Enabling NHS Staff to Contribute to Research: Reflecting on Current Practice and Informing Future Opportunities

Short abstract

This article considers how NHS staff can effectively contribute to health research.

Abstract

RAND Europe was commissioned by The Healthcare Improvement Studies (THIS) Institute to conduct a rapid review of the evidence base on engaging NHS staff in healthcare research. The review aims to help inform THIS Institute's efforts to establish and implement an effective strategy for engaging staff across the NHS with its research activities. The study will also be useful for other organisations and initiatives seeking to engage NHS staff in research.

The study is focused on a diverse NHS workforce that is directly or indirectly involved with care delivery, including individuals in clinical, managerial, administrative and support roles. The terms NHS staff, healthcare professionals and NHS workforce are used interchangeably throughout this study.

Staff across the NHS have important expertise to contribute to healthcare research. However, they also face competing demands on their time, not least delivering patient care. Any efforts to mobilise wide-scale NHS workforce engagement with improvement research need to understand what motivates staff to engage with research; to consider staff constraints; and to establish practical and rewarding mechanisms for harnessing their expertise, commitment to high-quality and safe patient care, and interest in evidence-based practice.

This Report Aims to Contribute to the Evidence Base on How to Effectively Engage NHS Staff in Research

RAND Europe was commissioned by The Healthcare Improvement Studies (THIS) Institute to conduct a rapid review of the evidence base on engaging NHS staff in healthcare research. The review aims to help inform THIS Institute's efforts to establish and implement an effective strategy for engaging staff across the NHS with its research activities. The study will also be useful for other organisations and initiatives seeking to engage NHS staff in research.

The study is focused on a diverse NHS workforce that is directly or indirectly involved with care delivery, including individuals in clinical, managerial, administrative and support roles. The terms NHS staff, healthcare professionals and NHS workforce are used interchangeably throughout this study.

Staff across the NHS have important expertise to contribute to healthcare research. However, they also face competing demands on their time, not least delivering patient care. Any efforts to mobilise wide-scale NHS workforce engagement with improvement research need to understand what motivates staff to engage with research; to consider staff constraints; and to establish practical and rewarding mechanisms for harnessing their expertise, commitment to high-quality and safe patient care, and interest in evidence-based practice.

This review is primarily concerned with active NHS staff engagement in healthcare research, for example in helping shape research questions or priorities, rather than considering NHS staff as study participants. Further, while many organisations make an important contribution to research capacity in the health system through clinical academic posts and research fellowships, this review outlines how the capacity of a wider NHS workforce can be mobilised effectively and through innovative channels.

Based on a rapid evidence assessment and interviews with experts, this study examines why and how NHS staff contribute to research, associated engagement challenges and potential enabling mechanisms. The study also summarises the evidence on the impact of NHS staff engagement on research processes and outcomes. Based on these insights, we provide a series of recommendations for THIS Institute and other organisations to consider, when developing strategies for engaging healthcare professionals in research.

Throughout our study, we use the words involvement and engagement interchangeably, reflecting the general practice in the literature. However, we recognise the need for the terminology related to NHS staff contributions to research to be clarified in the wider knowledge base.

Why Do NHS Staff Engage with Research?

NHS staff choose to engage with research for a variety of reasons, including: (i) personal interest in a research or evaluation topic; (ii) cultural expectations in some clinical disciplines that involvement in research is part of the job; (iii) a belief that research and evidence can improve the quality and safety of healthcare, patient experience and patient outcomes; (iv) a positive prior experience with research; and (v) prospects for career development, as well as reputational or financial benefits.

How Do NHS Staff Engage with Research?

NHS staff can contribute to research in a variety of ways. These include: (i) consultation-based involvement, where health professionals respond to requests for their views or for advice on various research issues; (ii) directly working with research teams, for example in advisory board roles or as members of clinical research networks; and (iii) as members of a research team, for example as co-researchers or members of project steering committees.

What Are the Challenges to NHS Staff Involvement in Research and How Can They Be Addressed So That Contributions Are Effectively Enabled and Rewarded?

While there are a range of challenges to effective NHS staff engagement with research, there is an evolving evidence base on enabling mechanisms and rewards that could be pursued. The key enablers and challenges discussed in the literature and emphasised by the experts consulted for this research are overviewed in Table 1. The rewards for engagement that matter most to NHS staff include career progression and professional development opportunities related to learning new skills, recognition in professional communities and reputational awards, and seeing the impact of their research contributions on clinical practice.

Table 1.

Challenges and enablers of effective NHS staff involvement with research

Driver of Effective Involvement	Challenges	Enablers
Governance, management and infrastructure	Lack of sufficient funding for research and/or a lack of awareness about how to access it. A weak or opaque governance and management infrastructure (e.g. an unclear, inadequate or unwieldy bureaucracy for research and development (R&D) approvals can inhibit research applications). A failure to recognise research contributions in job plans, appraisal systems and career pathways. Lack of clear leadership and definition of roles for NHS staff within research projects. Absence of information-sharing about research opportunities.	Formal roles such as the appointment of research champions in provider organisations. Clear guidelines and procedures for developing and implementing research to assist NHS staff. Well-designed time-management systems that recognise research activities of NHS staff. Financial recognition through pay progression. Mechanisms for awareness-raising about opportunities for involvement in research and how NHS staff can engage. Accessible funding for research. An enabling research infrastructure (equipment, facilities, information infrastructure). Organisational practices which free up time and headspace to engage with research.
Individual and organisational capacity to be involved in research	Lack of knowledge and skills needed to do research. Lack of access to relevant training. Lack of dedicated time to be involved in research.	Integration of research within clinical practice through the promotion of evidence-based practice and engagement with research in clinical decision making. Access to training for NHS staff to develop their research skills and confidence. Mentoring and informal teaching. Collaboration with other organisations and individuals with an active interest in research.
Culture, attitudes, values and behaviours	Insufficient support by leadership and associated lack of strategic planning for R&D at organisational level. Divergent views among NHS stakeholders about what topics are important to research. A perception that research is a specialist activity and outside the domains of some health professions. A perceived inability to influence practice through research. A perception among health professionals that it can be difficult to work with research teams in academia. Concern that time demands on NHS staff to deliver research tasks can be underestimated by research teams.	Organisational leadership and culture which values and promotes research activity. Recognition and awards for involvement in research. Effective mechanisms for the dissemination of research findings. A compelling narrative about the research. A culture of feedback on the impact of staff contributions to research and wider impacts. Exposure to research training in early career stages.

What Is the Impact of Engaging NHS Staff in Healthcare Research?

Evidence on the impact of engaging NHS staff in research is scarce, with more focus on the potential benefits of engagement rather than systematically evaluating impact. However, there is widespread acknowledgement of a diverse range of potential benefits. One such benefit is impact on research studies. This includes impacts on identifying research priorities, on the quality and relevance of study designs for the health service and patients, on enabling participant recruitment, on helping implement studies in healthcare provider contexts, and on influential communications and dissemination of research findings.

Another benefit is impact on the wider research system, for example through attracting funding for research and increasing the willingness of colleagues to engage with research. There is also potential for healthcare professionals engaged with research to influence clinical practice, for example through spreading knowledge about evidence-based practices and promoting the uptake of evidence. Finally, engagement with research can also have a personal impact on individuals, for example through the development of new skills, professional development and career progression.

Recommendations

We offer the following recommendations to inform strategies for engaging NHS staff in research:

1. Identify the most meaningful types of contribution on a case-by-case basis, depending on what best fits the needs of a project and organisation. Involving the NHS workforce with research effectively does not mean that they need to be involved at every stage or in every aspect of the research process.

2. Ensure at the outset that research roles and responsibilities are clear and well defined, and that there is a shared understanding of the purpose, scope and remit of healthcare staff engagement, and of the timelines associated with engagement and support systems available.

3. Consider the balance between targeting specific groups and opening up engagement more widely. Some research opportunities will benefit from the involvement of diverse types of staff, while others will require input from a specific community. Organisations should make explicit why and how different professional groups can add value.

4. Consider accessing existing data sources that shed light on issues that matter to the NHS workforce in order to complement internal approaches to identifying and specifying important research questions and to establishing study designs.

5. Frame opportunities for involvement in a way that aligns with what motivates NHS staff to engage with health research and communicate the relevance of the opportunity to their everyday work and job roles. This includes communicating how involvement opportunities relate to both personal and professional interests, and making clear how the research links to the potential benefits for clinical practice and patients.

6. Pay attention to the language used in communicating with healthcare staff and avoid unnecessary jargon. A clear and compelling narrative is important for communicating why an individual should get involved with research.

7. Consider how best to use established and trusted professional networks, in combination with online or other types of direct awareness-raising and recruitment, to help share information about involvement opportunities and attract NHS staff to take part.

8. Make engagement opportunities user friendly. Collaboration and contributions have to fit into the lives of busy NHS staff and must be relevant and easy to execute.

9. Establish and nurture relationships with leadership in healthcare provider organisations to ensure an enabling culture for research, including outside of leading research-active healthcare provider settings. Engage with executive leadership, middle management and frontline staff on the basis that engagement at all levels is needed to achieve organisational buy-in, and support organisational environments that enable staff to have time and headspace to engage with research.

10. Ensure that opportunities to recognise and reward involvement in research are created and communicated to healthcare professionals. This includes making clear how contributions will be acknowledged and how feedback on research progress and impact will be communicated, and working with professional bodies to consider benefits and rewards in terms of the career development of NHS staff.

11. Organisations should reflect on how they can contribute to research capacity building in the NHS through information-brokering roles. These extend beyond sharing information about research opportunities or study results. An example would be bringing together and sharing information on training and mentorship schemes in the health research system.

12. At the outset of a project, establish evaluation plans for assessing and learning about the process, outcomes and impacts of NHS staff engagement with research. Commit to sharing and disseminating learning from such evaluations. The evaluation plans for each project should make clear whether the focus of the evaluation is on the quality of the staff engagement process itself and/or on the outcomes and impacts of the engagement.