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How to cultivate a research culture in the emergency department
- 1. Building a research culture in the emergency department January 2015 @kellyam_jec
- 2. Conflicts of interest & permissions No conflicts of interest to declare The content of this presentation may be used freely for educational purposes It was first presented at the Society foe Emergency Medicine Singapore conference in January 2015
- 3. Objectives To understand: What a research culture is and why it is important The barriers and enablers to building a research culture in emergency departments Strategies to build and maintain a research culture
- 4. Ideal emergency department activities Clinical care Research Education & training Quality and safety improvement
- 5. ED activities – the real world! Clinical care Research Education & training
- 6. What stops ED having a research culture? “Research is not core business” “There is no time” “It’s too hard/ complicated/ etc” “Our ED is too small/ not university-affiliated/ etc” “Research projects are complicated and need a special team” “Research does not directly impact my patients” “There are no research questions that are relevant & feasible for our ED” “We get no credit for it” “It’s a doctor thing” “Research does not change the way I do things”
- 7. What is research culture? Research: generation of new knowledge Culture: shared values, attitudes, patterns of behaviour and structures that give an activity significance
- 8. Disabling words ‘Research’ is a disabling word for many ED team members An alternative perspective is that research is all about evidence Generation and/or application of evidence to do things better
- 9. Why is a research culture important for an ED? Facilitation of quality improvement by: Assisting transfer of evidence into practice Investigating clinical questions arising from local practice By research By search of literature and collation of evidence Enhancing ED standing within an organisation or system Harnessing the creative/ innovative power of ED team Enhancing ED morale and teamworkThere can’t be a great ED without a research culture
- 10. What does a good research culture ‘look like’? Values, attitudes and beliefs Strive to do things better Encourages questions and ideas for innovation AND has a structure to process them Focusses on important questions Collaborative and supportive Celebrates and communicates its success Structures Will vary depending on the environment Examples a research interest group a ‘named’ research centre
- 11. Letting you into a secret..(Shh) Joseph Epstein Centre for Emergency Medicine Research (JECEMR) 1 part-time research leader 0.2EFT 1 x 0.8 EFT research nurse/ co-ordinator 1 x 0.2 EFT admin officer Internationally recognised High publication output >12 papers per year over last 5 years Attracts higher degree students Attracts international fellows Attracts grants
- 12. How do we do it? Supported by: Small amount base funding by health service Several emergency physicians who assist with projects ad hoc in non-clinical and own time A group of keen nurses who come up with questions and assist with data collection Several registrars in training who do a project (and get published) – usually in own time Ad hoc students from universities Collaborations within and outside our health service
- 13. Why do they do it? Variety of motivations Individual Career enhancement Research interest but limited skills/ time See the benefits in patient care change Feel valued and included Collaborators EDs rich caseload Different perspective to inpatient cohorts
- 14. Barriers to research culture in ED Competing priorities, especially clinical service delivery Time Skills Funding Structural barriers Fear of change Lack of recognition/ credit
- 15. Enablers for research culture in ED Lots of important clinical questions generated from clinical caseload Lots of patients! Large, well educated team (medical, nursing, allied health, etc) Well placed for cross-discipline & system level research Used to teamwork and collaboration Relatively under-researched area
- 17. Structures to support a research culture Will vary with environment Aims: Promote importance of research to EM practice Encourage use of research/evidence to guide practice Process questions and ideas from ED team Build research skills (general and research management) Communicate about research – internal and external; ‘up’ & ‘across’ Facilitate collaborations –internal and external
- 18. Structures to support a research culture ED leadership team support Literally, ‘on the agenda’ Variety of structures Research interest group/ research team Named research group Clarity about how to feed in ideas and how they are handled
- 19. Activities of research group Awareness raising Regular research rounds Rotating poster displays in ED Research exchange events with other departments/ other ED Display of publications in ED Celebration of success – grant, publication, practice change Recognition of contribution Education and capacity building Structures to support mentoring Build relationships with other disciplines/ EDs for collaboration Host annual research forum (showcase)
- 20. Building and maintaining the culture Changing culture is difficult and takes time! The key is COMMUNICATION Why it is important What’s going on currently That all ideas are valuable and welcome That research is a team game and that everyone is part of the team That everyone’s contribution is appreciated That research is core business because of its link to quality Of successes Of value to patients and the organisation
- 21. An international parable Heaven and Hell In hell, all the people are seated around a long dining table piled with delicious food. Each of them has three-foot-long chopsticks. They are all starving because they are only trying to feed themselves. In heaven, same set up, long table, lots of food, three-foot-long chopsticks, but everyone is eating well because they are feeding each other.
- 22. Messages for research culture Research culture’s top priority is good relationships across the research team Respect other members, elevate them, advocate for them, celebrate their success With good relationships, results will follow
- 23. Leadership and research culture Building a research culture requires transformational leadership Influence Inspire Motivate Stimulate Disseminate Encourage diversity of thought Recognise and reward Coach and mentor
- 24. The importance of influencers What is an influencer? Harnessing influencers Inform and consult Listen and acknowledge Explain Touch base frequently Respect as an important part of your team
- 25. Leveraging off other research teams Often more established research teams in your organisation Learn from them Collaborate with them Establish mentoring relationship with their senior members Use them to advocate for ED research team
- 26. ‘Research is a doctor thing’ Nursing practice is a major contributor to ED care Emergency nursing very under-researched Safer handover Medication safety Triage Nurse-led models of care Educational needs Interdisciplinary teamwork in critical cases End of life care in ED Same applies to allied health/ other clinical groups
- 27. Importance of collaboration Vibrant research culture is truly collaborative All ideas for projects are welcomed and valued When projects are being planned, there is meaningful consultation with any clinicians impacted During projects there is regular two-way feedback about progress (and problems) It’s not just about the lead researcher – all contributors are appropriately acknowledged News about presentations and publications in shared with and valued by all members of the ED Growing & mentoring is promoted
- 28. Research culture is ...
- 29. Question #1 A research culture requires some resources e.g. non-clinical time, funding, etc. How do you convince the organisation to give you support?
- 30. Question #2 When you collaborate with other groups within your hospital or external groups there is the possibility of being ‘used’ by the other party. How can this be avoided?
- 31. Question #3 How do you get EM residents started in research in a busy clinical environment?
- 32. Question #3 Research review Journal club Research round Research project Sell benefit to their career & to patients Work in pairs with a nominated supervisor Keep the project small and manageable but relevant Provide active coaching and mentoring Retrospective data collection is probably more manageable for a first project Meta-analyses are also a good option
- 33. Question #3 Examples of recent projects my residents have done. Validation of the Ottawa SAH rules (Emerg Med Austral) Failed validation of predictors of surgery in renal colic Do paramedics over-oxygenate patients with COPD? Predictors of positive blood cultures in patients with pneumonia (HKJEM) The Relative Efficacy of Adenosine versus Verapamil for Treatment of Stable Paroxysmal SVT in Adults: A Meta- analysis.(Eur J Emerg Med)
- 34. Question #4 Is there a need for a formal research attachment (no clinical load) in an EM residency program?
Notas do Editor
- Research can be a disabling word – remote, scary
- IP, authorship, funding, effort