How to improve the way medical research is applied in frontline care Collaborations for leadership in applied health research aim to encourage staff in the NHS to adopt research-informed practices.
For the past five years, new teams of people have been trying to improve the way medical research is applied in frontline care.
Following on from the initial nine schemes, the number has been expanded to 13 and there has been research into how the organisations work.
Ministers see these schemes – collaborations for leadership in applied health research (CLAHRC, pronounced 'clark') - as a success, and to varying degrees they have fulfilled their initial aim of encouraging staff in the NHS to adopt research-informed practices.
But they have been closely scrutinised by researchers, including a team from Brunel University, London and RAND Europe, a non-profit institution that helps improve policy and decision-making through research and analysis. In a paper published this month in the Journal of Health Services Research and Policy we have picked out some of the key success factors arising from the rich experience of the first wave.
Perhaps the most striking feature of the two that we studied, one covering Cambridgeshire and Peterborough and one in the south-west of England, was the complexity of their task.
Many people assume that it is enough to present clinicians and managers with the results of medical research for them to adopt those techniques that work best. This is quite untrue. The scale and pace of medical advance poses a continual challenge, and there is often a gap between recommended care and actual care received.
The CLAHRCs have worked hard to find ways to engage with managers, clinicians and patients, drawing on expertise from business schools and the social sciences as well as from medical research. One researcher said, "We have learned that there are principles to short-circuiting having an idea and getting it into the hands of people who can use it."
Efforts to identify and undertake research that matters to the NHS need to be multidisciplinary. Ideally, representatives of each of the key groups that the CLAHRC wants to influence should be included.
This is partly to help provide insight into the particular concerns of each group. The more time the CLAHRC spent working closely with groups, finding out what information they need to support rational decisions, the more likely it was that group members could be persuaded to make changes if presented with compelling data.
Multidisciplinary working also allowed CLAHRCs to deliver their message to particular groups in an acceptable way, often by someone recognised as part of the group.
One example of this was when ambulance crews in the south-west started using tranexamic acid as a method of controlling bleeding. This technique was already in use by military doctors, and introducing it to the ambulance service was made easier because CLAHRC had already invited crews onto its evidence-based training courses.
Also important was local knowledge and good personal relationships to help researchers negotiate a way through different interests and organisations, often unique to each area.
NHS structures are complex and they change regularly. The rapid pace of change has meant that CLAHRCs have had to adopt a flexible, iterative process, putting forward their ideas, absorbing feedback, reviewing, adapting and re-presenting.
It is through this slow and painstaking process of building credibility and goodwill that they have been able to increase the ability of the NHS to absorb and act on research.
The process has been helped, though, by local NHS organisations who are required to match the research funding provided by central government; funding is still seen as a measure of the seriousness with which an initiative should be treated.
People establishing a CLAHRC for the first time may be alarmed to discover that there is no "road map" guaranteeing success. But, in contrast to those pioneers who set up the first collaborations five years ago, there is now a wealth of practical experience to draw on. These partnerships have proved their worth in delivering better healthcare; we hope that academics, NHS staff and patients will welcome the insight they can bring. Guardian Professional