Getting research into health care practice: General lessons and the case of geneticsSue DopsonSaïd Business SchoolTempleton College
Virtuous Circle R&D inform/ shape synthesise Practice Evidence implement
Research Aims • Interested in – what makes new knowledge credible and therefore utilised?; Why do actors decide to use new knowledge? What is the significance of the social context in which the innovation is to be embedded? • Research has explored the complexities of implementing EBM. Undertook an overview of 49 cases involving 1400 interviews in healthcare organisations with colleagues • Qualitative methodology; potential contribution to organisational studies
Key questions of the work together • Would it be additive to ‘scale up’ or aggregate analysis by taking an overview across a suite of seven related studies of the diffusion of innovation? • If so, what are the rules of method to be adopted? • In what ways are ‘the rules’ different from those apparent within the conventional systematic review paradigm?
Process adopted • What constituted the databases, transcripts, final reports • Reread of all final project reports • Summaries of key points/themes • Draft coding structure to examine reports • Collective discussion/simultaneous analysis
Issues arising • The varying theoretical approaches and values of researchers • The varied interpretation of key terms in research design, methods and data analysis • The importance of trust (structures/incentives) amongst researchers if sharing of knowledge is to occur
Common Core Themes • Robust evidence is not sufficient to facilitate diffusion • The interpretation of evidence is socially constructed • Evidence is differentially available for different professions • Hierarchies of evidence exist • Other sources of evidence are important e.g. tacit and experimental
Common Core Themes • Professional networks shape behaviour • Professional boundaries inhibit knowledge diffusion • Context as an influence on diffusion • Opinion leaders as change facilitators and inhibitors
Policy and Managerial Implications • No magic bullets • No magic targets • Receptive context for change includes: • A favourable history of relationships between professionals and managerial groups and between professional groups • Sustained political and managerial support and pressure for change at a local level
Policy and Managerial Implications • A supportive organisational culture, clear goals for change • Effective and good quality relationships within and between local groups • Access to opportunities to share information and ideas within the local context • The introduction of organisational innovations to foster improved and effective interchanges between groups
Barriers to Knowledge Flows - Questions • People – Can the relatively poor exchange of information between groups working within healthcare be improved? • People – Why are the complex ways in which clinical practice is influenced ignored? • Organisations – Are organisations structured to facilitate the sharing of fragmented information flows? • Institutions – Are we yet to put in place the right frameworks for today’s knowledge flows?
Recent research – Scoping Exercise: Genetics knowledge Parks Bids put in to D of H and DTI 6 ‘parks’ funded Each park gets approximately £5 million over 5 years
Data collected in the first stage: • Expectations of Genetics Knowledge Park • Views on the two key objectives of the funding • To ensure results of research translate to the NHS • Commercialisation
Expectations of GKP • A range of views. Extremes. + ‘bringing things together’ - ‘not much in practical terms’
Barriers to translationSome emerging themes • The history of genetics research in Oxford • The speed of the production of scientific knowledge • The state of the Oxford Trust • The role of the media • Ethical issues • Public understanding • Clinical groups understanding
Barriers to translationSome emerging themes • The capacity of the NHS to fund and deliver the results of the research • The impact on roles, educational training • The non awareness of purchasers • Background, career paths, incentives • The organisation and management of ‘genetic services’ • Physical location of the actors involved • What is NHS R&D
Commercialisation • Range of views e.g. ‘markets are quite small, there is little money to make’ to ‘the commercial spin outs cover a wide spectrum’
Issues • Implementation, what thinking is being done on this. • Knowledge intermediaries • Education and training • How will this all impact on patients • Other GKPs, how will the six ‘GKPs learn from each other • The role of funding bodies
I need help . . . . . please • Significant research questions?