In recent years the role of NMAHPs in clinical research has become increasingly important towards driving high quality, innovative patient care – yet challenges remain at the interface between research and clinical practice.
In this blog, Dr Linda Tinkler explains how her PhD explored the inextricable links between how we deliver research and how we develop our staff to work as part of a thriving research culture, and why making them work in synergy is so important to the future of our healthcare landscape.
Clinical research activity is vitally important for a range of reasons, most importantly the health benefits it brings to our population.
My research interests have developed over more than a decade, and are based on my own personal experiences of:
- working at the interface between research and clinical practice;
- seeing and hearing the experiences of other research focused staff;
- seeing and experiencing a direct impact on our ability to invite patients to research studies that are relevant to them;
- and my personal interest in NHS leadership, NHS culture and how we behave as people in response to a range of situations and experiences.
Resistance and avoidance behaviours present at the interface between where research happens and where clinical services are delivered have the potential to negatively affect our ability to successfully deliver research – meaning some of our patients may miss out on opportunities relevant to their health.
In addition to this, staff may miss out on opportunities to be involved in supporting the research; learning more about its vital importance; understanding it is not as scary as it may look; and driving forward improvements in services and care.
A national leader in research
Evidence is growing that research active organisations have better quality outcomes – such impact is now well known. We work in an increasingly research informed and led system, and certainly in Newcastle, we are leading the way with so many research endeavours such as our NMAHP Researcher Development Institute (RDI), partnership working within Newcastle Health Innovation Partners (NHIP) and our hosting of significant NIHR infrastructure.
Our research delivery teams make an amazing contribution to our wider landscape and strategy as they quietly go about their business of making research happen.
However, the complexity of how NHS systems and processes are often set up and understood (or not), can sometimes be counter-productive to those working at the interface between research and practice. This may create unintended tensions that ultimately impact on staff morale, job satisfaction and intention to remain in post, and on our patients and their access to research. Sometimes this happens in a way that is difficult to see clearly.
There isn’t a great deal of evidence that tells us about how those practicing alongside, yet outside of clinical research teams, view research delivery and the role of staff who deliver research.
This is an important issue to understand and ultimately optimise, both as part of our NHS People Promise, and in light of the huge positive push towards research activity as core business.”
Clinical research delivery teams work hard to bring innovations and improvements through working on studies exploring early diagnosis, new treatments and new ways of working, but sometimes they face resistance and avoidance due to pressures within the system.
Helping to unlock resistance and barriers
The challenges I have touched upon are broad and wide reaching. They must change if we are to really drive forward research as core business and enable staff and patients to understand and be involved in a way that they are comfortable with and not put off by. We have a range of national regional and local strategies and huge numbers of people working within research and across the research–practice interface.
The links between how we deliver research in the NHS and how we develop our staff to work as part of a thriving research culture are inextricable and so important to the future of our healthcare landscape.
This is something I am determined to improve and open up, to help unlock other sticking points we see across research delivery, development and clinical academic careers.
Following on from previous research I had undertaken, I first completed and published a way of looking at the research literature called a “realist review”. This is a particular approach to exploring what the evidence says about a topic area and had a flexible but pragmatic approach, enabling lots of evidence to be included. This was undertaken to generate theories about the interface between research delivery and clinical service delivery.
Group concept mapping
After the realist review was completed and I had a good sense of the issues that needed to be explored, a group concept mapping (GCM) approach was adopted to test one of the theories generated in the realist review. This involved asking Nurses, Midwives and AHPs who importantly work outside of research delivery teams, about what they thought their role was in relation to the delivery of research.
There were a couple of stages to this, and participants sorted the views collected by everyone thematically before then considering how likely each view was to generate resistance or avoidance behaviours. They then scored the same views on how important each was to address.
The final concept map that was generated by the study contained 99 unique statements. These had been sorted by participants into 6 conceptual clusters:
- “We value & understand the importance of research”
- “How it should be & how we could work together”
- “Behaviours, beliefs & missed opportunities”
- “Dissonance & disengagement”
- “Time & capacity affects our ability to engage”
- “I keep thinking of ways to facilitate research as everyone’s business but it is hard”.
Participants felt that three of the six clusters were most likely to generate resistance and avoidance behaviours (three, four and five), and two were most important to address (two and five).
It was apparent from the results that a range of contextual factors, perceptions and ways of working are likely to generate resistance and avoidance behaviours. It was also clear that seeking the views of participants practicing outside of research delivery structures provided a rare opportunity for their perspectives to be heard.
What was interesting was that in contrast to how research delivery staff considered they were perceived, participants expressed a desire for time to engage with research delivery and wanted increased opportunities to be involved with supporting studies in their clinical areas.
There was a clear theme indicating that improved communication between clinical research delivery teams and clinical service delivery was considered pivotal to the success of research.
This represents just a small snapshot of some of the themes from what was ultimately a 300 page thesis, but it’s important to highlight how positive the findings are and the potential these results hold if we use the opportunity to maximise the positive views.
How Linda’s Doctoral Research Fellowship was made possible
This research was funded by the Royal College of Nursing, via a Doctoral Research Fellowship as part of the Strategic Research Alliance with the University of Sheffield.
Linda had also completed an NIHR funded MClinRes (Leadership) prior to this award, which had set her off on her research journey and enabled her to publish early results to add to the evidence base.
Following the MClinRes, Linda applied to the NIHR for one of their Doctoral Fellowships, whilst undertaking a further research study with an RCF award from Newcastle Hospitals. Whilst the application to NIHR was unsuccessful, the learning from it helped Linda to rework her application for the RCN fellowship, which was serendipitously launched a week after receiving a rejection notice from NIHR.
Linda says she believes her work was much better positioned through the fellowship she was eventually awarded and timing could not have been better.
Dr Linda Tinkler (PhD, RN) is Trust Lead for Nursing, Midwifery & AHP Research, a Visiting Fellow at Northumbria University and NIHR 70@70 Senior Nurse Research Leader.