Trust leaders say the top three areas in the NHS informed by health services research (HSR) are quality improvement, patient safety and service design.
Distinct from clinical research, HSR looks at how areas such as finance, social factors, organisational structures and operational processes affect the quality, cost and outcomes of healthcare. It can be generated by a think tank, university or from within a healthcare provider.
Although the benefits of HSR are understood by trust boards – according to respondents to a survey carried out by NHS Providers and Health Services Research UK this spring – there is significant variation in the extent to which research activity and engagement is embedded across NHS organisations. So what then, given the pressing need to meet changing patient needs and manage severe capacity constraints, would greater engagement with HSR offer trusts, staff and patients?
Supporting evidence-based decision making
Over four fifths (84%) of respondents said their trust board regularly discusses HSR. They see their responsibilities in oversight and challenge, assuring patient safety and ensuring research has the necessary ethical approvals.
They are, critically, clear on the benefits of HSR in supporting evidence-based decision making (90%) and a culture of learning (90%), as well as:
- improving quality of care and outcomes
- challenging current practice and norms
- identifying transferrable good practice and innovation
- developing staff capability, and attracting and retaining staff
- income generation.
Variability and barriers to engagement
There is considerable variability in the degree to which boards and their organisations are actively engaged with HSR.
Over half (52%) said engagement varies by department, often with a reliance on motivated individuals. For others (27%), engagement is ad hoc. Only 16% said it was a consistent expectation across departments.
Why is this the case? The top three barriers that prevent trust boards from engaging in HSR were: organisational prioritisation of other issues (mentioned by 62%), insufficient staff capacity (60%) and limitations on board bandwidth (53%). Lack of awareness of research, or difficulty accessing studies, were also frequently cited, along with staff and board capability, lack of funding, and insufficient links with health services researchers.
An appetite for more
There is, however, appetite across trusts of all types, with 87% respondents saying they wanted their board to be 'somewhat' or 'much more involved' with HSR in future. So how can the barriers be addressed, and what does good look like? Our survey results pointed to four key areas.
For an organisation to be informed by research, its board needs to be engaged
As they grapple with unrelenting operational pressures, board bandwidth is at a premium. This makes it essential to seek out those tools which best enable robust and clear-sighted decision making. The evidence-based approaches offered by HSR are one such tool.
While a number of respondents described their oversight role, others pointed to a more active approach. This was best summed up by the description of board responsibilities around "fostering a culture" and "recognising [HSR's] importance and making sure the infrastructure for research is both present and funded". The importance of having an effective and embedded research strategy was noted, as well as promoting the benefits of research, forming research partnerships, acting on recommendations to improve services, and encouraging both staff and patients to participate.
From board to ward, we need to develop research capability
The impact of staff shortages was recognised as a constraining factor, despite the acknowledged role of research in supporting recruitment and retention. A reliance on particular individuals driving research also came through in the results, pointing to a need to develop broader staff capability and engagement.
There was recognition too that trust boards needed to develop their own capability, with one respondent commenting that "boards are frequently made up of staff who have never taken part in research, do not understand the methodologies and therefore see it as a 'nice to have' option rather than a fundamental necessity".
National prioritisation and promotion of HSR
Respondents identified a range of support that would help their board. The most common response was better sharing of best practice and the practical benefits of research. Others mentioned the importance of research featuring more prominently in conversations at national and regional level, including a focus on evidence-based decision making and circulating findings, board development opportunities and funding to support research capacity.
Make research easier to access, share and use
Trust leaders primarily find out about HSR findings through research journals, email newsletters and board updates. But they would welcome more direct engagement driven by health services researchers. Respondents also pointed to a number of ways to make research easier to use:
- providing a summary of conclusions to support decision making
- making clear the implications for policy and/or practice
- using accessible language and avoiding jargon
- quantifying the impacts of the research
- supporting trusts' ability to apply learning within their organisation.
There is a clear opportunity and an appetite among trust leaders to develop their engagement with HSR, and to move towards whole organisation capability. Many would like to see a more mature and embedded approach, and are making the links between a more robust evidence-base and service priorities. Bandwidth and capacity are highly constrained in the NHS, but prioritising the role of HSR and becoming research active can offer valuable support and insight to help boards navigate those pressures.
This opinion piece was first published by National Health Executive.
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