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Laura Eyre and Martin Marshall: Researchers in residence

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Laura Eyre, Research Associate and Martin Marshall, Professor of Healthcare Improvement at UCL give an inside perspective on moving improvement research closer to practice.

Publicada em: Saúde e medicina
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Laura Eyre and Martin Marshall: Researchers in residence

  1. 1. Researchers-in-Residence; moving improvement research closer to practice Laura Eyre, Research Associate, UCL Martin Marshall, Professor of Healthcare Improvement, UCL Nuffield Trust; Evaluation of complex care 2015
  2. 2. What problem is the researcher-in- residence model trying to solve? 1. There’s a lot of useful Health Services Research out there but it doesn’t have sufficient impact on practice 2. Evaluation findings are rarely of much use to those being evaluated 3. Researchers aren’t scratching where decision makers are itching
  3. 3. Defining features of the in-residence model 1. Core member of an operational team 2. Bring specific expertise in: • the evidence base and its interpretation • theories of change • evaluation, both formal and informal • use of data 3. A focus on negotiation and compromise rather than imposition – ‘a meeting of experts’
  4. 4. “The scientific man has been too scientific and the practical man too practical and the result has been unfortunate for both” WM Barton, quoted in JAMA, 1912 “Evidence-based practice needs practice-based evidence” Larry Green, 1974 Origins (1): separation of academia and practice
  5. 5. Origins (2): use in other sectors Barnsley FC Poet-in-residence British Library Innovator-in-residence Department for Education Researcher-in-residence
  6. 6. Adapted from Canadian Health Services Research Foundation, 2003 Problem Knowledge transfer Solution Improved dissemination of evidence to users (‘Push’) or demand for evidence from users (‘Pull’) Knowledge production Work together to define, refine, generate and implement evidence (‘Co-creation’) Nature of evidence A product A process Nature of decision process One-off event Iterative social process Origins (3): knowledge mobilisation
  7. 7. Origins (4): participatory research • Collaboration across a range of relevant stakeholders • Desire to solve practical problems • Focus on initiating change through greater understanding and shared learning • Emphasis on reflection and collective inquiry • Willingness to find common ground through negotiation and compromise • Grounded in experience and sensitive to context • Orientation to agency and democracy • Reject polarised epistemologies
  8. 8. Examples of UCLP’s R-in-R models University College Hospital Great Ormond Street Hospital Waltham Forest, East London And City (WELC) Newham General Practice Whittington Health Setting Acute provider Acute provider Collaborative made up of CCGs, acute providers, mental health provider and AHSN General Practice/Primary Care Acute Provider/Integrated Care Organisation Type of expertise Social Science - Anthropology Operational Research Social Science – Critical discourse Social Science - management Health Services Research Seniority Senior Mid-level Early Post-doc Mid-level Research Fellow with MSc Workforce model Full time 3 years Part time 3 years Full time 2 years Full time 2 years Part time 1 year Positioning in the organisation Executive Team With front line clinicians Across levels Across levels Service Improvement team Funding Organisational host funding Organisational host funding Organisational host funding Organisational host funding External funding (through a fellowship scheme) Types of projects OD, strategy on clinical leadership Improving patient flow Evaluation, implementation Evaluation, implementation Evaluation, data analysis, strategy development,
  9. 9. Early learning • The model seems attractive to commissioners and providers • Some academics like the idea – particularly those at the beginning and end of their careers - but many have concerns • The required skill-set is becoming clear: credibility; ability to listen and reflect; excellent communication skills; negotiation and influencing skills; resilience • The current service environment is a challenging one in which to build relationships • It takes time to develop trusting relationships – initial suspicion that the researcher is ‘just another management consultant’ • Some conversations are very sensitive – knowing when to intervene can be challenging • The role of patients in the model is not yet clear • The ethical dimensions are uncertain
  10. 10. Applying the Researcher-in-Residence model in East London Evaluating the Waltham Forest, East London and City (WELC) integrated care pioneer programme
  11. 11. Waltham Forest, East London and City (WELC) integrated care pioneer programme
  12. 12. WELC integrated care pioneer programme
  13. 13. The role of the Researcher in Residence in WELC: stakeholder expectations “…the executive group want a more embedded and process oriented evaluation…focuses less on whether the programme ‘works’ and more on how to use research evidence to optimise effectiveness of the programme…” “…hold up a mirror to the implementation of the integrated work on the ground…. the role is wide ranging…expected to negotiate their contribution once in post …likely to include : • being a visible and accessible resource for evaluation… • working with stakeholders to interpret international evidence for the WELC context… • examining engagement and understanding of stakeholders… • examining implementation of interventions on the ground… • comparing approaches to implementation across WELC… • exploring facilitators and barrier… “…expected to utilise established social science methods … including analysis of documents, participant observation of meetings and implementation, interviews with stakeholders...”
  14. 14. The role of the Researcher in Residence in WELC: my contribution • Critical and interpretive approach to policy analysis • Critical discourse analysis – Language as social practice – Importance of context – A focus on the processes of recontextualisation  the vision and objectives of integrated care are translated through phases of development, implementation, and delivery from a centralised perspective to a local perspective and from a strategic to an operational perspective • Optimising delivery of the programme objectives • Responsive, relevant, useful  an exciting opportunity!
  15. 15. Challenges: getting embedded and engaging with key stakeholders Friday 3rd October 2014 This week has been almost overwhelmingly full of new and increasingly complex seeming information. The complexity of the WELC programme combined with what feels like my own ignorance (?) or naivety (?) around aspects of the programme can feel very frustrating. No amount of reading has, to date, prepared me for the often impenetrable language and complex practices of the people, workgroups and teams engaged in the IC programme. The process is slow and often bewildering. Nonetheless I am, slowly but surely, making connections with a wider network of people involved in IC not just at a WELC programme level, but also, increasingly, at a local borough level and at a provider level…there is hope…!
  16. 16. Strategies: Getting embedded • Be prepared to get uncomfortable (!) • Networks and contacts: – In the programme (‘gatekeepers’ and ‘key informants’  ‘sponsors’) – Outside the programme (UCL, embedded researchers, mentors) • Be visible (physically and electronically) • Use key forums to negotiate your role and your position within the programme (Evaluation Steering Group) • Develop key contact points, i.e. meetings, and attend regularly: – IC board meetings in Newham/Tower Hamlets/Waltham Forest – WELC wide workstream meetings – IC steering group/board/delivery group/operational meetings in provider organisations • Research diary – this is valuable learning! Not physically embedded in one organisation/place but embedded in the space between strategy and delivery
  17. 17. Defining the scope of the research • Challenges: – One researcher in a complex, large scale programme that is conceptualised centrally, delivered locally – Demands and expectations – Negotiating a critical and qualitative approach in a traditionally positivist field • Strategies: – Be clear about my skills (and limitations) from the beginning – Evaluation Steering Group and executive stakeholders defined expectations of the evaluation prior to starting the role – Be clear about my position within the programme  between strategy and delivery – Discussion and negotiation of research design and methodological approach leading to collaborative development of protocol – agreed through Evaluation Steering Group – Continuous communication, negotiation and reflection based on emerging findings, programme developments, etc.  reflective discussion and action planning sessions – Clarity re. milestones, timelines, processes, etc. Defining the scope of the research = an ongoing process
  18. 18. Getting evidence into practice • Challenges: – Demonstrating value – Influencing development across WELC with limited time and resources and multiple responsibilities • Strategies: – Communication and regular updates to all stakeholder partners – Negotiate expectations and timelines – be honest – Phased approach to data analysis and negotiation  start with high level analysis for quick feedback and early discussions; buy time for more detailed analysis following negotiations – Be reflexive and embrace interpretivism  knowledge and learning are co-created so don’t be afraid to share early and emerging findings – but do caveat – Find tangible areas to demonstrate value and impact – i.e. MDT development across WELC – Be flexible about the approach – negotiate approach for specific context/practice/person
  19. 19. Getting evidence into practice: emerging findings A highly complex programme in which complexity is often underrepresented (and therefore underestimated?) Contradictory discourses around IC: • ‘scale and pace’ vs. it takes time – there is no quick fix • Innovation and transformation vs. existing structures and risk averseness • Empowering patients vs. this is not the right time/place to engage them A continuum of engagement – full buy in to vision/ethos of IC regardless of role, background, length of service, etc. – “this is the right thing to do” BUT fragmentation at level of interventions and enablers, i.e. service delivery
  20. 20. Any questions?