Driving healthcare change through collaboration between researchers and health and social care professionals. Burke, M., Carroll, C., Hodgins, M., Lyons, R., McDarby, G., & Power, M. . Introduction. Results .
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Driving healthcare change through collaboration between researchers and health and social care professionals.
Burke, M., Carroll, C., Hodgins, M., Lyons, R., McDarby, G., & Power, M.
Collaboration between health and social care professionals and researchers offers possibilities to advance theoretical and empirical knowledge, while ensuring that research is driven by clinical need and findings are translated into practice. Whether it is adequate examination of best practice, quality of care or evaluation of interventions, health and social care research is essential to promoting and ensuring evidence based practice (Metcalfe et al., 2001). Nonetheless, participation in research by health and social care professionals is frequently lower than for other populations. Here, a diverse range of factors have been identified as contributing to this situation including workload demands, resource constraints, survey fatigue, weak research cultures and differing professional discourses and interests (Metcalfe et al., 2001; Asch et al., 2000; Flanigan et al., 2008).
The themes identified broadly fell into two categories – the gaining of access to potential participants and the gaining of participation. These categories were arranged in a framework, with four themes emerging as core issues. These core issues included ‘fear of regulation and distrust of researchers’, ‘variation across agencies regarding procedures and practices’, ‘the power of gatekeepers’ and ‘paternalistic attitudes of health and social care professionals to vulnerable populations’. These in turn were seen to manifest in the context of a poorly articulated research culture within health and social care services.
In spite of the researchers’ diversity of backgrounds and areas of interest, this study identified the gaining of access to potential participants and the gaining of participation as the two most significant challenges. Both challenges were shaped by marco (health system complexity), meso (organisational structures and cultures) and mirco (procedures and practices) level influences. Nonetheless, it was identifying, accessing and negotiating successfully with gatekeepers that most often dictated the extent of success or failure. Moreover, there were frequently multiple types and layers of gatekeepers whether in the form of research ethics committees, administrative staff and/or health and social care professionals. As reflected in the literature, gatekeepers’ engagement is shaped or constrained by a complex milieu that can include expectations and previous experiences (Mulhall, 2003), the absence of a culture of research (Walter et al., 2004), a lack of an appreciable translational value (Woolf, 2008), a sense of paternalistic duty toward vulnerable populations (Alexander, 2010), time and resource demands (Van Lente & Power, 2014) and a concern over the backdrop of litigation and blame (Cusack, 2000). If such considerations point to the need to create environments that can nourish and support a research culture and partnerships between all stakeholders, the increasing focus on continued professional development (CPD) presents as a significant opportunity. Certainly, the provision of CPD points for engaging with research, whether as gatekeeper, participant, researcher or research partner, would appear a potentially powerful catalyst for encouraging greater collaboration between health and social care professionals and researchers.
This study was designed to explore the barriers and facilitators experienced by health and social care researchers, by analysing their personal experiences of conducting research in health and social care settings over time using the Critical Incident Technique (CIT) (Flanagan, 1954).
The sampling strategy was convenience sampling. Academic staff (n=6) of the School of Health Sciences, from a range of disciplines and with extensive experience of conducting health and social research, participated. The Critical Incident Technique (CIT) was employed and participants focused on three key areas – the Situation, the Action and the Outcome.
The Situation: brief description of the scenario that was concise and sufficiently descriptive for subsequent analysis.
The Action: description of the action(s) in context, identifying the significance of the event, describing what worked and what did not.
The Outcome: review of the actual or potential outcome of the action.
Analysis: four members of the research team read and re-read each incident and identified recurring themes in light of the research questions (ie. facilitators and barriers). Subsequent to this, the researchers classified the data into categories and sub-categories. The final stage involved the development of an overall thematic framework (Gremler, 2004).
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Asch, S. et al. (2000). Problems in recruiting community-based physicians for health service research. Journal of General Internal Medicine, 15: 591-599.
Cusack, D. (2000). Ireland: Breakdown of trust between doctor and patient. The Lancet. 356, 1431-2.
Flanagan, C. (1954). The Critical Incident Technique. Psychological Bulletin. 51 (4), 327-358.
Flanigan, T., McFarlane, E., & Cook, S. (2008). Conducting research among physicians and other medical professionals. A review of the current literature. Accessed January 2014. http://www.amstat.org/sections/srms/proceedings/y2008/Files/flanigan.pdf
Gremler, D. (2004). The Critical Incident Technique in service research. Journal of Service Research. 7(1), 65-89.
Metcalfe, C. et al (2001). Barriers to implementing the evidence base in four NHS therapies. Physiotherapy, 87 (8), 433-441.
Mulhall, A. (2003). In the field: Notes on observation in qualitative research. Journal of Advanced Nursing. 41(3), 306-313.
Van Lente, E., & Power, M. (2014). Standardising assessment instruments and care planning in Ireland. Quality in Ageing and Older Adults. 15(1), 1-15.
Walter, I. et al. (2004). Improving the use of research in social care practice. Social Care Institute of Excellence. Bristol.U.K.
Woolf, S. (2008). The meaning of translational research and why it matters. Journal of the American Medical Association, 299(2), 211-213.