Optimising the impact of health services research on the organisation and delivery of health services: a mixed-methods study

M. Marshall, Huw Davies, Vicky Ward, J. Waring, N. Fulop, Liz Mear, Breid O’Brien, Richard Parnell, Katherine Kirk, Benet Reid, T. Tooman
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引用次数: 1

Abstract

The limitations of ‘knowledge transfer’ are increasingly recognised, with growing interest in ‘knowledge co-production in context’. One way of achieving the latter is by ‘embedding’ researchers in health service settings, yet how to deliver such schemes successfully is poorly understood. The objectives were to examine the nature of ‘embedded knowledge co-production’ and explore how embedded research initiatives can be designed more effectively. The study used four linked workstreams. Workstream 1 involved two parallel literature reviews to examine how ‘knowledge co-production’ and ‘embedded research’ are conceptualised, operationalised and discussed. In workstream 2, a scoping review of exisiting or recent ‘embedded researcher’ schemes in UK health settings was carried out. Workstream 3 involved developing four in-depth case studies on such schemes to understand their mechanisms, effectiveness and challenges. In workstream 4, insights from the other workstreams were used to provide recommendations, guidance and templates for the different ways embedded co-production may be framed and specified. The overall goal was to help those interested in developing and using such approaches to understand and address the design choices they face. Embedded research initiatives in UK health settings. Data were sourced from the following: analysis of the published and grey literature (87 source articles on knowledge co-production, and 47 published reports on extant embedded research initiatives), documentation and interviews with key actors across 45 established embedded research initiatives, in-depth interviews and site observations with 31 participants over 12 months in four intensive case studies, and informal and creative engagement in workshops (n = 2) and with participants in embedded research initiatives who joined various managed discussion forums. The participants were stakeholders and participants in embedded research initiatives. The literature reviews from workstream 1 produced practical frameworks for understanding knowledge co-production and embedded research initiatives, which, with the scoping review (workstream 2), informed the identification and articulation of 10 design concerns under three overarching categories: intent (covering outcomes and power dynamics), structures (scale, involvement, proximity and belonging) and processes (the functional activities, skills and expertise required, nature of the relational roles, and the learning mechanisms employed). Current instances of embedded research were diverse across many of these domains. The four case studies (workstream 3) added insights into scheme dynamics and life cycles, deepening understanding of the overarching categories and showing the contingencies experienced in co-producing knowledge. A key finding is that there was often a greater emphasis on embeddedness per se than on co-production, which can be hard to discern. Finally, the engaging and influencing activities running throughout (workstream 4) allowed these research-rooted insights to be translated into practical tools and resources, evidenced by peer-reviewed publications, for those interested in exploring and developing the approach. Embedded research has a strong underpinning rationale, and more is becoming known about its design and management challenges. The tools and resources developed in this project provide a coherent evidence-informed framework for designing, operationalising and managing such schemes. It cannot yet be said with clarity that the potential benefits of embedded research are always deliverable, nor what the cost would be. With the means to describe and categorise different types of embedded research initiatives, more evaluative work is now needed to examine the relative merits and costs of different designs. This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
优化卫生服务研究对卫生服务组织和提供的影响:一项混合方法研究
人们越来越认识到“知识转移”的局限性,对“背景下的知识共同生产”的兴趣也越来越大。实现后者的一种方法是将研究人员“嵌入”医疗服务环境,但人们对如何成功实施此类计划知之甚少。目的是研究“嵌入式知识协同生产”的性质,并探索如何更有效地设计嵌入式研究计划。这项研究使用了四个相互关联的工作流。工作流1涉及两篇平行的文献综述,以考察“知识协同生产”和“嵌入式研究”是如何概念化、操作化和讨论的。在工作流程2中,对英国卫生环境中现有或最近的“嵌入式研究人员”计划进行了范围审查。工作流程3涉及对此类计划进行四次深入的案例研究,以了解其机制、有效性和挑战。在工作流4中,来自其他工作流的见解被用来为嵌入式联合制作的不同方式提供建议、指导和模板。总体目标是帮助那些有兴趣开发和使用这种方法的人理解和解决他们面临的设计选择。英国卫生环境中的嵌入式研究计划。数据来源于以下方面:对已发表和灰色文献的分析(87篇关于知识合作的原始文章,47篇关于现有嵌入式研究计划的已发表报告)、文件和对45项已建立嵌入式研究计划关键参与者的采访,在四个深入的案例研究中,对31名参与者进行了为期12个月的深入访谈和现场观察,并在研讨会中进行了非正式和创造性的参与(n = 2) 以及参加嵌入式研究倡议的参与者,他们参加了各种管理论坛。参与者是利益相关者和嵌入式研究倡议的参与者。工作流程1的文献综述为理解知识协同生产和嵌入式研究举措提供了实用框架,与范围界定审查(工作流程2)一起,确定并阐明了三个总体类别下的10个设计问题:意图(涵盖结果和权力动态),结构(规模、参与、接近和归属)和过程(所需的功能活动、技能和专业知识、关系角色的性质以及所采用的学习机制)。目前嵌入式研究的实例在这些领域中有很多。四个案例研究(工作流3)增加了对方案动态和生命周期的深入了解,加深了对总体类别的理解,并显示了在共同产生知识时所经历的意外情况。一个关键的发现是,通常更强调嵌入性本身,而不是联合制作,这可能很难辨别。最后,贯穿始终的参与和影响活动(工作流4)使这些植根于研究的见解能够转化为实用工具和资源,同行评审的出版物证明了这一点,供那些有兴趣探索和开发该方法的人使用。嵌入式研究有着强大的基础理论基础,其设计和管理挑战也越来越为人所知。该项目中开发的工具和资源为设计、实施和管理此类计划提供了一个连贯的证据框架。目前还不能清楚地说,嵌入式研究的潜在好处总是可以实现的,成本是多少。有了描述和分类不同类型嵌入式研究计划的手段,现在需要更多的评估工作来检查不同设计的相对优点和成本。该项目由国家卫生研究所(NIHR)卫生和社会护理提供研究计划资助,并将在《卫生和社会保健提供研究》上全文发表;第10卷第3期。有关更多项目信息,请访问NIHR期刊图书馆网站。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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