Herne, S. (2000), "Change promoting research for health services", International Journal of Health Care Quality Assurance, Vol. 13 No. 3, pp. 140-141. https://doi.org/10.1108/ijhcqa.2000.13.3.140.1
Emerald Group Publishing Limited
Many texts have been written on research and development for health services, particularly focussing on methodology. This book is a welcome addition which bridges a major gap in previous literature – how do we engage managers in the R&D process and ensure that the research which is carried out is actually useful in practice?
As a manager in a large teaching trust, this is a pertinent question. Many current government initiatives are pushing the NHS in this direction, but without much advice on how to do it. For example, clinical governance requires managers to ensure that the services provided by their staff are in line with evidence‐based practice and major public health initiatives such as Health Action Zones and encourage innovation and evaluation. The book not only recognises these issues but also formulates some specific ideas on how to approach them.
The initial section of the book gives a history of R&D in the NHS and the significant changes which occurred in the 1980s and 1990s. For those with little knowledge of the system it provides a useful overview and brings out the political dimensions of R&D which remain a key feature today. However, as with most areas of the NHS, policy has moved on since the publication of the book and the Clark report has introduced subtle changes to NHS R&D which are particularly relevant for the manager. Updates to this section will need to ensure that participants in R&D, whether they be clinicians, academics or managers, realise the increasing emphasis being placed on R&D as a means of pushing forward government strategy and the need for financial accountability.
The later sections of the book detail the basic model championed by the authors – research should be a collaboration of managers, clinicians and researchers which utilises the different skills of each group. This “new paradigm” aims to ensure the right questions are asked, the study design enables the question to be answered and the issues of getting results to influence practice are addressed at an early stage in the process. The authors then move on to suggest ways of promoting this collaboration in three key areas – doing research, commissioning research and putting research into practice. Each section draws heavily on the experiences of the authors and their collaborators setting up programmes of R&D in the North‐West of England.
Interestingly this model of manager, clinician and researcher is one which Barts and the London has adopted – ensuring peer review includes general and financial managers and addresses issues such as the strategic value of the research, its feasibility and relevance, for example. Comparing the authors’ suggestions to our own experience of bringing these groups together and widening the criteria used to assess the value of research tended to expose the weaker areas of the book. These should certainly be borne in mind by anyone putting the ideas into practice.
Bringing together a disparate group of people, with different professional backgrounds and different perceived levels of expertise inevitably ruffles a few feathers. Groups tend to go through the various “forming, storming, norming” stages before they work effectively. No one should under‐estimate the political sensitivities of multidisciplinary working. At a time when many clinicians feel their autonomy is being eroded, sharing power in the context of R&D can be an uncomfortable process. Some of these realities are mentioned in the book, but not given sufficient emphasis. In addition, the whole area of R&D management as a specialist, growing area of expertise and the role it can play in facilitating this collaboration is a major omission.
The second difficulty is the general under‐estimation of how much it is necessary to sell the idea of being an active participant to managers. For those working in small organisations, research may not be of major relevance and tends to come low down the list of priorities. Managers may well be interested, but it carries little weight in the grand scheme of things. To those working in larger organisations, particularly with a training function, the relevance is more obvious. However, research has to compete with all the other demands placed on these staff. Consideration of what would persuade managers to become involved would have sharpened the focus of the book. Experience in East London has suggested that there are a number of particularly powerful drivers:
R&D has a multiplicity of resource implications. It has the potential to save money, act as a major source of income or be a major drain on already restricted budgets. The financial dimensions of R&D carry real weight and an exploration of the issues or reference to other relevant information would have been valuable.
The ability to offer professionals the opportunity to become involved in research is important in terms of recruitment and retention. Whilst this is mainly true of the medical and dental professions, it is becoming increasingly apparent that other staff groups also want diversity in their work. The idea that some research’s main role is as a form of continuing professional development is not really explored.
Clinical governance has been a major aid to pushing research up the scale of priorities. The importance of this initiative and the ways in which research and development can form important planks of governance could have formed a central theme to the discussion.
These criticisms should not detract from the validity and importance of the message and the value of many of the ideas put forward. My only other concern was more concerned with the medium rather than the message. I suspect that a manager prepared to pick up this book and read through to the end would already be a convert. Those who need converting are unlikely to reach for a book and persevere through some long, detailed and technical sections. They need a medium which gets straight to the point and makes clear what’s in it for them.
Perhaps that is where R&D managers come in…