Hard grafting: how to get organisational research used by busy healthcare managers

The last twenty years has seen a marked increase in the volume of scholarly outputs on how evidence gets used in policy and practice. There has been a turn towards more complex and adaptive thinking – we now know, for example, that evidence journeys do not follow straight lines and that research often plays a small part in decision-making. Theoretical advances have identified multifaceted systems and dynamics which need to be activated for research to land. But have we lost something in rejecting old-fashioned linear models of evidence use?

This blog explores the distinct challenges for getting organisational evidence used by healthcare managers and highlights the efforts needed to make that happen.

Epistemic, cultural and organisational barriers

I recently completed a PhD bringing together a decade of publications around the work needed to get organisational research used by healthcare managers. Existing evidence tends to focus on the ways in which doctors and nurses use clinical research. But complex, or context dependent, organisational research is more difficult for healthcare managers to access. It is often poorly organised and indexed; it lacks agreed or single hierarchies of study design; and it can be hard to synthesise.

In government health policy and planning, peer-reviewed research is also largely limited to biomedical or public health research. For example, the government’s recent Ten Year Health Plan for England contains only a handful of health services research studies among its 272 references. Missing are links to relevant high quality organisational studies such as research on hospital at home or the impact of additional roles on general practitioner (GP) workload. The Plan is dominated by statistics, surveys and analysis from government departments or think tanks and unpublished data from small-scale service case examples.

This reflects, perhaps, a culture in which service leaders and managers do not look to organisational research to support them in service transformation or system change decisions. There is no equivalent, for healthcare managers, of the National Institute for Health and Care Excellence (NICE), offering approaches to translate organisational research into practical guidelines.

Given these barriers, hard graft is needed by both researchers and managers to transform research into evidence which is useful – especially as much of this work is not visible or valued.

What can we do differently?

Drawing on my publications and professional experience supporting a national health services research programme and evidence centre, here I offer some potential strategies.

1. Researchers can take active steps to extract, contextualise and format findings through channels that managers use.
2. Managers must work hard to access and interpret complex research. I use worked examples of telehealth and twelve-hour nursing shifts to show the critical appraisal skills managers need (and often lack) when making sense of evidence of different kinds.
3. Intermediary bodies can filter and summarise evidence and create active translation spaces where researchers and managers can transform research into actionable findings. Analysis of some innovations in this space add to a sparse literature of practical learning on the role of intermediary bodies.

System thinking versus pipeline – a ‘third way’?

The past decade has seen a shift towards nuanced, iterative, and system theories of evidence use. Yet, in older ‘pipeline’ models of knowledge transfer, there was often clearer guidance on dissemination strategies to tailor and target research to the intended audience.

Attention to collaborative or participatory forms of knowledge sharing, and to dynamic processes and systems is welcome. But the literature can be theoretical and abstruse. One recent integrated framework, for example, featured 37 constructs across five domains. This seems very abstract in the context of a healthcare manager making a business case for a frailty team or wondering what evidence supports different kinds of admission avoidance schemes.

There is a ‘third way’ – between the reductive linear thinking of old and highly sophisticated, but at times abstruse, knowledge mobilisation theory. This involves understanding complex evidence journeys and the systems in which research findings may be used, while extracting clear(ish) messages for managers. Even if definitive answers are lacking, research can, and should, in the words of Dennis Tourish “contribute to the progressive reduction of ignorance”, by lessening uncertainties on key decision points.

To make this happen, we need to illuminate the practical steps that: researchers can take to package and contextualise findings; managers can take to appreciate what research adds and to develop ‘good enough’ appraisal skills; and intermediary bodies can do to create spaces for meaningful dialogue between the two communities.

We can then make more visible the work needed to make organisational evidence used by, and useful for, managers in a health system under pressure.