Research the ‘doing’

Similar to marrying research to local needs, some actors prognostically framed CLAHRCs as vehicles that should research the ‘doing’ of practice. Here they focused on tailoring their

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efforts on examining attempts at improving services in their local NHS organisations. There were two main methods of doing so.

First, in one CLAHRC that was more of a greenfield site, the decision was taken to prognostically frame the CLAHRC in terms of aligning CLAHRC activity with practice through the use of a quality improvement methodology. The idea here was to operate on the basis of improving the quality of service first and foremost, and to look how research could be employed in the process of doing so.

Clinical science academic, NHS facing, Case D: Well I suppose the guiding philosophy for the whole CLAHRC is that we actually want to make a difference, this isn’t just research, so in terms of what we are about it should be about making it better for patients and then making it better for staff. I know that sounds a tad grandiose, but the reality is that is kind of the premise, so we always try and bring it back to what are we trying to do and we are actually trying to make it better for patients. If we know we don’t do something terribly well, how do we learn from that and change it into something we do do terribly well.

The prognostic frame was based on the assumption that the ‘research’ should not be divorced from the ‘doing’.

CLAHRC management three, Case D: An implementation project which is using the evidence, but recognising that what we don’t know is the best way of implementing it in a specific setting… which is the whole point is second translational gap… Therefore, we aim to generate new evidence on how you implement things and how you do things in the real world. We’re not generating pure new evidence for this translational gap.

The idea was to generate new evidence about the how of implementation. In doing so, the model required that a number of different forms of evidence needed to be generated.

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CLAHRC management one, Case D: For evidence-based implementation we have a concept that there are three types of evidence that you need to be looking at. First, there’s evidence of what to implement, which often comes from previous controlled trials. Second, there’s evidence of how to implement, which we know a lot about and leadership once it’s working, ownership, measurement for improvement and those types of things. Third, there’s evidence of what happens when you implement things. We start essentially using the three steps of the model for improvement; what is it that you’re trying to achieve? How will you know that a change is an improvement? And, what changes can you make or test to see if they make you a desired improvement? And so it’s recognising it’s not about solutions, it’s about ideas.

The management of this approach involved asking NHS actors in the locality to engage with the CLAHRC to help the support innovation initiatives and to research the process on an ongoing basis. As we will outline in the next chapter, this shaped the way in which the CLAHRC engaged with different stakeholders in rolling out its activities.

The second approach differed in that it did not employ a strict quality improvement methodology, and rather than seeking new service innovation projects, it sought to engage with existing initiatives. Therefore, researching practice worked through a process of establishing what the important service innovation projects were in the local region, with a specific eye on selecting the larger, more organisationally focused projects, and then building into the project performance and ongoing evaluation systems, both formative and summative.

Social science academic two, Case E: It took me a long time to understand what was going on in the XXX CLAHRC, and the other day the penny finally dropped. He’s a genius. Rather than scrabbling around for bits of matched funding here and there, he’s taken a bigger picture perspective. He’s said to the local NHS organisations, ‘what are the big service innovation projects that you have at the moment? I’ll get the CLAHRC to work into them to provide a real time evaluation’. You can’t get any more embedded than that can you? And it deals with the issue of matched funding all in one. Genius!

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The added advantage of this approach, which was different from the ‘marrying approach’, was that it enabled researchers to be embedded into the local NHS organisations’ activities from day one. In this way it was more than a ‘marrying activity’, it was more about a ‘working into’ process. The model was also one that aligned well with established ways of working for the NHS organisation and one where management were able to retain control over resources and the way projects were run over the course of CLAHRC.