How the 'lonely ones' can drive meaningful change

Three years ago we wrote an article for HSJ with Tara Lamont about why the NHS must evaluate complex service changes. 

There were two key messages. Without trying to measure the impact of changes, we will never know which ways of organising services will be most helpful in maximising benefits for patients and minimising costs. Researchers can help service leaders clarify goals, gather relevant evidence and identify appropriate methods to assess service changes, local and national.

We are now collaborating with a range of service, academic and PPI colleagues, including Breid O’Brien from the Health Innovation Network, on why embedded researchers are an effective way of supporting service leaders and front line colleagues to make effective evidence-based changes.

Shared responsibility

The definition of embedded research we are working with is: trained researchers, co-creating knowledge in a health or care setting in order to improve the organisation and delivery of care, spending part of their working week in the health or care service. In other words… researchers being part of a local team with a shared responsibility for the success or failure of an improvement initiative.

Typically an embedded researcher will be employed by a university but based in a host organisation, usually an NHS trust or local authority. This means that the researcher gains an understanding of the service pressures, politics and other contextual factors that the organisation faces.

Embedded research roles are often lonely ones, speaking truth to power, disrupting existing practices and finding solutions to support front line colleagues

They can then understand which research questions will make an impact to the lives of patients, residents or staff, who operate within these services and how best to maximise that impact. Sometimes these are very difficult questions.

One of the embedded researchers we recently met had been working on the issue of the effects of Universal Credit on the residents of their host organisation, the local council.

Three case studies of embedded researchers in action were published in BMJ Open in 2018. They worked in Bristol and central and east London. The researchers were integrated into local teams. In the central London programme they were also allied to the local Collaboration for Leadership in Applied Health Research and Care.

In Bristol, a two-way collaboration between the university and local Knowledge Mobilisation Team saw the healthcare workers embedded into the university for part of their week, as well as the researchers being embedded into the work of the health sector teams. In the East London initiative the researcher worked across a number of provider, commissioner and local government organisations.

The embedded programme is deepening our understanding of what work is being rolled out in this field. It will develop a toolkit of products for those organisations who would like to host an embedded researcher and for researchers considering these roles. These will be very practical products such as sample job descriptions, person specifications and adverts.

With the rest of the embedded research team we’ve worked with existing embedded researchers to consider some of the issues that can make them successful/ affect their work. These include their level of independence, political dynamics, the intensity of contact they have with the research subjects and their capability and capacity to produce knowledge.

Embedded research roles are often lonely ones, speaking truth to power, disrupting existing practices and finding solutions to support front line colleagues. Academic Health Science Networks, ARCs and their equivalents in Wales and Scotland provide support for researchers. The embedded programme is massively strengthening this support by establishing a network for embedded researchers.

We know that for busy managers hearing about stories of good practice from other sites is a great way to learn and enables us to then apply that learning to our everyday practice. On the embedded website embeddedresearch.org there’s a series of webinars and other resources to view, with more content being developed over the next 12 months.

Service leaders, clinicians and managers are committed to getting the best outcomes for their service users. Embedded researchers can support you with small or wide-ranging changes and give your staff the input they need to run impactful service.