"We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research": A Research Impact Evaluation at a Regional Australian Hospital and Health Service

If health organisations and staff engage in research, does healthcare improve? Strengthening the evidence base through systematic reviews

BACKGROUND

There is an often-held assumption that the engagement of clinicians and healthcare organizations in research improves healthcare performance at various levels. Previous reviews found up to 28 studies suggesting a positive association between the engagement of individuals and healthcare organizations in research and improvements in healthcare performance. The current study sought to provide an update.

METHODS

We updated our existing published systematic review by again addressing the question: Does research engagement (by clinicians and organizations) improve healthcare performance? The search covered the period 1 January 2012 to March 2024, in two phases. First, the formal updated search ran from 1 January 2012 to 31 May 2020, in any healthcare setting or country and focussed on English language publications. In this phase two searches identified 66 901 records. Later, a further check of key journals and citations to identified papers ran from May 2020 to March 2024. In total, 168 papers progressed to full-text appraisal; 62 were identified for inclusion in the update. Then we combined papers from our original and updated reviews.

RESULTS

In the combined review, the literature is dominated by papers from the United States (50/95) and mostly drawn from the Global North. Papers cover various clinical fields, with more on cancer than any other field; 86 of the 95 papers report positive results, of which 70 are purely positive and 16 positive/mixed, meaning there are some negative elements (i.e. aspects where there is a lack of healthcare improvement) in their findings.

CONCLUSIONS

The updated review collates a substantial pool of studies, especially when combined with our original review, which are largely positive in terms of the impact of research engagement on processes of care and patient outcomes. Of the potential engagement mechanisms, the review highlights the important role played by research networks. The review also identifies various papers which consider how far there is a "dose effect" from differing amounts of research engagement. Additional lessons come from analyses of equity issues and negative papers. This review provides further evidence of contributions played by systems level research investments such as research networks on processes of care and patient outcomes.

Development of a team-specific research strategy using a modified Delphi method in a regional public hospital dietetics department

OBJECTIVE

Evaluate research capacity and culture among regional hospital dietitians, develop a team specific research strategy, and build research skills of novice researchers.

METHODS

The Research Capacity in Context Tool was used to assess current research capacity and culture at organisational, team and individual levels. Results were analysed using descriptive statistics and content analysis of free text responses. A modified Delphi method gained consensus regarding research capacity building.

DESIGN

Mixed method study.

SETTING

Dietetics department of a regional tertiary hospital (Modified Monash Category 2).

PARTICIPANTS

All clinical dietitians currently employed within the hospital (n = 20) regardless of employment duration.

MAIN OUTCOME MEASURES

Self-rated response to research capacity and culture to produce a dietetics-specific research strategy.

RESULTS

Fifteen dietitians (75%) completed the Research Capacity in Context Tool. The overall mean score was highest at an organisational level at 7.9 (IQR 2), and lowest at team and individual levels at 4.3 (IQR 2.7) and 4.9 (IQR 3.3) respectively. Common barriers to research included time, lack of skills, knowledge and support. Using the modified Delphi method 39 statements relating to research capacity building met consensus and informed the creation of a research strategy.

CONCLUSION

The results of the Research Capacity in Context Tool from this regional study reflect those reported in the literature at metropolitan sites. A dietetic-specific research strategy was developed to assist with increasing research capacity at a team and individual level in a regional setting. Evaluation of long-term outcomes post implementation will be the subject of further research.

Exploring the motivation of health professionals to engage with research at various career stages

BACKGROUND

Research is crucial for improved healthcare and better patient outcomes, but there is a current shortage of clinician-researchers who can connect research and practice in the health professions field. This study aimed to investigate the effect of career stage, previous training and involvement in research on health professionals' (HPs) motivations to engage in research while in public hospital clinical roles. HPs' perceived motivation concerning the importance, value, and barriers attributed to research during different career stages were examined.

METHODS

A mixed methods study design was adopted for this research. An online survey developed based on the Expectancy-Value-Cost (EVC) theory was distributed to HPs (doctors, nurses, midwives, and allied health professionals) in three North Queensland Public Hospitals. Data analysis included descriptive and inferential statistics for the quantitative data and content analysis for the qualitative text responses.

RESULTS

Three hundred and fifty-five responses were received. Prior research training and involvement in research influenced respondents' perceptions about the importance, attitude, motivators, and barriers to research. Attainment value was the overarching motivation for involvement in research and research training for all career stages and all professional HP groups. Positive attitude to research was significantly higher (P = 0.003) for the allied health group (27.45 ± 4.05), followed by the medical (26.30 ± 4.12) and then the nursing and midwifery group (25.62 ± 4.21). Perceived importance and attitude attributed to research were significantly higher (P < 0.05) for those who had research training (26.66 ± 3.26 and 28.21 ± 3.73) compared to those who did not have research training (25.77 ± 3.77 and 23.97 ± 3.53). Significantly higher (P < 0.05) perceptions of organisational and individual barriers were reported among early career (50.52 ± 7.30) respondents compared to their mid-career (48.49 ± 8.14) and late career (47.71 ± 8.36) counterparts.

CONCLUSION

The findings from this study provide valuable insights into the factors that influence HPs' motivation for research. The results underscore the importance of professional group, involvement in research, exposure to research training, career stage, gender, and organisational support in shaping HPs' attitudes, values, and perceived barriers to research. Understanding these factors can inform the development of targeted strategies to enhance research engagement among HPs and promote evidence-based practice in healthcare.

Co-implementation: collaborative and concurrent approaches to advance embedded implementation in the health sciences

There is a global movement towards stakeholder engagement in healthcare research. This movement has been catalyzed by a need to create context relevant evidence of maximal utility to health service provision and policy. The concept of "co-implementation" has potential to inform and extend these discussions of partnership and to complement the growing literature on collaborative implementation. Attending to this concept may preempt conceptual confusion and provide opportunities for sustainable and context-responsive embedded research necessary for the strengthening of health systems. In this perspective article, I seek to advance the discussion of co-implementation through an examination of the concept and through consideration of it merits to the health sciences.

Embedded Research: Possibilities for Learning Health Systems Comment on "'We're Not Providing the Best Care if We are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service"

Brown et al show that research investments in an organization with a research and translation mandate can make important gains for research impact across domains, including quality of care and patient outcomes. Their multi-stage mixed methods evaluation provides insight into research capacity development in rural health systems in Australia and draws attention towards persistent geographic inequities. In extension of this important contribution, here, a focus on the "what and the why" of embedded research is offered. Specific attention is paid to the sustainability potentials of systematized data capture systems, funding-operational mandate alignments, researcher-scientist career pathways, and networked approaches to mentorship.

If Providing Best Care Means Being at the Cutting Edge of Research, Should It Be Implemented System-wide? Comment on "'We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service"

The COVID-19 pandemic intensified debates about the desirability of integrating health research systems into healthcare systems. An excellent evaluation undertaken prior to the pandemic examined a purposeful strategy to improve healthcare through an expansion in research capacity in the Townsville Hospital and Health Service (THHS), a regional service in northern Queensland. This comment puts that evaluation into a rapidly developing wider context, drawing on other work showing an association between research engagement in healthcare organisations and their improved healthcare. In most previous studies this impact arose as a by-product of the research activity. The Townsville scheme went further. But while the evaluation identified some progress and impacts, they were patchy, not system-wide. Recent pre-pandemic studies showed that going even further and integrating a health research system across a national healthcare system markedly improved healthcare, despite continuing challenges. The UK's research experiences during COVID-19 are giving additional momentum to this approach globally.

Cutting Edge Research? Realistic Expectations of Priorities, Scope and Engagement Comment on "'We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service"

While research is linked with informed decision-making and improved healthcare delivery and patient outcomes, the process of generating and translating research evidence in practice and capturing its impact can often be challenging. Based on document and database reviews and interviews in a regional Australian health system, Brown et al discuss the challenges of assessing the impact of research investments over a ten-year period. This commentary explores three inter-related lessons from this article for developing and sustaining a research culture and supporting translation in a health system: (i) achieving a shared definition and expectation of research; (ii) the importance of stakeholder engagement particularly for research prioritisation; and (iii) enabling research across a system. In doing so, it highlights the role and value of engaging knowledge generators and end-users from clinical, management and community domains not only in research development but most importantly in research prioritisation.

Bibliometrics, the "Clinical Diagnostics" of Research Impact Comment on "'We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service"

Following the Townsville Hospital and Health Service (THHS) strategic revision as a "research-based" institution, Brown et al have investigated the impact of THHS research, and its key drivers, based on 15 stakeholder interviews and two quantitative indicators. This commentary argues that the quantitative analyses and findings would have benefitted from applying evaluative bibliometrics, hopefully, conducted by experienced bibliometricians. We present the potential of bibliometrics for assessing the scholarly impact of research, as well as a few examples of its application to the case of THHS, for informing research policies and strategies.

Translating, Contexting, and Institutionalising Knowledge Translation Practices in Northern Australia: Some Reflections Comment on "Sustaining Knowledge Translation Practices: A Critical Interpretive Synthesis"

In this commentary, we reflect on how the three processes of translating, contexting, and institutionalising knowledge translation (KT) practices, as introduced in a critical interpretive synthesis on sustaining KT, might be drawn on to improve KT sustainability in the northern Australian health system, and some likely challenges. The synthesis provides a useful reminder that health systems are social systems and offers an analytical framework against which to map approaches that aim to align knowledge production and utilisation. By positioning "places" of knowledge utilisation and actor roles and networks as key to KT sustainability, the framework also offers the potential to draw attention to non-clinical settings, actors, and relationships that are central to improving health, but that may be historically neglected in KT research and scholarship.

Retrospective Impact Evaluation Continuing to Prove Challenging Irrespective of Setting: A Study of Research Impact Enablers and Challenges Cloaked as an Impact Evaluation? Comment on "'We're Not Providing the Best Care If We Are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service"

The original article provides a detailed and insightful presentation of enablers and detractors for research participation, translation, and impact, at a regional Australian hospital and health service. This information builds on existing knowledge, from the perspective of a non-metropolitan healthcare organisation. It stands to inform all healthcare organisations keen to embed research into their institutions. However, what the article fails to do is present the results of the research impact evaluation in a systematic and useful way for the reader to assess the benefits of research investment by a healthcare organisation including delivery of better quality care and improved patient outcomes. This commentary suggests why such information is critical to justify continued research investment by healthcare organisations and to showcase the potential benefits of the embedded research model. It also discusses the limitations of undertaking impact evaluation retrospectively and suggests that a prospective approach coupled with proper data collection systems and processes upfront could help future reporting of organisational research impact.