Achieving a cultural dividend – the use of Embedded Research

One advantage of effective alliances between academia and healthcare institutions is better patient outcomes that transcend the direct results and education and represent a ‘cultural dividend’ from involvement in these activities. Imagine the health impact if that same culture could be fostered in all healthcare providers. In this article Liz Mears and Naomi Fulop describe one way of addressing this challenge.

John Tooke

There appears to be ‘a cultural dividend’ in healthcare institutions that engage in research and teaching. This dividend exceeds the direct outputs of the research and education activities by creating a culture where the adoption of evidence-based practice, quality improvement and innovation can thrive.

However, this spin-off benefit is not straightforward to achieve. Research has shown that organisational responses to quality improvement interventions can be contingent on the availability of slack/ downtime to reflect and implement changes (Jones et al, 2019) https://www.bmj.com/content/364/bmj.k5437

We currently work in a health and care environment with much centrally driven change. Dixon-Wood et al (2012) https://qualitysafety.bmj.com/content/21/10/876 have argued that ‘problems can occur when improvement efforts are accounted to centrally driven national pushes and pressures are introduced into environments already suffering organisational stress and mandated requirements’. Locally driven and owned change can help to mitigate some of this organisational pressure. Researchers who are part of this locally driven and owned change by being embedded in organisations/teams providing health care may be an effective way of supporting service leaders and front line colleagues to make effective evidence-based changes.

We are part of an NIHR-funded study (Embedded) which aims to increase our understanding of the practice of Embedded Researchers. The definition of embedded research that we are using is: trained researchers, creating knowledge in a health or care setting, for the benefit of the organisation, spending part of their working week in the health or care service. Marshall et al (2014) https://www.ncbi.nlm.nih.gov/pubmed/25111565

The study is developing a toolkit of products for those organisations who would like to host an Embedded Researcher and for Researchers considering these roles. We have also established a network for Embedded Researchers. Our initial findings show that an Embedded Researcher may be one way that an organisation can achieve some headspace, have research at the heart of teams and consequently build research and implementation capacity into the organisation.

The NIHR Dissemination Centre has recently published findings from 5 research studies into how commissioners use research evidence https://www.dc.nihr.ac.uk/highlights/health-commissioners-research-evidence/evidence-at-a-glance.htm

The findings include:

• Managers of all backgrounds find it hard to make sense of and apply evidence in their everyday work
• Managers tend to make less use of formal research. They value examples and experience of others, as well as local information and intelligence
• Senior managers rely on a small conversational circle and trusted colleagues to identify and interpret evidence
• Evidence does not speak for itself. Organisations need to engage experts and frame research for different audiences
• Timing is key - having good enough evidence at the right time trumps perfect research which arrives too late for decision makers to use
• Having skilled individuals, on the spot to contextualise and interpret evidence helps managers use evidence when making decisions about systems and services

Embedded Researchers could be the individuals who help leaders, managers and commissioners clarify goals, gather relevant evidence and identify appropriate methods to commission services, assess service changes and their impact on outcomes at a local and national level.

An Embedded Research role is not an easy one. Embedded Researchers sometimes have to tackle challenging issues where the research shows unexpected results or results that may not be welcome to the organisation or the Board of the host organisation. The roles are often lonely ones, speaking truth to power, disrupting existing practices and finding solutions to support front line colleagues. (HSJ Mear and Fulop May 2019) https://www.hsj.co.uk/service-design/how-the-lonely-ones-can-drive-meaningful-change/7025001.article

The release of time and insistence on honesty which can be promoted by an Embedded Researcher may allow delivery and payer organisations to reflect on what is important and maximise the cultural dividend of using research/evidence based decision making. The Embedded study will provide lessons for organisations and researchers about how this can be achieved – watch this space!

About the authors

Liz Mear is Chief Executive of the Innovation Agency (the Academic Health Science Network for the North West Coast), Naomi Fulop is Professor of Health Care Organisation and Management at University College London