At the NHS Providers' Governance and Quality Conference 2021– Fresh Perspectives: complexity, risk and relationships, from 17-20 May, there will be a session on 'problem-sensing boards'. These are boards that listen to the signals from their internal hard and soft data to guide decision-making. Here we highlight the potential benefits to boards of including health services research as part of their intelligence and becoming 'research-engaged boards'.
Providing boards with timely and appropriate intelligence is essential to guiding decisions. The case for Boards to engage with clinical research as part of their intelligence, as well as to produce their own clinical research, has already been made. It is widely recognised that research-active healthcare settings have better outcomes and patients report receiving better care. We argue here that intelligence provided to boards often lacks the contribution of timely, appropriate and contextualised health services research.
Health services research (HSR) is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organisational structures and processes, health technology, and personal behaviours affect access to health care, quality and cost of health care, and ultimately our health and well-being. The main goals of HSR are to identify the most effective ways to organise, manage, finance, and deliver high-quality care; reduce medical errors; and improve patient safety.
By including contextualised HSR within the intelligence examined, boards have the potential to be better at 'problem sensing' but also to make better informed decisions.
Senior Fellow
By including contextualised HSR within the intelligence examined, boards have the potential to be better at 'problem sensing' but also to make better informed decisions. Research engaged boards are also positioned well to shape their local HSR agenda to better suit their information needs and also to align any HSR projects happening on site with their decision-making timepoints.
The barriers to HSR uptake – and a crucial role for boards
There are barriers in the production and use of research in NHS organisations.
NHS staff have reported across a number of studies of their declining capacity to undertake or engage in clinical research. This finding no doubt applies to health services research, as well.
At the board level, research has found that when financial and performance pressures mount a focus on intelligence or research surrounding important issues like quality can be lost. Another study found that the diversity and complexity of external reporting expectations and requirements that NHS organisations face make it challenging to create unifying visions or agree objectives on safety and quality.
One key enabler on the uptake of research findings in NHS organisations is the extent to which board members engage with evidence.
Senior Fellow
Yet, one key enabler on the uptake of research findings in NHS organisations is the extent to which board members engage with evidence. A study in the US found that boards that paid greater attention to clinical quality and more effectively engaged with quality metrics had managers who better monitored quality performance. Other studies have noted the positive influence of board engagement with quality on clinician engagement on the quality agenda, and specifically clinical board engagement with QI with more in-depth QI activities. Research has also found that board teams who reflect on their own roles in identifying and addressing safety and quality problems can be a powerful driver of change that delivers real benefits for patients. A 'research-engaged board' making HSR evidence-informed decisions will no doubt have a trickle-down effect to the rest of the organisation.
How to embed HSR – and how Health Services Research UK can help
HSR UK is keen to help support boards to embed HSR into their intelligence by helping trusts gain access to evidence at critical timepoints, when Boards, managers, and staff need it most. Yet, more than filling a gap in evidence on an ad hoc basis, HSR UK is keen to support boards to make the HSR research agenda sustainable. Sustainability means embedding research into the culture of the organisation.
If boards are willing to create a vision for how research can be used and that vision is linked to a research-supportive culture in the organisation, and cultures are supported by easy access to timely evidence, then it is possible to sustainably embed research practices. There are a range of easy actions that can get boards started – for example, think about how a HSR can be aligned with improvement and innovation agendas, or creating a committee or role with responsibility for linking with HSR UK or research dissemination centres, such as those at NIHR.
As you take time away from your day-to-day to enjoy the NHS Providers Governance and Quality conference, we ask you to spend some time thinking about what might it take for your organisation to become a research-engaged, high performing health organisation? And what role might you and your board play? Contact us with any questions, we'll be undertaking some research on 'research-engaged boards' in the coming months.
Find out more about problem sensing boards at our Governance and Quality Conference 2021 taking place online over four days from 17-20 May. Tickets are free for members – book your place today.
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