access to mentors and relevant training opportunities—key indicators of growing institutional support for professional development in research.

Despite these gains, challenges persist in research culture. Agreement that research is viewed as a burden by non-research staff rose slightly, from 78% to 83%. Also, a substantial number of respondents (71% increasing to 80%) still perceived research as being outside the formal scope of clinical staff. These findings highlight the need for continued work in normalizing research as a core function of clinical practice. Nonetheless, belief in the value of research remained strong: the proportion of staff who agreed that research enhances patient care rose from 95% to 98%, and nearly all respondents continued to support the idea that research should be part of patient care (rising from 98% to a unanimous 100%).

Moreover, there was improvement in clarity surrounding roles and responsibilities—reflected in a decline from 56% to 46% of staff agreeing that roles in clinical departments are unclear.

Goal 3: Enhance Patient Recruitment and Experience

TOH revised the “Permission to Contact” (PTC) process and implemented updated protocols for obtaining consent to be contacted for research both in person and by telephone, in collaboration with the legal team and in alignment with local privacy laws. These changes aimed to promote more consistent and equitable patient access to research opportunities. Staff received updated training on respectful and inclusive recruitment practices. Members of the Patient and Family Engagement Program at TOH actively contributed to the development of these protocols, ensuring that patient perspectives remained central. In addition, research messaging was integrated into the hospital’s secure on-line patient portal (i.e., MyChart), allowing patients to receive targeted information about relevant clinical trials. Operational data collected after implementation demonstrate meaningful improvements: the proportion of patients providing permission to be contacted for research increased from 38% in 2022 to 48% in 2025.

While these initiatives represent significant progress, survey responses reflected broader concerns about privacy-related barriers to recruitment. Agreement with the general statement that privacy requirements hinder patient recruitment rose from 41% to 54%. It is important to note, however, that this was a broadly worded survey item and does not necessarily reflect the impact of the targeted improvements made to the PTC process.

In addition, over the past 3 years, there has been increased awareness and sensitivity around cybersecurity threats and an increase in the number of trials involving artificial intelligence. Both of these factors have contributed to additional ethics and privacy reviews which can lengthen study approval timelines and contribute to the perception of privacy-related barriers to recruitment.

Goal 4: Improve Governance, Oversight, and Administration

In 2024, TOH initiated regional harmonization of research ethics processes through formal agreements with several partner research institutes, with ongoing efforts to include additional institutions. This initiative complemented the adoption of the Clinical Trials Ontario (CTO) Stream platform, which streamlined multi-site ethics submissions and approvals. Internally, departmental approval pathways were revised to minimize delays and support more efficient research start-up.

Despite these improvements, survey results reveal that governance and ethics processes continue to be perceived as significant barriers to research productivity. Agreement that ethics reviews contribute to delays increased markedly—from 68% to 83%—signalling growing frustration with existing review processes. In parallel, fewer respondents found the feedback from Research Ethics Boards (REB) to be helpful, with agreement dropping from 36% to just 20%, and two-thirds of participants expressing active disagreement. These perceptions reflect genuine challenges; however, delays are caused by multiple factors including investigator and sponsor response times. The responsibility for delays is often shared, and the solution will require collaboration and commitment from all interest holders, ethics board, investigators, and sponsors. ⁴

Administrative burden remains a consistent challenge. There was near-unanimous agreement—exceeding 85%—on the need for greater administrative support in key areas such as ethics, finance, and monitoring. Perceptions of inefficiency in billing processes also persisted, with the proportion of staff who found billing to be time-consuming rising from 48% to 54%.

While governance modernization has laid important groundwork, these findings highlight a continued gap between structural changes and the day-to-day experience of researchers. Addressing this disconnect will be critical to reducing friction, improving satisfaction, and ultimately accelerating research progress.

In summary, the follow-up survey results indicate that the comprehensive, multi-faceted strategy has led to meaningful progress in several areas, although some domains have yet to show improvement. Many initiatives are in early stages, and the full impact of the action plan will require ongoing evaluation through future surveys and monitoring metrics. Importantly, the initial survey was conducted to explore and prioritize the themes identified through the interviews and were not specifically designed to measure the pre- and post-impact of the initiatives implemented. For example, they did not include targeted questions about PTC rates, reductions in ethics turnaround times, nursing involvement in research, or the influence of new support roles. Thus, while the follow-up survey provides an important initial indicator of progress, it is not a definitive measure of the action plan’s effectiveness. TOH is now developing specific KPIs tailored to each initiative and has committed to maintaining this project as an ongoing, iterative effort.

Leadership Implications

This initiative highlights how a structured, interest holder-driven approach can catalyze system-level change within complex research ecosystems. Central to its success was the strong commitment and transparency of executive leadership, whose visible support fostered alignment across departments and reinforced research as a core institutional priority. TOH’s model emphasized collaboration among clinicians, researchers, administrators, and patients, ensuring the resulting action plan was firmly grounded in real-world challenges and guided by pragmatic, actionable solutions relevant to the Canadian healthcare context.

While similar challenges and best practices have been documented elsewhere,^1,4–11 TOH’s initiative is distinguished by its intentional focus on inclusivity, particularly by elevating the contributions and leadership of non-physician research activities. This emphasis has helped foster a more diverse and inclusive research culture.

The TOH experience yields five core lessons with direct, replicable recommendations for health leaders seeking to enhance clinical research integration:

1. Lesson: Executive Leadership Is the Keystone.

• Recommendation: Secure and demonstrate active, visible commitment from the highest levels of administration at the hospital and affiliated research institute (Chief Executive Officer, Chief of Staff, Board of Directors). This is non-negotiable for ensuring a shared strategic direction, aligning decision-making, allocating resources, breaking down silos, and signalling that research is a core institutional mission, not an optional add-on.

2. Lesson: Inclusivity Is a Catalyst for Innovation, Relevance, and Impact.

• Recommendation: Intentionally cultivate an inclusive research ecosystem by creating dedicated funding, recognition, and career pathways for all research team members, including nurses, allied health professionals, trainees, and research staff. This unlocks diverse, frontline clinical insights and ensures research addresses a comprehensive range of patient needs. Crucially, move beyond a top-down directive. Co-develop strategic plans with the full spectrum of interest holders (e.g., clinicians, researchers, administrators, and patient partners) to foster ownership, ensure practicality, and pre-emptively identify implementation barriers.

3. Lesson: Diagnosis and Improvement Must Be Continuous and Data-Informed.

• Recommendation: Frame the initiative as a continuous cycle, not a one-time project. Diagnose systemically with a mixed-methods approach and begin with a comprehensive, interest holder-informed review. Use these insights to build the action plan and track progress with specific KPIs (e.g., ethics approval timelines and recruitment rates) to enable iterative, data-driven adaptation of the strategy.

4. Lesson: Patient Partnership Is Fundamental to a Learning Health System.

• Recommendation: Integrate patient partners from the design stage and simplify recruitment pathways by embedding research opportunities into clinical workflows (e.g., patient portals). This ensures research addresses questions that matter to patients and enhances recruitment equity and accessibility. In addition, patients should also be integrated into research priority initiatives and research governance.

5. Lesson: Streamlined Governance Is a Force Multiplier.

• Recommendation: To accelerate research, simultaneously streamline governance and integrate operations. Restructure ethics and administrative processes through digital platforms and regional harmonization to reduce procedural delays. In parallel, invest in bridging roles (e.g., Clinical Research Liaisons and Navigators) and shared technology infrastructure (e.g., integrated EMR tools and data platforms like REDCap) to seamlessly connect research with clinical workflows, reducing project start-up costs and improving investigator satisfaction system-wide.

Conclusion and Next Steps

The Clinical Research Review at TOH presents a replicable framework for academic hospitals aiming to strengthen research as a core pillar of care through comprehensive interest holders’ engagement, mixed-methods evaluation, and co-developed strategies. Ongoing monitoring will evaluate the impact of newly introduced roles and systems. Embedding research into clinical practice requires more than resources; it requires strong and transparent leadership, cultural transformation, operational alignment, continuous evaluation, and unwavering institutional commitment.

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