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Focusing on Impact: Cochrane’s Strategy to 2020

Mark Wilson

CEO, Cochrane

NETSCC, Southampton - 15th October 2014

A lot to be proud of …

The Cochrane Collaboration’s first 20 Years: an astonishing success

Contributed to the mainstream acceptance of ‘Evidence-Based Medicine’ and the acknowledged global leader in systematic reviews

Dramatic growth: contributors to Cochrane

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• Today there are nearly 34,000 contributors in over 120 countries worldwide.

• In 2008 there were fewer than 10,000 authors; now more than 22,400 active registered authors of Cochrane Reviews.

Dramatic growth:Organisational infrastructure

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• 14 regional Centres & 25 Branches

• 53 subject-based Review Groups

• 16 Methods Groups

• 12 thematic Fields & Networks

Dramatic growth inCochrane Review production

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More than 8,500 full Cochrane reviews and protocols in the Cochrane Database of Systematic Reviews; and 725,000 entries in the Central Register of Controlled Trials published in The Cochrane Library

Dramatic growth inuse of Cochrane evidence

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In 2013, 13.5 million abstract page views on The Cochrane Library published by Wiley; and another 4,181,131 page views of Cochrane Summaries.

Over 7.4 million full text downloads of Cochrane Reviews in 2013

2013 Impact factor: 5.959Five-year Impact factor: 6.706Total citations in 2013: 39,856 (more than the BMJ)One of the top 10 medical journals in the world

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2008 2009 2010 2011 2012 2013

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Cochrane Involvement in WHO Guidelines (n = 101)

CochraneReviews

Teammember

GRADE

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But Cochrane facesconsiderable challenges …

1. Complex Cochrane Review production process:

• Provides insufficient prioritisation of critical reviews needed/key answers required – ‘ad hoc’ production

• Increasingly long production process – can be unsatisfying for authors & slow and burdensome for Cochrane Review Groups

• Makes it unattractive for authors to keep reviews up-to-date or return to do another review

• Means the percentage of up-to-date reviews is falling • Leaves us exposed to competitors who can produce reviews

faster, more simply and efficiently, and with a better author experience.

Whilst unique, Cochrane is no longer alone

Academics & Other

Journals

Government-affiliated bodiesCommercial companies

Not-for-profit groups

“Anyone who produces, or who finds a way to make Systematic Reviews more digestible and more relevant to the audience, is in

competition with Cochrane”

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Cochrane challenges

2. Knowledge Translation ‘Gap’; and an Improved ‘User Experience’ is needed for content presentation, delivery & usability:

• A need to improve the applicability and links of Cochrane evidence to health policy and practice

Reputational Audit showed us that generally Cochrane and our Reviews are seen as

the ‘gold standard’

Robust methodology

Comprehensive

studies

100% independent

Respected name

International reach

Passionate and

enthusiastic reviewers

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“As a policy maker, to be able to say ‘this is the Cochrane Review on x,y,z’, is ticking a box to say ‘we’ve got the most exhaustive summary of the evidence possible’. It’s a reassurance”

Cochrane challenges

… but the Impact of our Reviews is reduced by our failure to translate them sufficiently

into the wider world

! Difficult to understand

! Lack ‘actionable’

output

! Not focussed on key

issues of the day

! Inflexible

! Avoid anything except

randomised trials

! Appearance of an

‘exclusive’ club

! Limited awareness

outside academics

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“Sometimes these reviews come out and you say, ‘Okay – now what?’. It is about making the connection and prioritising reviews that are the most impactful.”

“It’s a very kind of elite medical review community that understands Cochrane.”

Cochrane challenges

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Cochrane challenges

2. Knowledge Translation ‘Gap’; and an Improved ‘User Experience’ is needed on content presentation, delivery & usability:

• A need to improve the applicability and links of Cochrane evidence to health policy and practice

• ‘So what?’ for users – implications of the findings• Great progress made in recent years (Summary of Findings

Tables; Plain-Language Summaries; Cochrane Summaries; Cochrane App; ‘Anywhere Article’ launched in June 2014 improves readability/usability on mobile devices)

• But need to provide new tools, ways and products that allow users to find information they want more quickly and easily …

• A focus on the ‘end user’ not the Cochrane producer.

3. Are we really as globalas we think we are?

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Africa1%

Oceania9%

Asia19%

Europe35%

North America32%

South America4%

Two-thirds of Cochrane Review downloads come from users in Europe and North America

Most authors come fromEurope and America

Most funding comes fromthe UK and USA

Content is primarily in English

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Cochrane challenges

4. Incomplete Global Access to Cochrane Content:

• Inadequate provision of content in different languages prevents us reaching global audiences in their own languages – and therefore reduces our impact

5. Organisational and Resourcing:

• Complex structure overly reliant on individuals in positions of authority within their own organisations: creating challenges of accountability and generational change

• ‘Inward- facing’: creating problems for advocacy, marketing & communications, fundraising, partnership development and increasing membership

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Cochrane challenges

5. Organisational and Resourcing:

• Unrealised potential of contributors from non-English speaking countries and L&MICs

• Squeezed research budgets worldwide affecting infrastructural funding to Cochrane groups

• Over reliance on income from sales of The Cochrane Library as publishing moves towards Open Access

Responding to the Challenges:

Strategy to 2020

Vision Mission

Our Vision is a world of improved healthwhere decisions about health and health care are informed by high-

quality, relevant and up-to-date synthesized research evidence.

Our Mission is to promote evidence-informed

health decision-making by producing high-quality, relevant, accessible systematic reviews and

other synthesized research evidence.

Vision Mission Goals

Goal 1: Producing Evidence - To produce high-quality, relevant, up-to-date systematic reviews and other synthesized research evidence to inform health decision-making

Goal 2: Accessible Evidence - To make Cochrane evidence accessible and useful to everybody, everywhere in the world

Strategy to 2020

Goal 3: Advocating for Evidence - To make Cochrane the ‘home of evidence’ to inform health decision-making, build greater recognition of our work, and become the leading advocate for evidence-informed health care.

Goal 4: Building an Effective & Sustainable Organisation - To be a diverse, inclusive and transparent international organisation that effectively harnesses the enthusiasm and skills of our contributors, is guided by our principles, governed accountably, managed efficiently and makes optimal use of its resources.

Objectives

High quality

Up to date

Relevant

Wide coverage

Pioneering Methods

Efficient production

(2)

Objective 1 of 7:

We will continue to develop and implement comprehensive quality

assurance mechanisms for editorial and methodological

standards throughout our production and updating

processes.

Goal One: Producing Evidence

Strategy to 2020 Vision Mission Goals Objectives

Strategy to 2020 Vision Mission Goals Objectives

Goal One

7 Objectives

High quality

Up to date

Relevant

Wide coverage

Pioneering Methods

Efficient production

(2)

Goal Three

8 Objectives

Global Profile

The ‘Home of Evidence’

(2)

Global Advocate

(3)

Global Partner

Global Impact Goal Four

7 Objectives

Inclusive & Open

Global &

Diverse

Financially

Strong

Efficiently Run

Investing in

People

Transparently

Governed

Environmentally Respons

ible

Goal Two

6 Objectives

User-Centred

(3)

Open Access

Accessible Language

Multi-lingual

Vision Mission Goals Objectives Targets

2014 Target: High Quality

Goal One: Producing Evidence

Objectives

High quality

Up to date

Relevant

Wide coverage

Pioneering Methods

Efficient production Create a prioritised set of the existing

MECIR standards with the aim of achieving 100% compliance to them for

new Cochrane Systematic Reviews.

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Delivering Strategy to 2020

Vision Mission Goals Objectives Targets

4 Goals

28 Objectives

21 Targets for 2014

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Delivering Strategy to 2020

http://cochrane.org/strategy2020

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Goal 1: Producing EvidenceTo produce high-quality, relevant, up-to-date systematic

reviews and other synthesized research evidence to inform health decision-making

Cochrane’s production challenge:

“dedicated to delivering evidence more quickly and

effectively, without compromising on quality ”

Create a prioritised set of the existing MECIR standards with the aim of

achieving 100% compliance to them for new Cochrane Systematic Reviews.

• Quality assurance process has been highly successful and continued due to demand

• An audit process has now also started which will lead to the development of the subset

Vision Mission Goals Objectives Targets

Target 1.2: MECIR subset

Goal One: Producing Evidence

Objectives

High quality

Up to date

Relevant

Wide coverage

Pioneering Methods

Efficient production

Objectives

High quality

Up to date

Relevant

Wide coverage

Pioneering Methods

Efficient production

Vision Mission Goals Objectives Targets

Improve production processes by implementing a web-based author

support tool

• Decision made on preferred provider following RFP process

• Implementation work will start immediately with anticipated full launch in Spring 2015

Target 1.3.i: Author Support Tool

Goal One: Producing Evidence

Goal 2: Accessible EvidenceTo make Cochrane evidence accessible and useful to

everybody, everywhere in the world

Cochrane: Focused on Users –Focused on Impact

“What we produce only has value to the extent that it is

meaningful to people making decisions about health.”

Vision Mission Goals Objectives Targets

Objectives

User-Centred

Open Access

Accessible Language

Multi-lingual

Develop a roadmap for achieving universal open access to new and

updated Cochrane Systematic Reviews by the end of 2016.

• Significant work has been undertaken to scope out possible models for Cochrane

• A recommendation to explore two specific models in detail is being considered by the Steering Group

• Open Access roadmap will be in place in early 2015

Target 2.4: Open Access Roadmap

Goal Two: Accessible Evidence

Vision Mission Goals Objectives Targets

Objectives

User-Centred

Open Access

Accessible Language

Multi-lingual

Goal Two: Accessible Evidence

Finalise strategy, establish an integrated translation management system and introduce key digital content and multi-lingual portals in French, Spanish and three other languages.

• Strategy approved and translation co-ordinator appointed

• Translation Management System adopted and already in use by 12 language teams –with many more to come

• €400,000 raised for translation into German & East European languages

• Multi-lingual web sites to be launched in 2015

Target 2.6: Translation Strategy

Vision Mission Goals Objectives Targets

Objectives

User-Centred

Open Access

Accessible Language

Multi-lingual

Learning As We Go

Gather systematic data and improve our understanding of end-user

experience and need; and establish a framework for ongoing reassessment.

• Critical to informing our future development

• Larger scope than anticipated, so we have deferred the deadline to ensure it is done properly

Target 2.1: User Experience Review and Framework

Goal 3: Advocating for EvidenceTo make Cochrane the ‘home of evidence’ to inform

health decision-making, build greater recognition of our work, and become the leading advocate for evidence-

informed health care.

Cochrane – Engaging with the World

“Transform Cochrane to be truly Global, working more in partnership with others, and using our position to advocate and speak out for our

goals. ”

Vision Mission Goals Objectives Targets

Objectives

Global Profile

The ‘Home of Evidence’

(x2)

Global Advocate

(x3)

Global Partner

Global Impact

Goal Three: Advocating for Evidence

Create a coherent Cochrane brand across all content.

• New logo approved• Full launch of new brand on

schedule for Jan 2015

Target 3.1: Coherent Brand

Vision Mission Goals Objectives Targets

Objectives

Global Profile

The ‘Home of Evidence’

Global Advocate

Global Partner

Global Impact

Goal Three: Advocating for Evidence

Identify and establish partnerships with three to five international

strategic stakeholders to advance evidence-informed health decision-

making.

• GIN and Wikipedia partnerships formed

• Campbell Collaboration partnership imminent

• Will begin working on new Cochrane-WHO work plan 2015-

Target 3.2: Establish 3-5 strategic partnerships

Objectives to 2020:

Inclusive and Open

Financially Strong

Investing in People

Environmentally Responsible

Goal 4: Building an Effective & Sustainable OrganisationTo be a diverse, inclusive and transparent international organisation that effectively harnesses the enthusiasm

and skills of our contributors, is guided by our principles, governed accountably, managed efficiently and makes

optimal use of its resources.

Global and Diverse

Efficiently Run

Transparently Governed

Reputational Audit asked: What is a typical ‘Cochrane persona’?

Academic

Unique

Volunteer

British heart

Passionate

Rigorous

Respected

Independent

Out-dated

Rigid

Obsessive

Exclusive

Passionate but seen better days!

Vision Mission Goals Objectives Targets

Objectives

Inclusive & Open

Global & Diverse

Financially Strong

Efficiently Run

Investing in People

Transparently

Governed

Environmentally Responsi

ble

Goal Four: Building an Effective and Sustainable Organisation

Introduce a Cochrane Membership scheme.

• Aiming to make Cochrane open and accessible to anyone who subscribes to our mission

• We want to launch the membership scheme by the end of 2015 – preferably at Vienna Colloquium

Target 4.1: Membership Scheme

Vision Mission Goals Objectives Targets

Objectives

Inclusive & Open

Global & Diverse

Financially Strong

Efficiently Run

Investing in People

Transparently

Governed

Environmentally Responsi

ble

Goal Four: Building an Effective and Sustainable Organisation

Develop, and begin implementation of, an inter-professional and inclusive

training and professional development strategy.

• Training strategy approved – Sept 2014 - £3m over 4 years

• Implementation to start by the end of the year

Target 4.2: Training Strategy

Vision Mission Goals Objectives Targets

Objectives

Inclusive & Open

Global & Diverse

Financially Strong

Efficiently Run

Investing in People

Transparently

Governed

Environmentally Responsi

ble

Goal Four: Building an Effective and Sustainable Organisation

We will increase the transparency of the organisation’s governance and improve the opportunities for any

contributor to participate in governing …

• Cochrane Steering Group (CSG) to be reformed – non-executive directors to be introduced

• Review of governance and accountability of all Cochrane Groups in 2015

Target 4.3: Governance Review

Vision Mission Goals Objectives Targets

Objectives

Inclusive & Open

Global & Diverse

Financially Strong

Efficiently Run

Investing in People

Transparently

Governed

Environmentally Responsi

ble

Goal Four: Building an Effective and Sustainable Organisation

Review and adjust the structure and functions of the global network of

Cochrane groups

• Cochrane Review Group Review already started in 2014

• Reviews of Centres & Branches, Fields, Consumers & Methods Groups to follow in 2015

Target 4.4: Structure & Function Review

Focusing on Impact:Cochrane’s Path to 2020

• Cochrane continuing to grow– Nearly 35,000 registered volunteers; with over 8,000 active in the last six

months

– Five new Cochrane branches opened in 2014: Japan, Malaysia, Mexico, Portugal, Poland; and French Satellite of the Musculoskeletal CRG opened

• Cochrane Library Sales– Record year in 2013-14 for sales revenues and royalties

– Sales on target - 5% increase in 2014 projected;

• Strong financial position– Excellent 2013-14 results: £1.2m operating surplus;

– Reserves at record £7.2m – but we’ll need it: strategic investments to be made (‘Game Changers’) & OA transition to be managed

• Substantial challenges - Strategy 2020 will address them46

Focusing on Impact:Cochrane’s Path to 2020

We want better healthcare decision making to create a world of improved health …

by producing and promoting the use of high-quality evidence-informed research …

then making this information accessible & usable to everyone who needs it.