Funders’ responsibility to ensure value in research: a self- audit by the Health Research Board Ireland [version 1; peer review: 2 approved]

Abstract As a public funder of health research, the Health Research Board (HRB) Ireland has an obligation to manage its funds well and to maximise the value of the research that it funds. Ways in which research funding can be wasted have been examined by researchers over the years, and a seminal series on research waste was published in the Lancet in 2014. The series systematically analysed every step of the funding lifecycle in five major stages and made recommendations to various actors including research funders.

Prompted by its participation in the Ensuring Value in Research Funders' Forum, between June and October 2019 the HRB undertook a self-audit against the 17 recommendations and 35 subrecommendations identified in the Lancet series. Key HRB staff collated relevant policies and practices regarding each recommendation and sub-recommendation and assessed the HRB's performance under each heading. The self-assessment reflects the state of HRB policies and practices in October 2019. Of the 17 recommendations, two were found not to apply to the HRB. Of the remaining 15 recommendations covering 33 sub-recommendations, five were found to be areas of strength and six were found to be areas of partial strength. These 11 recommendations encompass 22 subrecommendations. Areas of strength reflect work over many years such as support for evidence synthesis, strong processes around award selection, driving research integrity and open data including an HRB-funded open publishing platform.
Four recommendations were found to be areas for growth. These mostly revolve around real time reporting of study protocols and of ongoing funded research outside of clinical trials. Work is progressing to address some of these areas.

Reviewer Status
Invited Reviewers

Introduction
Funders of health research typically receive money from members of the public directly in the case of charitable organisations or via taxation in the case of state agencies. Funders have an obligation to make best use of this income, to maximise its societal benefits. Research waste occurs when the use of money and/or effort is not optimal. Ways in which research waste can occur have been examined by researchers over the years (Chalmers & Glasziou, 2009), leading to the publication in 2014 of a series in the Lancet, put together by Chalmers and Glasziou, (Chalmers et al., 2014), (Ioannidis et al., 2014), (Salman et al., 2014), (Chan et al., 2014) and (Glasziou et al., 2014) that systematically analysed every step of the funding lifecycle in five major stages. These include 1) funding research that is relevant to knowledge users, 2) ensuring appropriate design, methods and analysis, 3) efficient research regulation and management, 4) information about the research being fully accessible, and 5) unbiased and useable research reports. It spelled out recommendations for funders, researchers, research performing institutions, publishers, policy makers, regulators and research ethics committees.
Individual funders across the world have grappled with how best to optimise the use of their funding for a long time. This is a complex and multi-faceted endeavour where best practice shifts over time. In 2017 a group of funders from different countries, including the Health Research Board (HRB), came together under the banner of the 'Ensuring Value in Research Funders' Forum' to work together on approaches to optimising the use of their funding (Chinnery et al., 2018). This is a place where health research funders of all sizes and with different remits can share ideas, learn from each other, collaborate and create impact. In 2019 the HRB undertook a self-assessment of its own practices and policies in a systematic way.
The HRB is the main funder of health research in Ireland, and a statutory agency under the Department of Health. The HRB funds research across a wide spectrum from patientoriented and clinical research to population health sciences and health services research. Funding is provided for project and programme grants, career development, infrastructures and networks.
The HRB has an annual funding envelope of €45 million and manages 350 active awards with a total value of €240 million. Its funding Directorate includes approximately 27 staff. The HRB sees itself as a learning organisation with a tradition of leading in the development of best and next practice in specific policy areas. The HRB has three other functions: the Evidence Centre develops evidence synthesis products for the Department of Health; the National Health Information Systems provide information for health service planning and makes its data available for research; and the nascent regulatory function of the HRB encompasses the Health Research Consent Declaration Committee and a National Research Ethics Committee.

Methods
For comparability the methods used for the HRB self-audit mirrored those reported previously by the Patient-Centered Outcomes Research Institute (PCORI, USA) (Whitlock et al., 2019) and are informed by those used by National Institutes of Health Research (NIHR, UK) for a similar exercise (M. Westmore, personal communication). Both PCORI and NIHR are members of the Ensuring Value in Research Funders' Forum.
In total, four HRB members of staff (all authors) were chosen to participate in this self-audit based on their role in the organisation: Head of Pre-Award, Head of Post-Award and Evaluation, Programme Manager Policy and EU Funding, and Director of Research Strategy and Funding, respectively. All roles include a remit for policy. Jointly they are familiar with the spectrum of HRB funding policies, most of which have been driven personally by these individuals, and the national and international discussions informing these policies. The first author suggested the concept of a self-audit, the composition of the study team, methodology and respective roles at a team meeting. Approval for the project was given by the Director of Research Strategy and Funding. Work was completed as part of the overall work of the study team members for the HRB, without any additional compensation.
The group examined HRB's existing policies, initiatives and practices against 17 recommendations for funding agencies from the Lancet series. Many of the recommendations contain a number of sub-recommendations to capture multiple dimensions, leading to a total of 35 areas to assess (Table 1).
To ensure that diverse perspectives were captured, initially each author collated relevant HRB materials, policies, or practices of which they were aware in their area of expertise. This material was collated by the first author, shared with the other authors and then added to collectively. The scope of the material to be included under each recommendation was agreed jointly.
On this basis, each author then independently categorised fidelity to the 17 recommendations as: 1) "area of strength" -HRB's practices reasonably address all sub-recommendations; 2) "area of partial strength" -HRB's practices reasonably or partially address all sub-recommendations; 3) "area of growth" -HRB's practices do not address all sub-recommendations, either reasonably or partially; or 4) not applicable. These rating were used by PCORI in their self-audit. Discrepancies were resolved through discussion and final ratings reflect consensus.
The kick-off meeting took place in the HRB offices in June 2019, with in an depth discussion of the methodology and approach. Two more meetings took place in July to finalise the collation of materials feeding into the self-audit. The individual assessments of HRB performance against the recommendations were completed in October 2019 with good Table 1. Assessment of HRB's policies and practises related to ensuring value in research.

Lancet series recommendations
Related processes or initiatives at HRB

Self-assessment agreed
Questions are relevant to users of research 1. More investigations into research should be done to identify factors associated with successful replication of basic research and translation to application in health care, and how to achieve the most productive ratio of basic to applied research The HRB funds basic research only in limited circumstances and as a result has a very small portfolio of basic research awards.  information on open research and associated skill attainment in national level research reporting and evaluation support and reward for researchers within the academic career system who participate in a culture of sharing their research results adoption of 'responsible metrics' by Funders and institutions and rewarding the full diversity of outputs and of recording the broader social impact of research ('next-generation metrics') HRB leading various national discussions on cultural shift to better regulations and rewards e.g. GDPR, Ethics, research integrity, promotion of DORA, conference presentations etc.
2. Area of partial strength practices reasonably or partially address all subrecommendations 16. Research funders should take responsibility for reporting infrastructure that supports good reporting and archiving HRB has own publishing platform for various types of articles and datasets (HRB Open Research) HRB has a suite of policies on Open Access, data management etc and has worked nationally and internationally to determine best way of making data FAIR 2. Area of partial strength practices reasonably or partially address all subrecommendations overlap between authors. Any differences in rating were resolved at a meeting in October 2019. The wording for publication of the HRB related processes or initiatives was finalised and agreed in February 2020.

Results
The self-assessment reflects the state of HRB policies and practices in October 2019. It adopted a whole-of-organisation approach beyond the HRB funding remit. Table 1 sets out the results across the five key stages of research: (1) relevance of questions; (2) appropriate design, conduct and analysis; (3) efficient regulation and management; (4) full reporting and accessible data; and (5) complete, unbiased and useable reports. Of the 17 recommendations, two were found not to apply to the HRB (1 and 8) due to its remit. Of the remaining 15 recommendations covering 33 sub-recommendations, five were found to be areas of strength (3,6,9,13 and 16) and six were found to be areas of partial strength (2, 10, 11, 12, 15 and 17). These 11 recommendations encompass 22 sub-recommendations.
Four recommendations were found to be areas for growth (4, 5, 7 and 14).

Discussion
By nature, any self-audit has the potential for bias. We aimed to avoid bias by using an external framework that had been published previously, including contributors with different perspectives, and concluding multiple rounds of discussion and feedback on each recommendation and its sub-recommendations.
This self-assessment positively highlighted areas where significant effort has been made over many years. The areas that scored well have been a core part of the HRB work programme for some time: quality of the scientific peer review process in all its aspects, in-house and extramural support for evidence synthesis and methodological support for researchers. The role of the HRB in the implementation of Irish legislation accompanying general data protection regulation (GDPR) in the context of health research is also reflected positively.
Since the self-assessment, the HRB has hosted and managed a national research ethics committee for coronavirus disease 2019 (COVID-19)-related research with expedited turnaround times for decisions, and national research ethics committees for clinical trials of regulated medicinal products and of medical devices are in imminent.
As the main funder of health research in a small country, the HRB typically issues funding calls that focus on the type of outcome expected, not on the subject area. We therefore emphasise collaboration between researchers and knowledge users in a variety of funding schemes to ensure the relevance of research findings.
The HRB has been very active in the international and national development of research integrity, FAIR data and open research, including the development of coordinated policy and frameworks. Training in research integrity is mandatory for recipients of funding and their teams, and HRB contributes to a national subscription to an online training platform for research integrity. In Ireland the HRB has played a leading role in the development of PPI capacity with innovative and new system-wide approaches.
Progress has been made in all these areas, but there are still opportunities to further improve the implementation of policies across the spectrum and enhance institutional and researcher capacity to 'do the right thing'. The authors view the undertaking of self-audits as part of continuous improvement efforts.
For example: • The culture change required for the meaningful inclusion of members of the public across the research endeavour has only started. The HRB introduced public reviews for some funding schemes in 2017 and is providing infrastructure support for institutions to enhance their capacity for PPI, but more researchers and PPI contributors need to gain more direct experience.
• Having a route via HRB Open Research to publish protocols and outcomes quickly and without publication bias is important, but alone does not guarantee that they are published. In a recent call for COVID-19 research the publication of protocols was mandatory, which was fully implemented. We are reflecting on this experience and starting to roll out such a requirement across other schemes. There is a noticeable increase in study protocol publications on HRB Open Research across other funded projects.
• A current area of focus is around data, encompassing the review and publication of data management plans, the further broadening of FAIR data capacity through the training of data stewards in institutions, and a proof of concept initiative facilitating the safe linkage of datasets and secondary use of data. This is an evolving area internationally and capability and capacity are currently limited in Ireland.
Whilst work is ongoing in some of the four areas for growth, it is currently not clear how to address some subrecommendations. Some areas are challenging for many funders including the HRB. The registration and real time reporting of ongoing funded research (particularly outside of clinical trials), which is captured in recommendations 4, 5 and 14, poses difficulties, with few suitable repositories. In their selfaudit PCORI note similar challenges in this space (Whitlock et al., 2019). This is an area that requires more consideration in the future and would benefit from infrastructural solutions beyond the remit of the HRB.
The framework used here included recommendations for all players within the research ecosystem. It is relevant to research funding organisations but not specifically tailored towards them. Based on the experience of their respective self-audits, HRB and PCORI are currently contributing to the development of a new tailored tool for the self-assessment of research funding organisations by the Ensuring Value in Research Funders' Forum. This will align with the Ensuring Value in Research principles, provide guidance on methodology and areas to consider, and better focus the work associated with a self-audit.

Data availability
All data underlying the results are available as part of the article and no additional source data are required.

Mona Nasser
Plymouth Institute of Health and Care Research, Peninsula Dental School, University of Plymouth, Plymouth, UK In order to be able to reproduce the data, the readers need to know more about, "...initially each author collated relevant HRB materials, policies, or practices of which they were aware in their area of expertise." -Either how they identified/searched them or a list of these documents (if not all of them is possible, at least some examples of them).
In Table 1: It would be useful that in the self-assessment that you would differentiate between transparency around having criteria and process in place on how decisions are made (which a lot of funders do) versus transparency around how those procdess are implemented e.g. minutes of meeting or external observants in the room (which less often done by funders). Table 1, row 3 item (a): For this, "Requirement of systematically gathered evidence ((1) systematic identification of previous work, 2) critical appraisal, 3) synthesis of the evidence and 4) interpretation of findings) in growing number of schemes", is it possible to give a more accurate number than growing number of schemes or at least an estimate of how many schemes or applications that applies to. It will be also useful to highlight whether it is for researcher-driven grants or commission based one too or both? Consistency in using the abbreviation -In this sentence, "HRB involved in Department of Health Group preparing Health Information Strategy Health Research Forum to be set up by DOH with national healthcare provider, HRB and other stakeholders", if you use DOH as abbreviation might be useful to add after department of health (DOH).
It wasn't clear to me how (HRB funding and dissemination activities) addressed item 11.
You have DMP in the table 1 as abbreviation but not written as full in other parts.

Are sufficient details of methods and analysis provided to allow replication by others? Partly
If applicable, is the statistical analysis and its interpretation appropriate? Not applicable

Methods:
In Recommendation 1, please provide information on how you define basic research (e.g. Health Research Classification System -Research Activities).
What does 'good overlap between authors' mean? Please elaborate on differences in rating to provide a clear sense of the extent of agreement between authors.

Other comments:
In Recommendation 4a, data on awarded HRB research grants should also be submitted to a grant data portal that consolidates grant data from various funding sources. This would greatly facilitate broader research funding analyses. We admit, however, that there is currently a scarcity of available public data repositories.
It would be helpful to provide a timeframe for the next iteration of HRB's self-audit to monitor progress on areas of partial strength and areas for growth.