Implementing recommendations to optimise professional support in the medical workplace: A participatory approach.

Abstract

Introduction: The professional support (including remediation) of practising doctors has not been widely researched, and there have been no studies to date that have implemented evidence-based recommendations about support and remediation in the medical workplace. Our goal was to bridge the gap between research and practice in respect of optimising the delivery of professional support programmes for doctors in their workplace.

Methods: We used a participatory-action research (PAR) approach to implement recommendations from a previous study, RESTORE 1, in five UK sites: two hospitals, two professional support units and a professional support body. Informed by observations and interviews, we conducted a series of workshops (12 in total, with 35 relevant stakeholders [doctors, professional support leads, coaches etc.]). These were recorded and transcribed for analysis. Analysis was deductive, using the Promoting Action on Research Implementation in Health Services (i-PARIHs) framework, the core constructs of which are innovation, recipient, context and facilitation.

Results: Important aspects of innovation related to the perspective, language and tone of the recommendations and the finding that recipients often valued other types of evidence rather than research. In terms of the recipients, sites' motivation for engagement in the study was crucial. We identified a variety of enabling/constraining contextual factors including resources, type and role of organisation and responsibilities of the professional support programme, as well as macro-level changes. The extent to which participants adopted the recommendations (facilitation) was limited.

Discussion: The successful implementation of research into practice is challenging. However, new learning, shifts in relationships and increased awareness are equally valuable outcomes. 'On-the-ground' change takes time, depending on trust, relationships, partnership working and understanding context. Unfortunately, this does not align well with research systems that privilege studies with measurable outcomes produced within a set timeframe. We call for more discussion in medical education about the process of implementing research findings into practice.