Michael Smith Foundation for Health Research With Bev Holmes

While people in the community have been doing their part to stay home during the COVID-19 pandemic, it is still important to seek health care when necessary. As President & CEO of the Michael Smith Foundation for Health Research (MSFHR), Dr. Bev Holmes is focused on the funding, production, and uptake of health research and healthcare-related evidence in British Columbia. On today’s show, Dr. Holmes is with host Douglas Nelson to discuss the impact of COVID-19, the pandemic response among indigenous people who use drugs, and widespread impacts on BC’s health research capacity and workforce. She shares how concerned she is about the effects of the pandemic on the research community and how the pandemic has really heightened uncertainty for researchers at a critical point in career development.

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Michael Smith Foundation for Health Research With Bev Holmes

On the show, our guest is Bev Holmes. She’s the CEO of the Michael Smith Foundation for Health Research here in British Columbia and we’re pleased to have her on the show. Welcome, Bev.

It’s great to be here, Doug. Thanks for inviting me.

For our audience who may not be entirely familiar with the role of the Michael Smith Foundation for Health Research, tell us what your organization is and what role it plays in health research in our province.

The Michael Smith Foundation for Health Research is BC’s health research funding agency. We’re funded by the provincial government although we’re arms-length from government. We have our own board and there’s an agency like ours in most provinces. We collaborate with each other and federal funders. We’re named after Michael Smith of BC’s first Nobel Laureate 1993 who received the prize for his work in site-directed mutagenesis, which I hope you won’t ask me to explain. Our primary role is research talent development.

We support researchers at all stages of their careers and all types of research from basic lab research and from research that takes place out in the community with stakeholders. Our funding does three things. It frees up the time of researchers so that they can focus on discovery, it gives them a competitive advantage because when they have a Michael Smith Foundation award, they can get other funding more easily, and then it trains the next generation of health researchers because people we fund are also bringing other people into their teams to work. Lastly, I’ll say that we fund through competitions and that’s our niche in a very complex provincial and national research ecosystem.

Through my time at the BC Cancer Foundation and having been involved in philanthropic funding for research for a number of years, your foundation plays an essential role in leveraging the smartest kids in class to take on the most pressing problems in the health system. I’m curious, as health research has come for many of us as a result of the pandemic, you’re sitting right in the middle. You get to see how researchers all across the board are responding to the public health crisis. How did your organization respond?

Isn’t pivot one of the most used words? I have heard that so much but yes we did pivot as well. A couple of different ways. First of all, we were asked to respond by he government. Occasionally, when there is a health emergency, they will ask us to step in and fund specific research. The government gave us $2 million to fund research on COVID-19 for British Colombians. They also asked us with that funding to initiate a strategic research advisory committee. We provide secretariat support for a group that is not overseeing research but they’re looking at the research that has being done in the province and what some of the gaps are.

They’re there to advise researchers and the government. That’s one of the exciting piece of work that we’re doing. Secondly, this is not about COVID but it’s related to COVID. We did our own research because we’re quite concerned about the effects of the pandemic on the research community. Interviews are literature to review a survey about 300 researchers and we want to know about the impact of COVID-19 on their current work and their future plans. Based on that, we’ve done a lot of change in our programs and processes to better support them like extended deadlines, flexible expenses, continuity fund and so on.

What have you learned through doing that work?

We have learned that researchers are keen to study various aspects of the pandemic. Our funny program got a lot of applications and incredibly varied. To give you a few examples, there’s a study at Thompson Rivers University in the Okanagan on how frontline healthcare workers are fairing during the pandemic. There’s mathematical modeling taking place at UVic on the early detection of future waves of COVID-19. At UBC, there’s a study to assess the impact of COVID-19 and the pandemic response among indigenous people who use drugs. The goal of that is to inform a culturally safe response for that population. At SFU, there’s a team using health system data and interviews to understand immigrants’ experiences. It’s a huge range. We’ve also learned from the provincial committee that it’s hard to support and coordinated response to anything in a situation like this.

It’s hard enough at the best of times but we’ve learned a heck of a lot about complexity. In that secondary of the research system due to COVID-19, we’ve learned that the pandemic is having widespread impacts on BC’s health research capacity and workforce. Eighty percent of our survey respondents said the pandemic had a negative impact on their ability to conduct research. Their work is delayed. You’ve read and heard about the lab closures. We’ve got clinician-researchers and we want them to be providing care rather than doing research but that has a knock-on effect. The pandemic has heightened uncertainty for researchers at a critical point in career development. We should care about researcher’s careers because these are the people who are seeking solutions for critical health issues. It’s difficult to turn that work on and off. Lots of learning through the pandemic about a number of things.

Learning about the complexity is an interesting point because a lot of the research you’re funding and coordinating are the most complex issues that all of us face our health. Are there lessons that you’ll take with you from coordinating this response to the pandemic?

All of us have learned what can be achieve when people work together on shared goals which is not to suggest it’s all been easy or that everything’s gone well but you can’t deny that people have been working their hardest to solve problems. The most exciting lesson to me is that those of us who are working in health research system know what needs to be done to improve it. A research system has a definition from the World Health Organization. It’s the people, institutions, and activities that generate high quality knowledge is used to promote, restore, or maintain health. That’s a health research system. Over the last decade, there have been a lot of reports generated on various aspects of the research system.

Some have been acted on but some have not. Those of us working in the system have experienced firsthand why those reports were written in the first place. It’s time to dust them off and address the challenges. I’ll mention a couple of them. There needs to be much better connection between those who produce evidence and those who use evidence, whether patients and the public, governments, clinicians, and health charities. We need to strengthen those mechanisms. Another one is the reward systems for researchers need to be much more closely aligned with the work that they need to do to solve big societal challenges. Researchers are largely rewarded for competing with each other, working on their own, publishing, and getting grants not building relationships with people. That would ideally change.

It’s one of the questions that donors ask. I’m sure, any fundraisers who are reading have had to feel this many times. If I give money to research, why are they so competitive? Why aren’t they sharing the information that they find? How do I know who to give it to if it’s a competition? What advice would you give to the fundraisers? How to respond to donors about that?

You’re bringing up the subject of partners, which is we rely on our partners a lot and that goes back to the whole notion of a system because the Michael Smith Foundation plays a tiny little role in a health research system. We certainly are not going to go to donors and ask them for money to fund something as generic as health research. We rely on our partners who know what their donors want to fund. Our partners are experts in what are the challenges and their specific areas and they’re experts in fundraising. They know they have very meaningful relationships.

What the Michael Smith Foundation can do though is we know how to find and support outstanding researchers in specific areas through our competitions. When researchers apply to the Michael Smith Foundation, they’re having to make a case for the research that they need to do. They’re having to make a case to our peer reviewers that they know that this is an issue, why it’s an issue, and the research isn’t duplicating anything. This goes through a very rigorous peer-review process. We take care of the award administration. That’s why we value our partnerships so much. If we’re co-funding with health charities, we’re all meeting the goals that we need to meet.

From your perspective, what is so appealing about that partnering with health charities? Is it the ability to borrow from their expertise and their resources to extend research?

Resources are certainly part of it but I think you’re onto something with that expertise. Our partners know what the issues are and they have deep relationships. We don’t have those relationships. For our part, it’s how do we run competitions. How do we do the award administration? How do we monitor? There’s leveraging. Both of us are doubling the value of the available research funding, getting recognized for it because our names are both on the award but there’s the connection piece too. We’re offering partners a chance to build relationships with researchers in their field and connecting their stakeholders and donors directly to the research they’re supporting.

It’s a powerful value proposition to a donor but it also means something to the researchers to see that there isn’t an ecosystem or a community that’s coming together to fund their work.

Foundation For Health Research: Researchers are deeply invested in solving problems, and they want to work with the people who understand the problems and who have the problems.

Unfairly sometimes, people see researchers as being almost apart. They have these brilliant ideas. I sometimes hear that people think that it’s an elite group that is well-funded, untouched, and off discovering things. I’ll say I’ve never met a researcher like that. These people are deeply invested in solving problems, they want to work with the people who understand the problems and who have the problems. That connection for the researchers is so important.

You do work with so many health charities that are raising money to support research. Is there any advice that you could share with new partners or potential partners on how they can maximize working with the Michael Smith Foundation?

Every relationship is unique. My encouragement is seek us out and have a conversation. There are certain guidelines that we need to work within and the partners will have those as well but ultimately let’s have a conversation on what the issue is that we’re trying to solve. It goes back to your question about the lessons. The valuable lesson in COVID-19 is the science can be better supported and coordinated. That is a multi-stakeholder effort. That’s not the Michael Smith Foundation knowing exactly how to do this and then telling other people how they can partner with us. That’s a conversation about how we can work together.

It sounds like a very healthy approach to such a complex system.

We welcome those conversations. We enjoy them.

I want to ask a little bit about your board. You’re not an entity of government do receive government funding. How do you select your board members?

We have a governance committee of the board. Their responsibilities will include board succession planning and renewal, processes for identifying vacancies, approaching people and so on. What they’re doing is they’re looking at competencies and sector knowledge. Our board is not representative of organizations. If someone is coming from UBC, they’re not presenting their feedback as a representative of UBC. They’re bringing a perspective. We’re looking for a great number of perspectives. I will say our bylaws do provide for a government member. They appointed a ministry of health member, which is very helpful for us.

I asked that question because there’s a lot to be learned from that the way the Michael Smith Foundation board works. The role of a board member is not to represent the interests of research in a particular area or institution but to provide that perspective on what’s the most important for the health research sector in general. Other than going online, how have the conversations around your board table changed since the start of the pandemic?

I was going to say the table itself has changed. There isn’t one. They’ve become virtual, shorter and we have more frequent meetings. I am very lucky I have a wonderful board. It’s an extremely thoughtful board and they pay a lot of attention ongoing to how involved they should be in what. I would say that because we’re in response mode, we have more conversations about our work, supporting research on COVID-19 and about the research community as affected by COVID-19. We also have some productive conversations on that line between government and operations. I’m asking their advice more than I ever have but they’re also respecting if I want to suggest that something feels operational versus governance. Lots of great lessons learned there.

Can you think of an example or perhaps share a story of how that perspective that you look from your board has come to brought to bear over the course of the pandemic?

From time-to-time, our board has discussions on the split of investments into research that is purely driven by curiosity and discovery, which we absolutely need. In fact, there wouldn’t have been as much progress on pandemic-related research if we didn’t have that basic discovery research. There’s also very important research into decisions that are needed now, as in, “We need evidence on this so that we can make a decision about a policy.”

There’ve been more and more discussions for us on what that balance should be. That’s one of the very fruitful discussions. Another related one is back to that core mandate of talent development. There’s a strong evidence to suggest that the pandemic is compromising the careers of young investigators as well as their perception of science as a profession, which is hugely worrying. What does that mean that we should be doing right now even as we have to respond to a pandemic by supporting that research? Lots of complexity in the discussions but fruitful.

The immediate response that’s required as a result of the pandemic includes looking to the future and what the future of science looks like. That is a contradiction on one level but it’s so important to be able to focus on the here and now and what is to come. I’m curious, we have worked with organizations across the country particularly, in the health charity sector, we’ve seen some boards jump right into the operations willing to volunteer and to answer phones on the switchboard or having comments on how the switchboard is being answered. Others have drifted away into the stratosphere and can’t be found. What is your experience been like with your board? Has it been consistent? has there been getting a little closer on some areas and leaving you to have that free hand on some issues?

I would say that they’re neither right in operations or in the stratosphere, which is great. They’re in the middle but it’s because they’re very aware that those things are possible, the operations versus the stratosphere. That line between strategy and operations is blurry. As I mentioned, we’re seeking their advice more because this is unprecedented. Lots of conversation. I feel lucky to be able to say to my entire board during a board meeting, that’s interesting. I would have thought that this was more on the lines of operation. I feel lucky to be able to say that and then we’ll have a conversation about that. They will feel comfortable to push back if they think it’s not operational. The conversation is the key.

One of the other things I found working with CEOs who have been successful and I would certainly put you in that category, the comfort level of being able to say, “I don’t know,” to your board. There’s something powerful that comes when you’re asked a question by the board and say, “I don’t know.” It takes confidence but it helps establish that advisory perspective role you need from a board, particularly in the social profit sector.

I know colleagues who approach board meetings as if it’s a performance and they want an A. Everything is so rehearsed. It’s not necessarily their fault. They have a board that expects that but there’s a lot of richness that’s missing from a situation like that.

Those board meetings as performance are good for our business here at the Discovery Group because the first question that those CEOs often say is, we have these great board meetings and we’ve the best PowerPoint presentations this side of the Rockies. Our board doesn’t seem engaged. “Why do you talk at them for three hours?” They’re not engaged.

The wonderful feeling of that first time is when you say you don’t know to a board and you realize everybody is still sitting on their chair, they haven’t fallen off. They’re not looking like they’re going to fire you tomorrow or anything like that and that starts a conversation.

The reality is as CEO of the Michael Smith Foundation or a large social profit organization, a lot of the issues that come to the level of the board are there because they’re very difficult. There’s complexity or confusion as to what the actual question is you’re trying to solve or what’s the problem we’re trying to solve. If everyone assumes they know the answer and isn’t open to saying, “I don’t know,” it can be difficult to even define the question you’re trying to answer. I heard you say you’re very fortunate that you’ve got a great board and I know you do. I know many of the people on your board. Is there an issue you’d like your board to spend more time on than it does?

It’s a moving forward question. It comes from these lessons that will be important to dig into. Right now, we’re good. We think of our work as a foundation in two areas. There’s the whole notion of what we can do because we can more or less control it. We can run competitions and so on. There’s that other area of what we can’t do because we have no control but if we don’t try to influence it, we won’t ever be as successful with our programs as we could be. Our board will have some great conversations about our role in both those areas as we come out of the pandemic.

Foundation For Health Research: If we work with others who have ideas and can help us change incentives, we can do so much together.

I’ll go back to those same examples I gave. The discussion of that split of investments into the curiosity research and applied research that supports decision-making on big societal problems and then the other one being the talent. What does that mean that we should be doing with our competition but what does it also mean that we should be working with universities to say, “If researchers are going to solve these problems then the reward mechanisms need to change?” those sorts of things. Those are going to be huge conversations.

What’s interesting is knowing around your board table that much of the health research sector is looking to your foundation for some guidance on how to best answer those questions.

We would absolutely welcome that. It goes back to partners. Certainly, we can talk about co-funding partners but it’s not all about money. It’s about what we’re trying to achieve together. We’re in the grand scheme of research funding in the province. We’re pretty small but we’ve got some catalytic funding. If we work with others who have ideas, leavers and can help us change incentives, we can do so much together.

That’s a great perspective to bring to that very important and large issue. Before we move off your board, is there an issue that you wish your board spent less time on?

No. Isn’t that a wonderful thing to be able to say? We’re at the point with our board where we do so much talking about how to be an effective board and serve the organization fully that I can’t think of anything. If I did, I would be talking to my board chair about it and we would be having a conversation with the full board.

You wouldn’t wait to break it as news on The Discovery Pod.

I will not do that.

That’s not the conversation we have here. It is interesting to get to the point the way you answered that there aren’t issues either with the board spent less on. Your board has a real shared understanding of how to make the organization successful, what the role and the mission of the organization is. What is it about your board and the conversations that you’re having with your board that allows them to stay focused and not fall into some of the traps of, “Let’s talk about the minutes some more or zombie issues that plague in so many organizations?”

We have a strategic plan. We’ve embarking on a strategic plan for years. Funnily enough, it was called Delivering for BC in a Changing Environment before the pandemic. You can imagine, as we launch it, this strategic plan is going to be very much alive and adapting ongoing. The board was involved in that because they see that as one of their main roles. It’s to set us on a course with a strategic plan. That provides high-level guidance for us as does the monitoring of that strategic plan.

I’ve been lucky with the finance committee and the discussions about finance around the board. They’re about money but they’re about the strategy behind money. “Why do we want to spend this money? What is it trying to achieve?” We’re on a good path with having a strategic plan and annual plans that keep us focused. With the pandemic, as much planning as we can but not overly planned. Who can do that in these times?

All of the details say that you’re not going to be able to find the answer so don’t spend a lot of time writing it in ink.

That’s right.

As we move into 2021, you mentioned your strategic plan but is there anything that you’re particularly looking forward to?

I was so worried about the expectations that everybody had for 2021 at the end of 2020. Do you remember it? Everybody was saying like, “We’re done. Bring on 2021.” It almost like we had a choice to move away from everything that happened in 2020. I have to say, for us, at the foundation, I am excited about being part of that much-needed change in the research system. It’s not to play down the response to date of research, public health, healthcare and our government. It’s been very impressive. I feel lucky to live in British Columbia in Canada but we do need to make some changes. A couple of them is the culture of the research enterprise.

It still largely rewards people for competing with each other for funds and recognition. Those of us who can do something about it need to recognize that research requires teamwork and time. It takes wrong turns and engagement. We need to recognize and act on systemic racism and sexism that persistent in the research system like in every other system. There’s a big culture piece. The critical questions of policymakers and of society more broadly are important. The results of science in decision-making. They’ve never been so important not only for the pandemic but big societal issues.

I will mention one more thing. I’m excited for what 2021 might mean for societal engagement in science. You’ll be aware of all the misinformation circulating in the public sphere during the pandemic and it’s not surprising. It will always be there but what would help is a focus on science communication. I’m not talking about one way from scientists to the public, which is often the solution you hear is that people who know stuff have to talk more to people who don’t know stuff. I’m talking about conversations between scientists. Amongst scientists, citizens, government and other institutions. That will be very exciting.

As a follow-up, this pandemic has made health research clearly very important. Do you think Canadians are going to be more open to the directions that science say we should go when it comes to public policy?

What we’ve seen is that uneasy tension. In some circles, we’ve seen people realizing how important evidence is and then in others, I won’t say a downplaying of evidence but questioning about evidence. This reflects a need to have deep conversations about what evidence is. I hear the line, we need to better connect science and society. I stumble over it because science is a deeply social activity. It’s not disconnected in the first place. Scientists are social actors. I do think that even that line that we hear shows that we have to have more conversations about what science can do for society and what scientists can do for society. I know scientists are up for that, for sure.

A lot of those questions and the platforms for those conversations are going to run right through the Michael Smith Foundation here in British Columbia in the months and years to come.

We’re certainly up for them.

Foundation For Health Research: We need to recognize and act on systemic racism and sexism that are persistent in the research system like in every other system.

As we come to the end of our conversation, Bev, you were at the organization for a long time before becoming the CEO years ago. I’m interested in what advice you would have for other leaders either research leaders or social profit leaders to make the most of the current environment?

That’s funny. I thought that I would be asking your advice on that. I have a few thoughts but I will say that it’s advice that I’m trying to pay attention to and I’m not always successful. I’m trying to be aware that there’s only so much I can control. That is advice for any time particularly now when things are moving so fast. In fact, control is the wrong word to start with but people are not together. We’re doing things by email. It’s not always possible to manage everything. What does matter and what can be let go. I’m trying to do that. I’m trying to pay attention to how staff are feeling always especially now because people are stressed.

They’re working hard, their personal lives are affected by the pandemic and it’s not always easy for people to be forthcoming if they’re having difficulty. Those casual chats where things might come up, they’re not happening. Having team leaders checking with people and remembering that people are doing their best in very difficult times. That’s not only staff. That’s all of us. You mentioned learning mode. I’m trying to stay in learning mode. What can I learn from every person I interact with in every situation which is more difficult in times like this because some people look for certainty from a leader. They want to know things. I also think it’s more important to be in a learning mode in times like this. I also think that includes examining our own place in inequitable systems, in systemic racism and what we can do about it and other injustices.

I’d love to talk to you sometime about, “Can we do that as a group of social profit leaders.” Maybe those conversations are happening and I need to join them. One more thing I’m going to mention is to laugh. The reason that I bring this up is it’s sad. I laughed the other day and it surprised me. I didn’t know where it came from. I felt so much lighter and brighter. We have four grown kids. They’re not in our bubble which is very hard but we’re connected on WhatsApp and their conversations on that are hilarious. I look to those little diversions that make me laugh and that warm my heart. I do think we need to give ourselves a break and laugh. I’m not a physician but I do know that there’s research that says, “Laughter is mentally and physically good for you.”

It is the best medicine in a lot of cases. That is great advice and a great perspective that you shared from an organization at the eye and the response to the storm in health research. Thank you so much for making time to be a part of the show.

It’s been a pleasure. Thank you, Doug.

Important Links:

• Michael Smith Foundation for Health Research

About Dr. Bev Holmes