| Anna’s very, very visible. She’s very easy to talk to. And she’s approachable . . . Anna makes it . . . now part of the conversation . . . [research is] more and more becoming a part of the daily conversations at work I would sayMarkKaren:I think the embedded part, the difference it makes is that, it’s a little bit related to what I said before about the being, being there . . .Interviewer:Physically?Karen:Yeah, you’re not going looking for the lengths, you’re not going looking for the partnership, you’re already there, you’re in it, you know, so the co-production is natural and real because if you’re embedded, then what’s happening is coming out of the fact that you’re there | Olivia:So she was visible around the hospital, she was seen by staffInterviewer:And is that important?Olivia:I think so because, so the world of academia is over there, the world of health is over here . . . the world of academia is a mystery sometimes, isn’t it, to some, particularly if . . . they’ve not had any more further dealings in terms of research . . . | . . . the majority of the time I spend over at [place] because that’s where our base is . . . I like to be in the thick of things and that’s what I really, really enjoy about my role because through writing these narrative reports I’ve started to get a really . . . good understanding of the service . . .KarlaShe provides a level of security for people, that they’ll say about her being there because she’s employed by the trust, she gets the red pay packet and holidays that they do. She walks in the same door they do. So she’s not scary, she has that level of being around all the time. So she . . . and she belongs, she has that level of belonging. And she also . . . she’s good at, err, I don’t know almost how to put it really. But it’s . . . people want to be acknowledged that their work is hard and tough and we’re asking them to do extra. And because she’s there all the time, because they know her, because she’s doing things for them and with them all the time, they understand and feel that she is with them and on their sidePeggy | . . . there’s this thing of running into people in a hallway or in the kitchen and striking up a conversation or, you know, walking with a member of staff who comes across another member of staff and says ‘oh, have you met [deleted]? She’s an embedded researcher’ . . . there’s that type of dynamic that you can only get if you’re there . . . even if you’re sitting answering e-mails but people are seeing you working with the team and you know they have a quick question about something that we’re doing together you know, they can come up. So it’s completely different than them sending you an e-mail and you reply, you know, it’s that type of dynamic . . .Bella | Visibility | Home/location | Logistics | Structure |
| . . . the first part for me was getting [name] an introduction to, to the chair of that, and for [name] then to create that space for herself within that environment . . .. . . who’s going to be your allies . . . you know, because it can be a very lonely place for a person, if they didn’t have thatKaren | These posts are so dependent on having people at very senior level who can appreciate what you do . . .Interviewer:That process of getting your contract sorted . . . that negotiation?Jane:It was done by my colleague, so she achieved that when she was Head of the Faculty of Nursing . . . she’s very good at networking and getting money . . .Interviewer:. . . the development, and its sustainability, seems very dependent upon people, individuals and relationships?Jane:Yes | I really think that making, err, those key relationships work is an important thing to be able to do. I do think it is all down to your relationship. You’ve got to find the . . . at the university you’ve got to find the professor who is willing to work with you, who’s willing to be open-minded. Who’s willing to be helped and guided to work within the NHS and that’s not everybody by any means . . .PeggyLorraine:[Name] was working entirely in the medical research field in, in a portfolio of services that, when I joined the trust, trust, fell into my portfolio. And, and I didn’t know anything about her probably for the first 3 or 4 years that I was in post because she was hidden with the medical consultants supporting medical research in the trust. And then there was a bit of a, there was a bit of a dispute I think one day, over who funded her post. I can’t recall the detail of it but I think the university used to recharge us for her time or somethingInterviewer:RightLorraine:And her budget disappeared as a few things have a habit of doingInterviewer:MmmLorraine:A consultant wrote then and her job was at risk and a consultant wrote to me and said it’s absolutely terrible, blah, blah, blah, you can’t possibly leave somebody with [name]’s skills and expertise, you know the trust, the trust, our research programme will fall to pieces without her. Can you do anything? . . . so I went to meet with her . . . to hear her side of the story and what was going on. And I felt when I met her that she had so much more to offer the trust, in addition, in, in addition to the support that she gave to the consultants | What happened to us at [deleted] is we had two people who were really engaged but then they left the organisation, which is a major setback for us . . . So that also became quite an important lesson to say ‘OK, yes you have to have champions and sponsors, but also you need to spread’ . . .BellaSo the origin of that study was that the clinical leaders of the changes in [deleted] and [deleted] were old friends and over a coffee or beer or whatever at some point they said, and they were implementing as it happened different ways of doing this reorganisation of centralising acute stroke care and they said gosh, wouldn’t it be good to get some research funding to study these changes to see if they make any difference and if, you know, the difference between our two models. So they came to us and said are you interested in doing this and so from the very beginning we had buy-in to this research from the senior clinical leaders who then, and then we had buy-in from, you know, people involved . . .Julie | Relationships | Role creation and sustainability | Logistics | Structure |
| RES: Yeah, so I’d say that one of the quadrants definitely would be about [name] and the . . . director, would be one of the inner circle. But then I guess you’ve kind of like . . . she’s not my line manager, she’s my kind of equivalent, if you like, in the NHS. So she’s the Head of the . . . Directorate. . . she’s the person that I report to if you likeAnna:I guess she’s the person who I kind of report to [in academia] And also I collaborate closely with [Jill], because our research interests are similar. But also because [name] was the person who used to do this job, or something similar to this job, a few years agoInterviewer:What is . . . what is [name]’s title now?Anna:So she is Leader in Rehabilitation Research . . . we’re going through a bit of structural in management team, the way universities do . . . | | Peggy:Sometimes I can have a voice where she can’t again just because of my role. Erm, so . . . and I can say things that perhaps she can’t because of my role. So I think on a personal level I’m a sort of mentor and supporter of her, erm of a . . . on a work level I can enable her, sometimes, to do things that . . . erm, to get things happening that she wants to get happening . . . So what I can do is I can go and I can say I understand that that post is difficult at the moment to this. But you know [university] are paying half of it and as such I think you should be looking at what you can do to support that because I represent [university] and we are paying for half of this and we want to see it happenInterviewer:YeahPeggy:[Name] can’t say that but [name] can let me know what needs to be said | I think I supported the team as in once they had a project and they had a project lead, they worked with them and I really only saw them at our regular steering group meetings or I think they called them steering groups, but equally, they would contact me if they were having any challenges or things we as a trust weren’t, you know, moving things on . . . or if they felt their resource wasn’t being used well enough . . . my role was to try to make sure, you know, I suppose it was just making sure things, that everyone was clear on what they needed to do and it was never a problem because it was often people just busy at the frontline and needed a bit of a prod to think ‘oh yeah, I mustn’t forget I’ve got to do that’ . . .. I would say ensure that you build up your support mechanisms within academia before you start . . . you’ve got that peer support or a good line manager, you know, somebody that you can really, a mentor, coach, whatever, in the academic world. I would say at the beginning of your tenure as an embedded researcher be willing to commit quite a lot of time on relationship-building because that is what will get you through difficult times in the projectJanetBella:. . . one of the projects that we worked on . . . we had to go and tell them ‘your service is not fit for purpose, it’s not well designed’ . . .Interviewer:What was that like?Bella:So we had to go in and talk to him about it . . . this is the evidence and this is our role and we are critical friends . . . and if we didn’t share these findings, then we wouldn’t be doing our job . . . you need to constantly remind yourself that, you know, you are there to do a particular job. You are not like any other staff member within that organisation, you’re there as a researcher and there is that . . . academic layer to the work that you’re doing where you need to maintain that critical point really. . . . [T]here is that risk of, you know, of your, of creating potentially, you know, working really well with the service . . . becoming . . . subsumed into that and that affecting the way in which we’re doing research; there is always that risk . . . one of the key things that helped us a lot . . . is to have people in the team like [deleted] for instance. So a chief investigator on a professor level, someone senior in academia as well who is kind of part of the team but she’s not an embedded researcher . . . she would always be like the bad boss . . . she would be the person who said ‘no we’re not doing that’ . . . and she does that at a very senior level and we use that on purpose. So for me . . . as a researcher who has to go into the trust on a daily basis and has to build relationships . . . | Managerial/senior support | Support systems | Logistics | Structure Process |
| Which . . . So they’re the people that actually probably understand my role better than everyone else, so I mean [name] who I share an office with, is a really experienced researcher, but has never done anything like in her research, in trials, for this, so in terms of our similarity in that way is small and she’s not likely to have a connection with anyone in any of the other quadrants of the NHS but she’s probably the person that understands my role the best ’cause I come in and I talk about what I’ve been doing or I moan about it, or I’m facing some sort of challenge, so actually the boundary’s really good I think because it’s those wee people that are my support unitAnna | | So another person that I get, kind of have quite a bit of contact with, but I don’t know, I don’t know how to put her in terms of influence, is [name] . . . Talking to her she spans across the trust and [place]. So yeah, I suppose she’s, she’s very much like a partner, partner in crime I guess. So between us we run the quality improvement group for the directorate . . . She was brought in as the strategic lead to basically get research on people’s agendas. So she is, in terms of the pecking order, very high up within the organisation, and it was her job to integrate research into people’s day jobs . . . I’d say peer support to be honest, because we meet every couple of months, and we just chew the fat about life in the different organisations and things . . . Because [name] is still quite active in actually doing research, doing evaluation. So it’s kind of peer support that she’s done a PhD, I’ve done a PhD, and there aren’t many of us, what are we doing with that now? So with that one it is more peer support I guess, and thinking about and talking about the development of the quality improvement agendaKarla | There was one group that was created by some of the other researchers working under [name] work. I think you’ve talked to [name] already, so he’s had two embedded researchers at the time and they created a little support group and I think [name] who worked with [name] was part of that. [Name] in my department was the project lead and basically we got together and talked about the problems and things we were facing and trying to find out what the strategy that other people were using. It was a really good groupBella | Informal/peer support | Support systems | Logistics | -
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| Those who have come into our organisation in the last 3 years, erm have welcomed the opportunity and they have someone with that dedicated role. And because our ethos and our approach is an excellent in trying to build the . . . build that internal enquiry into [name] and into staff about saying actually how am I contributing to the four pillars? And so from a clinician and individual trail, from a service manager, how am I creating the conditions and giving staff the time to undertake evidence-based practice?Gillian | Sometimes these things are a question of timing and when, when you’re talking about you know, about much more transformation of leadership styles and more compassionate leadership styles, then, then I think you know, these sorts of ways of working, would, will be able to flourish much more, because it, it inverts the organisation. So it gives power to the frontline staff really. And it sort of, it fits with all the you know, I’m sort of showing my age really but you know, all the stuff around shared governance and you know, we map the history of some of this stuff. I think some of these things are just sort of points in time and I think it’s just when things need to converge to get the right ingredients to enable something like this to flourish. But I, I still believe that you, you have to try, even if, because it’s, it’s a long process to change the culture I thinkClare | Peggy:I’ve got my master’s and he said ‘that’s really good [name], if you were to apply for your job now’, bearing in mind I was a staff nurse, ‘I wouldn’t give you it because you’re overqualified’Interviewer:Oh my goodnessPeggy:And I thought I’ve got to get out, I have got to get out. This isn’t . . . this is not a place that is going to embrace me or people like me . . . that is an important bit of story because that really, for me, is the trigger for why I’m supporting people like [name]. . . But there were no opportunities when I was a girl at that time, for me to do what I would have loved to have done, which was be a clinical academic and to have that sort of mixture of erm a foot in both camps. And it was very evident that the culture wouldn’t have been there, even if I’d have created that, or had the power to create that I wouldn’t have got anywhere, as you can tell with attitudes like that, I really wouldn’t have got anywhere at allInterviewer:RightPeggy:So from then obviously, err I just . . . I spent 10 years at the [university] erm my job went from being a 1-year contract to, erm doing . . . made a permanent post. And from [university] I went up to [place], from [place] I went to [place] and from [place] I came here to [university] as a chair. So that’s obviously over a career of research in research time. But that is . . . my personal experience has always been like wanting the support embedded researchers or research . . . or clinicians that want to do research, erm and that’s really where my background comes from and where that influence is, how I feel, strongly I feel about embedded researchers | So in a way, my involvement was by chance because somebody suggested this as an opportunity and I just thought well actually this makes a lot of sense because if you’re involved in quality improvement, embedded research just seems like so naturally sits with it, but to be fair, I didn’t quite, it was a bit like, it just seemed natural to me rather than I was really ‘oh, my God this is the best thing ever’; it just made sense . . .. It was sort of by chance but actually made more sense to me and I’m really interested in research the sort of idea that we don’t wait for an end point, that was for me the sort of idea that this was translating and people working alongside actually you know, you’re learning as you do as well as [unclear-0:03:10.2] at the end, that for me was the biggest drawJanet | Leadership style (empowering others) | To support | Motivations | Intent |
| . . . and I just said . . . ‘If research was only about being more efficient, then first of all we’re never going to motivate staff to be more involved in research and second of all, I wouldn’t be a researcher if that was what it was all about’, you know, ‘I’m not driven by money and by savings, um, and actually I do genuinely perceive research as being crucial to improving people’s lives and improving the care that we deliver’ . . .AnnaHannah:. . . she’s quite focused on understanding what the clinical issues and clinical priorities are and has been using that to shape the research that she’s involved in . . .. There is that buy-in from the services that actually this is something that we said we’d like . . . people have really engaged with that . . . they understand the drive and the purpose behind it, so there’s a definite link between clinical practice and her role . . .Interviewer:Would it be fair to say you’re almost striving for a change in culture?Hannah:Yes absolutely . . . her focus is about undertaking research or undertaking research that actually will have an impact on practice, because it actually makes a difference to people and their outcomes . . . that’s one of the reasons why Anna is such a strong candidate for us . . . we’ve got people who are working so hard to deliver services, that unless for the majority of people, they would be undertaking and participating in research or applying research that they know it’s going to have an impact . . . | . . . no disrespect but she’s got a better understanding of the health-care arena and the constraints of the health-care arena, more so than perhaps somebody who’s got an academic research background but has never actually encountered a health-care setting. So the potential for Jane to pick up on things that somebody who’s not had that background is increased because she understands more, because she’s been embedded she understands more about the challenges . . .Sally | I did my PhD in [topic], and I got to the end of that, and I thought I don’t want to be a full-time ivory tower academic that does research that’s philosophical or abstract or metaphysical or any of those kind of things, I wanted to do research that had some applied meaning, that would mean something to [patients and their families] . . .Victoria | . . . one thing that keeps you going is the idea that what you’re doing has benefit beyond just you, social benefit rather than just private benefit.. . . Applied, particularly Health and Applied Research I would say it’s such an immediate social benefit, relative to something more theoreticalTim | Superiority (patient care focus) | To do/support | Motivations | Intent |
| Researcher:. . . when you meet with someone, and they’re like ‘Oh no, I would never be a researcher, like that is just so boring’ [chuckling], which happens all the time, it does happen, it’s happened to me in, in this job as well, I mean that is a personal insult to all of us, who have chosen um research as a career. Err and that it does happen at err different levels, so um there’s NHS [place] are developing that, err Nursing Midwifery [name] Health Strategy and I was asked to be in a group to um, contribute to how research should be included within this strategy and it went through various iterations, then went up to kind of the managers above us and it came back and research was only connected to the bit that was about better value and efficiency. So they had both sections about better patient care, better umInterviewer:Oh there’s no research involved in that, is there?Researcher 1:Yeah about better workforce and work satisfaction, um, better outcomes for people and research wasn’t in any of them, and err, I got err, fed back through and just said you know, ‘If research was only about being more efficient, then first of all we’re never going to motivate staff to be more involved in research and second of all, I wouldn’t be a researcher if that was what it was all about’, you know, ‘I’m not driven by money and by savings, um, and actually I do genuinely perceive research as being crucial to improving people’s lives and improving the care that we deliver’Anna and Jill | Jane:Key motivations, one is, erm, I, I’m passionate about growing a workplace culture where everyone can grow and flourish, I think that’s really vital, and the second, erm, the second one is about being person-centred and being person-centred with each and with our patients and staff and modelling those valuesInterviewer:’Cause when we say person-centred, people often, I would automatically go to that, being in terms of the patient, but you’re talking about that in a different way, aren’t you?Jane:Yes, about recognising the person, and the patient, recognising their choices as an individual and using those principles with each staff member as well | I am a strong believer that research should be driven by practice and the results should return to practice and if it doesn’t happen, then it’s not worth doing. So very much my work is very implied, so we don’t have any issues with that, you know; do you see what I mean? It’s like that’s almost a given for both [name] and I and our stance and where we . . . our philosophical view on what research is about. If it should be about, erm improving patient and family care experiences and staff experiences of care as wellSo I think that’s a shared . . . and that’s perhaps where, erm, where I benefit [name] is because she doesn’t have to make that argument with me, it’s given, it’s a given with me. Whereas some . . . if she’d have got these close associations with perhaps some other professors who were less from a practice background she might have had to have more conversations about well that might be very interesting technically but in terms of patients it’s not that interesting and therefore the trust won’t be as interested in driving it forwardPeggy | So kind of from early stages quite a direct interest in using research findings in a way that they can, you know, inform changes and practice in policy . . .It appealed to me the fact that there was an applied focus, definitely . . .Bella | | | | |
| I think that . . . the hybrid role, whatever the terminology, is hard; you’re always going to have competing priorities from both sides of your role . . . I think it’s just about being really, really clear and open about your role. Anna is really good at that; she will say to people and just signpost people to other places if that doesn’t sit within her role it’s not something that’ll be appropriate but she’ll make sure they get the support and advice from elsewhere . . . she’s just that kind of link and that conduitHannah | Jane:The two halves do integrate with each other, erm, in a funny way, ’cause it is also about practice, so what I do in the university I try always get involved in the trust, and benefit the trust wherever possible. What I do in the trust also benefits the wider research as wellInterviewer:So you’re kind of ticking everyone’s box?Jane:Yeah, that’s right, and kind of, and synthesising | . . . help clarify boundaries if that’s required but also . . . I feel at times with Rachel, I’m helping her frame her boundaries so that she has a visibility and clarity as to what role she will take in different places . . .. . . so it depends on what the demand of the job role is . . . what she could do and what she has to do and what she needs to do may at times be different . . . she could run a project, she could design, develop . . . a project and some clinical staff would love her to do that . . . but she knows that that’s not, she can’t do that because that’s not what we need her to do except in an area that we have pre-agreedCarol | . . . if you’re gonna set up a team like this, it needs to have support right from the top of the shop and it needs to have [pause] I suppose there’s something that, and I even reflected on how we could’ve done this. So something about building in, building in so that it’s not individual people . . . so, you know, if you’ve got somebody who is the sponsor and they leave, it won’t make a differenceJanet | Role boundaries | Competing research priorities and two roles | Perceived/potential challenges | -
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| I think the support networks within the university is crucial and the team that she works within erm but I think having leadership-level support in practice is crucial, it doesn’t really matter much about everyone else, it’s got to be supported at senior level. You know, they’ve got to believe in it as a useful approach rather than just agreeing to it, I think it needs the belief that it’s actually important and why it’s worth investing in . . . the person who’s in that leadership role, you know, if they’re motivated and interested and keen to support it it’s very opportunistic, but if it’s not there, if that support isn’t there the person who’s leading that furthest for example, if they’re not interested then you can’t do it. It also needs, you need support on the, at erm lower management levels as well because people, in my experience senior charge nurses, for example, are very powerfulKarenI think the leadership role part of that being acknowledged and appreciated by the team so she’s actually included, that part of the role has made a huge difference to erm the engagement and buy-in and the impact that they’ve had on the clinical service. I know for example perhaps with the nursing we have some clinical academic research posts erm and I don’t think they’re as well embedded into setting the direction and the drive and the purpose of the directory as [name] is because it has that leadership role. . . . because she has the visible support and buy-in at that level that helps the role become accepted by the managers, the clinicians and everyone else that sits thereHannah | I think the important thing for me and I, I think there’s still learning around this, is how you win the hearts and minds of other people that aren’t really very aware of what the capability of this sort of approach is and definitely have to have executive sponsorship. I mean I happened to be working with a chief executive who, at the time, was very, I mean he didn’t particularly understand it, or hadn’t experienced it, but he was very tolerant of actually us trying different things.I think I would say, on reflection, that I wasn’t really able to necessarily completely win the hearts of, of all the executive team, and I, I know that you know, my colleague that I handed the button . . . over to, who was my deputy, who became Director of Nursing, continued with, with [name]. But I know that they, they, you know, they had some challenges I think along the way with changes in executive team members and that sort of thing. So it, it’s one of those things that, you know, it has to become culturally the norm to the organisation and that takes time, and it takes a lot of time, and people don’t always, you know, aren’t always appreciative of what it, what, what how important it is, and I think if they took it away from [place] now, I think they would really understand what the impact wasClareIn another 5 years they would realise or wish they’d continued doing this sort of thing and you get the full cycle again, probably that’s what will happen, but do you know these posts are so dependent on having people at very senior level who can appreciate what you do.The previous Chief Nurse, [name], she was, she got a PhD so she’s not, you know, she’s a clever person, she’s got a PhD in decision-making, she wasn’t really using that ’cause it’s such a complex organisation and she was very supportive to me, she was very operational, her whole focus is on operations, it’s not about being proactive, being excellent, leading the way, which is what I’m used to doing and so, erm, she said to me when you explain to the interim chief nurse what you do, you’re going to have to translate what I do for her to understand, but actually I didn’t find that at all because of this point I mentioned which is, I don’t think the trust has used me strategically, erm, strongly enough. She understood all of that, so I’m thinking well maybe it is about somebody with the strategic visionJane[Name] knows, to really make change, takes a lot longer than some flash old boss, you know, we all know that, but for some CEOs, that’s how they operate. They get their mates in, and they know they won’t be there forever.Whereas I think [name] has really invested . . . I think because, from what I can see, I don’t know the trust that well, but the CEO has gone, the Head of Nursing is . . . who was very . . . you know, they’re not so much friends, but they’re just respected colleagues, who believe in her, and believe in her programmeJosephine | Where we have services that are, that have a supportive leading manager or a driving manager that sees the value, it’s transformative to the roles of people being able to engage in research. Where that doesn’t exist, it’s almost like, well let’s take our backpacks and go home, it’s not going to happen there. If the management don’t see the value in it, they will actively conspire and I will use that word advisedly, conspire against it happening and that’s despite what might be high-level imploring from trust boards which may or may not be there, then the reality of having to meet performance metrics of commissioned service delivery mean that few managers are prepared to take the punt and see research as a way of being able to both meet that target and improve at the same timeBillSo to me it’s, I’m absolutely delighted we’ve got them, I think they have a fantastic role to provide us with, they’re great and I think they’re right for us as an organisation where we’re at now . . . but I’m not sure that our senior management, for example, would understand why on earth would I want more of them rather than upskilling our clinical colleagues moreCarol | Bella:So what happened to us at [deleted] is we had two people who were really engaged but then they left the organisation, which is a major setback for us . . . So that also became quite an important lesson to say OK, yes you have to have champions and sponsors but also you need to do a lot of work to kind of spread some of that . . .Interviewer:So it’s putting a lot of emphasis on, the importance of individuals getting it, if you like?Bella:Yeah, yeah. . . So the way in which the team was designed was we had one kind of lead sponsor who was a really senior trust member so he led the whole kind of, so [deleted] is divided into kind of three parts, medicine wards, specialist hospital and surgery and cancer. So he led medicine wards just to give you an idea of that and he was like, yes, the person who was fighting for us to be thereThe day to day of trying to help these projects it was down to particular individuals on those projects and the degree to which they bought into usTim[Senior buy-in] is necessary but not sufficient. So you need it, but then you also need to do the really hard work on the ground, which, you know, I can talk about but I haven’t done for quite a long time. So it’s people like [deleted] who do that of building the relationships on the ground to do the work you know, erm but with that kind of backstop of the senior people whose supporting it, if you don’t have senior people supporting it, you won’t get the funding to go forwardJulie | | Buy-in | Perceived/potential challenges | -
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| The huge challenge with sustainability is that we’re a small, you know, we’re a small board, we have limited you know, internal resourceGillian | Josephine:It’s a different relationship nowInterviewer:Between academia and clinical practice?Josephine:Yeah. It’s still an important relationship, and sometimes it’s very close and works brilliantly, but it used to be like Director of Nursing would have a chat and a coffee with Director of . . . Director of Nursing trust would have, you know, maybe a regular meeting with Director of Education, and they’d say ‘well, we need someone for this’. And they’d say ‘well, we’ve got a little bit of money for the . . .’, they’d engineer somethingBut nowadays those things are more difficult, not because they don’t get on, it’s just financial issues on both sides, lots of reasons I think. Philosophical . . . so I think they’re rarer than they were, much rarerInterviewer:When you say philosophical, do you mean . . .?Josephine:Well, because I think education is the prime aspect of the university, and the students, and their student journey, and in the trust, pre reg[istration] and post reg[istration], the student is not the . . . the patient is the main reason they’re there. And things like 4-hour targets, and their financial pressures, so . . .Interviewer:Different priorities?Josephine:Different priorities and things are much tighter and . . . there’s not loose bits of money and stuff now, on both sides | I managed to push the trust to pay for me full time, but it had an academic arm, but with the financial crisis back whenever it was, the trust couldn’t really afford to keep me full time, but only have me as a part time. So even though I was part time for the trust, they were paying my full time salary, and that wasn’t deemed fair or they couldn’t afford to sustain that. So I went to the university and got the university to sort out the funding, and now the university pay 3 days and the trust pay 2Victoria | Generating knowledge in applied health research that we like to do is to have comparators and so that raises the issue about well then, how do you generate that research? Do you do that in an embedded way as well? So if you are looking at a particular change, for example, so that raises a question and the other is if you’re trying to look at different, a number of different sites. Because that same organisational case studies, I wouldn’t say the gold standard, but ideally one likes to look at the number of different sites where one is conducting the research to kind of enhance generalisability and different types of context where one is looking at the same thing. Or, comparators for the change one is looking at. And that is difficult, challenging in using the embedded research model because you’d have, it is potentially very costly. . . So that is, that is an important point about it that it is resource intensive and it limits, it can therefore limit you in comparison, either with places not undergoing that change or with other places undergoing those same set of changes to compare themJulie | Funding | Resources | Perceived/potential challenges | -
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| Mark:I’ve also had conversations with one manager who, who would like to try and use my research skills, in a way that provides direct benefit to the serviceInterviewer:MmmMark:That’s not in terms of developing things like interventions, which is what I’ve done before. To give you an example, what she’s interested in is looking at things like population trajections. So what, what are going to be the needs of our podiatry patients in 10, 15, 20 years’ time? What’s the evidence to support that? And she wants to use that to create business cases for service development and so on. So I think there’s a, there is an appreciation of the skills, but they want quick wins from it | | Key part of the getting research underway in the NHS is understanding the time pressures that staff have and trying to be flexible around that because they ask people what the barriers are for them to doing research and the first one that most people mention is time, they just don’t have the timeRachelRachel:. . . it’s not just one person on their own, they have to have the support network around them to make that possible . . .Interviewer:UmRachel:. . . erm, and that’s part of the culture change I think that we’re trying to gain momentum is that, erm, er, middle and upper managers understand the need to be flexible and, erm, recognise the value of research and supporting staff who are interested to do research . . . so that, you know, they can make allowances, maybe, you know, give a staff member a couple of hours off to go to some meeting about research or you know whatever, erm, can all make the differenceInterviewer:Yeah, that senior support buy-in, if you like?Rachel:Yeah, um | Tim:I was on a number of others that fit that sort of paradigm, which was rush, rush, rush, meet every 2 weeks, change something, barely able to evaluate what it was before, let alone afterwards and then just keep going and then do that again and then again and then again. I can hardly do anything. We were asked to write a report at the end of the year, but after 2 weeks any report we would have written would be out of date, you know . . .Interviewer:MmmTim:. . . I got very frustrated. And another different one where I submitted a final report after our, our year’s time was up, and I don’t think they looked at it. I’m pretty sure they didn’t look at it. But even if they had, a lot of it was out of date anyway, in the sense that it probably would have changed and I was speculating a lot. . . I was familiar with the research paradigm, I could do that, I could . . . you know, I, I understood my role, I understood their role, it all fit together and the timelines in particular really, really matched up with the ongoing sort of, let’s call it service development stuff. I didn’t really understand my role, I didn’t, I cou– . . . the timelines between different teams or you know, with the embedded research timeline and the ongoing service timeline didn’t gel at all | Incompatible time frames and time | Resources | Perceived/potential challenges | -
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| . . . if I make my research relevant to more strategic stuff . . . then it becomes valued . . . if I was doing this work and it was just sitting in the abstract with no perceived elements to clinical work, then I don’t think . . . there’d be so much buy-in and support from NHS as I’ve actually received. So they can, they can see the value that that bringsMark | I think the main challenge for me is to get strategic uptake. When I don’t have a, I don’t have a . . . That’s what I want to do next, when I finish this I want to go and be a non-exec[utive] director in this trust, that’s what I’d like to do, because they don’t seem to understand, the trust board don’t seem to understand the values that they need to live, to achieve the changes that are required.. . . often the findings are so ahead of the time people can’t understand what they need to do with it, so 5 years down the line they begin to realise if only we’d done that 5 years ago we’d be in a different position [laughing]Jane | Bill:. . . research roles are not always seen as, how can I put this delicately, they’re not always seen as worthy of investment by people who commission services as those in the services who value themInterviewer:Why do you think that is?Bill:I would have to say that for a large part, and there are some notable exceptions, the commissioning process is an evidence-free zone . . . I do think that commissioning is driven by anecdote and financial pressures rather than that is necessarily best for the health system as a whole . . . | As our time was coming to an end, I think we should’ve done more work from the beginning to demonstrate what we were doing and the impact of what we were doing. So we didn’t do a lot of the communications, the kind of PR [public relations] like this is our team, this is what we’ve accomplished in our first year, this is what we need doing. So we didn’t do that and I think that was a missed opportunity because then when we had to go to the trust to say ‘can you send our funding?’ they, they, we tried different routes and they said no, they didn’t see the value of that team. They were under great, financial pressures and they felt that they wanted to invest that money elsewhere and, but I think the big thing is that they, they couldn’t really conceptualise, you know, why would I invest in the team, what is it giving me, what is it giving my clinicians. I mean, you know, maybe we could’ve done that brilliantly as a trust, would they have still said no? I don’t know, just because of their priorities, but I think as part of the, you know, the blame is also on us because I don’t think we did that properly from the start. So I think it’s a lesson for, for other teams to, you need to think about dissemination right at the beginning and hopefully that will come laterBella | Value of knowledge/research | Strategic/organisational | Perceived/potential challenges | -
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| Gillian:Because we have a huge pressure on us in the system to keep people as clinically active as possible, you know, lots and lots of clinics, you know, and therefore, there’s, there’s not the same potential to, you know, the non-verses, it’s described as non-direct activity, so that research is better, doesn’t get the same level of support within the organisationGillian:. . . obviously within the health service there is a focus on quality improvement and improvement cultureInterviewer:Yeah, yeahGillian:And our board invested it, has invested very, very heavily in that over the last well 10 years, and one of the things that working alongside [name] and colleagues, colleagues at university in this, is around that understanding of the continuum that improvement isn’t the only answer, and about how we . . ., because there’s a, there was, obviously there was, care . . . and, and an unspoken attitude, that you didn’t need to do research in the health service, all you needed to do was the quality improvement and because actually that was how you were going to bring about quick change, you know, but the balance, I’m much more committed to the balance of that and, and research, and then, and that skillset we’d like to, as an approach, we’d like to instil on our staff | I think people, people are very suspicious of things that they don’t quite understand, and because I, I mean, you know, I haven’t really had this conversation with [name] but my, my reflections on it is that I mean it may be some things that, that we’ve got to reflect on professionally, but I do think that sometimes the way we use language, might sometimes act as a bit of an obstacle. We, we know what it means and we’re quite comfortable with it, but I think it’s, it’s a new language for other people and culturally I mean I’m very passionate about the NHS actually but, but culturally we’ve been in a situation where, you know, what trumps all is you know a top-down performance-type regime, which, you know, you and I and others would know actually is not very empowering for people, and did ask them . . . and actually doesn’t value what frontline staff really, who knows the business intimately and what they’re trying to achieve. It, it, it’s, you know, completely wrong, but that has been the culture of the NHS and has been driven really by this top-down stuff from the Department of Health, NHS England over timeClare | Rather than an initiative that, that seconds two people into a university and we never see them again, this was wholly about how do we work with the universities to, to give some of our staff an opportunity to, to practise and develop some academic research skills and bring that back into practice. And, and because, I suppose because it was sold as a, as an opportunity that was going to be meaningful they could see what the outputs were going to be in terms of the care that we deliver to patients on the, on, on the wards. Their, their ears pricked up a little bit I thinkLorraine | Now the other thing is, I think I talked to you about before was that the funding for the [hospital name] wasn’t renewed and the feedback I had about that was informally was that they knew chief executives wanted to focus the trust energies on clinical research rather than the applied health research or health services researchJulie | | | | |
| So what the managers want to look atInterviewer:UmResearcher 2:Is something very, very differentResearcher 1:Yeah I mean it is much, it is exactly like you say, that it’s about umResearcher 2:The floor and service delivery and uh huhResearcher 1:Service delivery and um yeah that’sResearcher 2:It’s a very different modelResearcher 1:Uh huh yeahResearcher 2:Which againResearcher 1:And a lot about value and efficiency that’s what their, um interest inResearcher 2:Yes, value for money, efficiency, throughput, flowInterviewer:Um, aligned with governmental . . . targets and stuffResearcher 1:YeahResearcher 2:ExactlyResearcher 1:Whereas the practitioners, what they want to know is ‘oh we’ve developed a, a new intervention’Researcher 2:That’s rightAnna and Jill | | Rachel:So it’s very much, erm, you know those tangible benefits, erm, but I think valued by the staff considering doing the research, but also the managers and the service around them in terms of supporting the research. If they can be told ‘well, if we do this piece of research, it might mean that we can make a cost saving or a more . . .’Interviewer:UmRachel:‘. . . efficient service’, then they’re much more likely to get that supportInterviewer:Onboard?Rachel:YeahInterviewer:So it’s a, I guess it’s . . . speaking a specific language to kind of, er, meet the broader organisational . . .Rachel:Yeah, yeah and sometimesInterviewer:. . . direction?Rachel:Yeah, I mean our trust has come out with nine prioritiesRachel:. . . so we’re realising, you know if you’re proposing to do a project, use these priorities, you know, mention them when you’re trying to describe what you’re proposing to do . . .Interviewer:UmRachel:. . . then you’re much [more] likely to get buy-in from the senior management to support you to do that because they will see that it’s working towards . . .Interviewer:UmRachel:. . . one of the key priorities . . . that have been identified | So the board would say ‘oh I think such and such a unit in this area of the organisation’, you know, . . . ‘they’ve got a challenge around x’, it would be really helpful. Anyway so the team then went to this unit and they went ‘no, that’s not the issue we’ve got here, it’s something completely different’Julie | Misalignment (front line/management) | Research priorities | Perceived/potential challenges | Intent |
| Interviewer:You said about [name] being a bridge?Gillian:YesInterviewer:Can you tell me a bit more about that?Gillian:. . . for her to have that contemporary knowledge around the research and the research community and to make those connections, erm again to understand what is active elsewhere, what we’ve got an opportunity to become involved in | I think the essence of this is the connectivity . . .. . . it’s working in that liminal zone, it’s the bridging, it’s the knowing who to go to as well as the actual insight that you gain, so that you can transfer knowledge and you can transfer skills, and I think [name] is a conduit in a similar way, she can bring her expertise and mesh it with the messy reality of the workplace and similarly the, the workplace . . .. I’ve been able to say to other people, ‘Well actually, there’s this work and there’s this person’, and if, it sort of connects the system. I’m very much one for permeating boundaries and . . . trying to bridge those gapsViolet | You know I think that people like [name], it’s a conduit . . .You know [she] can face me with the realities of . . . when I’m saying, ‘oh let’s do this’, ‘let’s do that’, ‘why don’t we do this?’, [name] can very much say to me, ‘mm but we have to be aware of x, y and z’. She very much is a bridge, negotiator, she is a diplomatPeggy | . . . the steering group that I have in that second circle, that wouldn’t exist without us because we created those groups at those trusts, so we know people might get together for different reasons and the health organisation, but for the purposes of this, we’ve put them together and we’ve built that infrastructure . . .Bella | Bridge | Facilitating connection | Qualities/strengths of researcher and role | Process |
| . . . she allows clinicians to see that they could potentially be a, a researcher within a health-care setting, but at the same time demystifying it all. Because it’s a little bit of a black box to those who aren’t in that world . . . She’s very easy to talk to. And she’s approachable and she’s done a good job going on all sorts of staff groups around the NHS here . . . The idea being research-active has become far less nebulous and out-there, as it might have been 5 to 10 years ago . . . more and more becoming a part of the daily conversationsMark | . . . when I talk to non-registered staff . . . when you say to them about doing a module at university to advance, ‘oh God, I couldn’t possibly go to university; I couldn’t cope with research or anything like that’. So they already have this negative perception of it and that’s a huge shame because they could come up with some of the answers to the challenges that we face.Jane’s very approachable, she doesn’t make you feel stupid, she listens, she’s an active listener and then she helps you assimilate it. So she’s, she’s got that, that, her communication skills are brilliant and she is . . . approachable and obviously the knowledge is there . . .Sally | . . . some people initially contact me saying, ‘oh, can you come and meet with us because I don’t know where to start with this form?’ . . . I think they’ve just seen it and initially been like, ‘oh, it’s academic, I can’t do it’, but then by the time I’ve met with them . . . I really tried to break it down for them, sort of really understandable language . . .. . . it’s that translation between academia and NHS which is massive that terrifies some people . . . I think it’s that experience of working with people to understand actually at what level you need to pitch things . . . because there’s definitely a fine balance between being really patronising and actually putting it in a way that everybody’s going to understand . . .Karla | Having the skills, you know, to, to be able to work well with other people, to be able to recognise the different contributions people can make to a project regardless of where they come from, you know. If they’re clinicians, if they’re managers, if they’re, you know, statisticians, you know, to be able to have, to really open, to have a way of dealing with people and to foster collaboration; I think it requires that, it requires a knowledge of context . . . understand how the context and the workings . . . ultimately shape your experience, people’s perceptions of you, your perceptions of other people . . . it’s that kind of really dynamic relationship between individuals in contextBella | Interpersonal skill | Making research accessible and inclusive | Qualities/strengths of research/role | Process |
| I think trying to humanise researchers in the university world is quite an important part in breaking down that barrier, which I suppose is something that I try to do . . .. I think the split with the university thing helps, because they see me as being both part of the NHS but also out with those hierarchical structures. I actually think a big part of it comes down to social interaction and personality because I, I do, I think it’s happening less now because people are more aware of me but certainly initially when I would go along to meet with people I could te–, I could feel that they were anxious and that they were intimidated by me being a researcher and being from the university or being new in the directorate because there is such a big gulf. So, like, [laughs] I’ve had lots of feedback from people who say now, ‘just, you’re such a normal person’, which I guess we should take as a compliment but I don’t know what they expect . . .Anna. . . it was a difficult meeting, because the starter session was really scary but, but it was such a positive meeting, because I came away from there, much, much more clued in to what exactly I was going to do and how, what questions I needed to ask . . . I think the person . . . have to have insight and understanding . . . she’s a very good communicator, she’s very good at facilitating, and encouraging things . . . I think that’s a real quality that she has, and she feels approachable . . . If somebody comes into post and they are too academic, it’ll just put people offJoanne | I always work to diminish that, and oh, yes, there are some people who I could, there is one or two people who, especially in health, human resources, ’cause I do a lot of work around workforce and they see themselves as the experts, but I’ve always worked with them, always collaborative, mind you we get the odd challenge, er, but because I’m collaborative, I’m always happy to see the world with their eyes, it’s just having the dial up. The people I can’t, I don’t like working with are the ones who are not authentic, or who are top down, top down in their approaches ’cause we know from all the evidence and the research, that that doesn’t work, but OK, I appreciate that’s what you’ve got to do, I will help you to be more effective in the ways that you work, even if you are taking a top-down approach . . .. I know I’m not intimidating but yes, I do appreciate thatJane | Karla:I’m really conscious again with that sort of, I don’t want to say, yeah I would say stigma, academic stigma, but I don’t want people to think that, ‘oh, an academic’s coming to talk to me’. Like, for example, as an example, yesterday one of the ladies on reception, she got really confused about my wage slip because she said, she came up to me and she said I’ve worked there for 2 years now, she said ‘are you a doctor?’, I was like ‘yes’, she was like, ‘oh, I had no idea’ and she didn’tInterviewer:That’s interestingKarla:Yeah, because I don’t tell people because when I go and meet with people I won’t, and when I, on my e-mail signature I won’t put doctor on most occasions because I don’t want people to think, ‘oh, she’s an academic, she knows lots’, I don’t want to engage in that, I kind of want to meet people first and you know if it comes up I will tell people, like if I feel like I have to clarify my sort of expertise in the area, but other than that I won’t say it because I don’t want people to have that sort of association | I think we were fortunate that most of the members in our team had worked in the NHS before, so I think that helped in terms of navigating the organisation and then problem-solving, and the other skills is, there’s a communication skill and that’s especially important for us qualitative researchers who, you know, if you look at our stereotype we tend to be quite worthy, well not worthy but, you know, to need lots of pages to transmit a message for instance or, you know, we, yeah I think it’s in terms of being able to communicate things in a simple way, a direct wayBellaThey need to, people need to see that they know what they’re talking about and it’s quite important I think in the NHS and from a, from a how they interact and work within the trust they need the [pause] good team players and if we pull that apart, you know, they need to have good communication skills, good listeners. Being able to constructively challenge in a, you know, in a friendly way that would, you know, but equally be quite resilient because their personal resilience is quite important . . .Julie | Relatable/adaptable | Interpersonal | Qualities/skills of researcher/role | Process |
| They were funny, because they’re . . . they’re both people who are . . . I think they were quite anxious about reviewing it at first. They were really keen to, I don’t know, they talked a lot at me, and they’re the people that were probably the earliest to give me like feedback, because they said then, you’re just a normal person, which I think was [unclear – 18:31], but I don’t know what they were expecting. If they thought I was, I don’t know, be like stern or talking in a completely different language to them, or . . . there was a lot of our meetings were kind of starting and ended with general chitchat about their daughter’s wedding, or weight loss or you know, just general chitchat . . . I’m perfectly normal(!) I think that helped, after the first few times. The first few meetings they just seemed really anxious, waiting for whatever piece of wisdom was going to come out of my mouth. I think they thought I was going to come in, tell them they were doing it all wrongAnna | You do need to have that sort of integrity, you know, and that thought, so you know, all these things that you talk about now, about thought leadership and integrity and trust and that sort of thing, so it doesn’t matter how much knowledge you’ve got, if you bring people together and you’re not being integral yourself, you’re not being seen as somebody who works in that way and also you’re not honouring them. So you need to be very, you need to be able to respect everything that people bring to you and be able to say ‘yeah that’s really worthwhile and really useful’ or even when they’ve seen quite negative things . . .Olivia | Karla:I’ll go over and just say, ‘oh’, you know, ‘are you on your own today? Do you want, I’m going to the kitchen, do you want me to get you a tea or a coffee? Oh, by the way I’m blah-blah-blah’, so then I’ve kind of connected with them, so then if they see me on an e-mail or whatnot, they know who I am, they know, they can approach me if, because I think that’s a big thing in work especially if we’re wanting them to sort of do extra, do this quality improvement, do service evaluation . . .Interviewer:YeahKarla:. . . I think it’s about them knowing that they’ve got someone that they can talk to about it and it’s that relational thing that if I embark in this I know I’ve got someone that’s friendly and supportive and whatnot, so I try and make that impression when I see people, just to kind of help them engage in the process and because I think sometimes that support that you can get can either help or hinder people in going forward in the first place and asking for the help . . . | Julie:She is absolutely superb at building relationships and getting in there and you know and all of that, oh, and that’s another thing about who you recruit to do these roles. . . what I’d say is you need that senior buy-in and it’s necessary but not sufficient. So you absolutely need it but no, it’s now you don’t . . .Interviewer:OK, OK I was going to say is that it?Julie:No, no absolutely not, no it’s not; so it’s necessary but not sufficient. So you need it but then you also need to do the really hard work on the ground which you know, I can talk about but I haven’t done for quite a long time. So it’s people like [deleted] who do that, of building the relationships on the ground to do the work you know . . . | Relationship-building/trust and respect | Interpersonal skill | Qualities/skills of researcher/role | Process |
| Joanne:It’s made it easier for me and it feels like she’s an ally because it’s very, very daunting and I think it would have been easier just to not do it, but part of me feels I have to do it, because it, the potential of coming up with some answers and that, you know, we’ve invested a lot so far in the literature research and that, we can’t just turn around and walk away, but sometimes it feels really overwhelming and I think especially because you’ve got your clinical remit and your, like I’ve got my team leader and my clinical remit, on top of it, which it would have just been easier just to not do it, but I think that knowing that [name] there, and it will make that process a lot easierInterviewer:You said you called [name] an ‘ally’, can you tell me a bit more about that?Joanne:Yes well I think that’s probably my expression of where I’m at with . . . governance . . . in a sense that they’ve, this, they’re the gatekeepers and the process that you have to go through is very daunting and the form that I’ve just sort of tried to fill out, has, it’s not the easiest of forms to do. So feeling like you’re on your own again, a barrier that you’ve got to overcome, whereas [name], she feels, well she’s definitely is on my, because she had e-mailed a quick reply, I was reading it one time, she said ‘Be careful how you word such and such or this will happen’, and she helped us a lot, you know, so she’s always there, sort of watching that I don’t trip myself upI’m just glad that she’s here, to be honest, [chuckling], like I said it has made a huge difference to me and my ability just to think, no we’re OK, we’re doing this and it doesn’t matter how long it takes, in fact, if it takes longer, the process of, of getting all our permissions, means that we actually have more data to look at, because we’re going back in a way, which is a good thing, but yeah, I, I, I would be struggling to sustain my energy and enthusiasm if it wasn’t for that I know that I’ve got [name], I can e-mail her, I can lift the phone and she has encouraged me | What she did was she gave ownership to the staff, the staff felt engaged, the staff felt empowered and if people feel that they’re more likely to take it forwards, they’re more likely to embrace it because actually they have developed it. Whereas if your managers come along and say ‘right, you do that’, you know, you’re not going to be as enthusiastic as it’s been done unto you and if you don’t agree with it that’s even more of a reason to drag your heels and implement itSally | I think my role is much more about helping them realise that they can do it, you know, just because they’ve not done any research before, or they haven’t done any for years, it, it always surprises me slightly, even though I’ve been in the job for such a long time, how frightened clinicians can be . . . of doing research, they don’t think they’ve got the skills to do it, they don’t think they, they don’t know where to begin, the whole NHS ethic thing terrifies them, because they hear stories and of course those stories are all true [chuckling], which doesn’t help, because you can’t dispel the myths, you can’t say ‘Oh no, no that’s nonsense’, because it’s like ‘Well actually yes that’s true’, but it’s about fostering an environment where it doesn’t feel so scary, where they know they’re supported, where they’ve got someone they can come to and go ‘Actually I just want to do this little project’, and it is, you know, or this great big world-changing project, and be supported in thatVictoria | There’s still something around having the skills you know to, to be able to work well with other people, to be able to recognise the different contributions people can make to a project regardless of where they come from, you know. If they’re clinicians, if they’re managers, if they’re, you know, statisticians, you know, to be able to have, to really open, to have a way of dealing with people and to foster collaboration I think it requires that, it requires a knowledge of context. I think knowing how to not only just list potential factors, because anyone can do that, but to understand how the context and the workings out ultimately shaping your experience, people’s perceptions of you, your perceptions of other people, you know, it’s that kind of really dynamic relationship between individuals in context . . .Bella | Harnessing potential in others | Interpersonal skill | Qualities/skills of researcher/role | Process |
| We wanted them to have a track record of interdisciplinary and interagency working, and also that they’ve been successful at securing funding, so they knew exactly all the challenges around funding you know and, and with regard to that in seeking funding and things, having that resilience around, so a tenacious person, because I, I know now that working with and I can see how important that is, is that with [name], quite often they’ll go in, and it’ll get rejected and have to be rewritten you know, and, and the time and the effort and the attention to that detail, you knowGillian | Anyway, so I followed up this idea of studentships, and then the money . . . they didn’t get studentships in the end, but I just had a chat with them, and then a telephone interview, and they were very supportive. She’s quite nurturing, she’s quite tough, she’s brought in life challenge, life support, which is what all her literature’s about. She’s quite tough . . .Josephine | I have to say, despite the extra stress, despite the extra hours, and despite the constant juggling and despite the fact that I have to live my life with a pair of trainers and a rucksack, because I’m never in one building long enough to just be able to settle, I have to, I run round [place], you know, I walk up to [name] which is where you’re going in a bit, and, and the CAMHS site is right over the other side of the city and I walk there, and the university campus is all spread out over here, and in one day I can be in four or five different buildings, I still love itVictoria | You’re not in an academic institution, you’re in, you know, somewhere that people, if people are having a bad day sometimes in the NHS, you know, it’s not the most welcoming place. So you know, you get to a meeting where this is your project and you are so interested in it and you’re so focused and the people around you have got operational roles and something has happened and they’re all a bit stressed and that does make it quite hard. So I think personal resilience and a very clear ability to work through quite a lot of thinkingJanet | Resilience | Committed/driven | Qualities/skills of researcher/role | Process |
| Anna:We’ve got this governance priority, which . . .Interviewer:It doesn’t sound very excitingAnna:Yeah, we’ve got about like information management, and regulatory bodies, and different things. And one of the groups is quality and effectivenessInterviewer:RightAnna:So when I started, that group were kind of, I guess, floundering a little bit, so it lead by an OT and a physio[therapist]. They are both very senior, they’re both service managers. And . . . but really, I mean, they knew that research was one of the standards that they were supposed to be looking after, but they didn’t have a clue at all. So I got paired up, put with them, as a critical strength, they were calling itAnd I think they were really, really, well at first I think they were very intimidated, they were a bit concerned about me turning up speaking about it, but then we just had a look at kind of defining well, what do we mean by research, and how is that different from quality improvement? How do we make sure that you’ve written your standards in a clear way, that’s about people using research evidence, or the fact that . . . and also that we’re doing research, at best as the option comes up.. . . So I’d been working with them . . . so I would say that yeah, the governance group set with the . . . Lead in that outside circle, but that certain individuals, as I start to work with them, they move a bit closer | I’ve used [name] as a critical friend, and our paths obviously still cross, because one of the areas of overlap is around the notion of facilitators in the workplace. We use lots of different language and we may sometimes be talking about the same thing but with a different language and these system leaders for me, need to be expert facilitators and that fits with a lot of the work that [name] has done and her team. So we’ve also linked with her recently around the piece of work that we’re doing, with the help of the Darzi Fellow, that I managed to recruit and that’s around the learning environment. So we’re doing a specific piece of work, looking at what will make an interprofessional learning environment in a PCN . . .VioletOlivia:Have you heard the phrase ‘critical friend’ before, because you just said that’s an interesting phrase?Interviewer:Well I’ve heard lots of people use it, but I imagine everyone’s using it in a different way, so your version would be goodOlivia:Yes I would imagine so. So the way that [name] described it to me at the time was that you would meet and it would be for mutual benefit, so I would talk about anything, that I felt I needed to talk about, that I either needed help with or just needed to reflect on, or think about and then she would do the same and the idea is that the other person would offer you, high support, but high challenge, in order to challenge your thinking, but support you to develop | Victoria:Yeah first started talking about evidence-based research, they talked about the importance of combining science with clinical judgement and decision-making, and, and people’s opinions and narratives and ideas, and that was a really sound definition of evidence, and we’ve moved away from that with this whole dominance of the RCT being the only possible way of doing research, but that misses all that real-world stuff. So I prefer, what I call naturally occurring data and ethnographic data, where you combine natural data with interviews and things like that, and I actually think it’s the clinicians who make the world go round, and to just disregard their views and opinions and favour testing drug A, in this sterile, unnatural environment, against drug B. It’s got a place, we need that kind of, I call it, I guess, proper science, we need that proper science, but we seem to have forgotten the value of people, in that, and we’re seeing a shift with qualitative research again being disregarded as being less important or not mattering, not being so relevant to clinical practice, but actually I would say it’s more relevant to clinical practice, than it ever has been before. So I think those partnerships between social scientists, scientists and clinicians, are really crucial, because I think if you just get a group of scientists, it risks all their natural biases coming into play and likewise if you just have a group of clinicians, all their natural biases. People, like-minded people come together and they agree with each other and if you haven’t got anybody in the room that says ‘Oh actually have you thought about X?’, no one will ever think about XInterviewer:Are you that person?Victoria:In some situations, yes, and in some situations, I’m just the person who facilitates another person to do thatPeggy:The benefit that [name] has, if I work in a R&D department it means that she’s always in research, even in the trust. Are you with me? So she never loses that. Unlike some of my other colleagues who are doing research and clinical practice. So the matrons, they’re very much driven by what service requirements areInterviewer:YeahPeggy:So very much research comes second, even though they’re excellent, it has to come second to what’s required for service . . . for the service side | So and I, I know [name] particularly is interested in what is embedded and what is embeddedness. I think she’s done a number of papers . . .. Or at least she’s . . . a lot of, certainly a lot of thinking on that thing and I did as well, so and I describe, you know, my colleague, the anthropologist by trade who wanted to very much observe and not affect her subject matter . . . don’t affect the natives. So she probably felt even more outside than I did but also just because if I was within that structure or if I felt more within that structure, I probably would have been much more hesitant to raise all these things . . . and to flag all these problems.So that’s what I mean is that people are up for it in theory except when actually you want to do some research to uncover. And we are not trying to make them look stupid or failing or, that’s not the point of the research but we do want to understandJulieInterviewer:So having the academic link? I’m using the word ‘link’ . . .Bella:Yeah, yeah it gives you the opportunity to say from an academic point of view and if we are doing rigorous research what you’re proposing, so if you’re proposing a design that you know will ultimately show improvements in terms of you know, will ultimately show that your service is actually improving quality of care, let’s say. So we know that that’s flowed from the start, but we can’t really do it that way, you know, we want to do proper evaluation of whatever it is that you’re doing or you know [unclear-0:33:06.3] and we will do it this way, we’ll do it together but there might be a possibility that the findings are not something that you will like. So we need to share and publish, that was a big one, we need to publish them anywayInterviewer:So that time you’re physically spending in your university setting or desk or whatever, environment, is that helping that process?Bella:Yeah definitely and it brings you back to reality as well. So it helps from a physical point of view of having connections with other academics and you can talk through things | Critical friend | Independent from team/NHS | Qualities/strengths of researcher/role | -
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| Researcher 1:Therapeutic radiographers, we had OTs, physio[therapists]s, we had dietitians and so on, and really, I think from that point of view, it really did boil down, it boiled down to the arguments, and it boiled down to the methods, and it was, it, it, it was kind of being able to talk about things at that level, that wasn’t about the detail of theInterviewer:Uh huhResearcher 1:Professional content or the clinical content, and that, that’sInterviewer:YeahResearcher 2:That’s where the skill comes in, I think, with this and it takes a while for you to get confident about that, but it is about the inherent knowledge, that we bring as a researcherAnna and Jill | I mean obviously it goes without saying, but the person probably needs a, a very deep understanding of research and the nature of research and methodologies, and so it needs to be able to be comfortable in working in both academic ways as well as actually in practice, and alongside [name]. They have to be able to cope with ambiguity, with messiness, with, you know, not having to control confounding variables, because that’s not possible, you know, so they have to be able to understand that you might start out with a question or a direction of travel, but it, it might meander a bitClare | Rachel:I think we might get some people who say, ‘oh, I want to look at this topic’ and not have a particular methodology in mind, in which case we can, erm, perhaps explore it with them as to which methodology would actually . . .Interviewer:UmRachel:. . . be sufficient to answer their question. So my role, so when I was, I was thinking about you know, this embedded researcher title, I’m thinking well I’m not actually doing much, any research myself anymore. When I worked for the university I did my own research and I did a master’s and a PhD, my own research . . .Interviewer:UmRachel: . . erm, but now I’m very much a kind of facilitator and signposter and that side of my role and the trust-funded part of my role . . .Interviewer:UmRachel:. . . is very much, erm, kind of guiding other people through the process . . . | Bella:Think in terms of think creative by the team, I don’t think that would exist without us. I mean I think the leads for each of the projects they would probably continue and they would have carried out essentially their own stuff either or without us thereInterviewer:How would that have been different, do you think?Bella:Well I don’t think they would have evaluated without us, for instance, because most of the cases and evaluation designs were not built into their intervention designs. We actually did that with them when we came in and a lot of the experts that the teams needed were around evaluation, so what might have happened is they might have rolled out the intervention without then having data required to evaluate . . .Interviewer:I seeBella:. . . which is a bit problematic | Methodological/research expertise | Knowledge | Qualities/strengths of researcher/role | Process |
| We also thought it was important that we understood, because obviously the post for us is that current health and social care research priority, so they understood, you know, they understood about the environment and they had some line of sight, and what they thought was important for future health and social careGillianShe has an understanding of the clinical world and that’s the other thing . . . It’s about understanding how strong . . . our research to be orientated into what makes it different to clinical practice and how to construct . . . people. And just what’s . . . what are our current priorities, helping, you know, give direction to the research that, erm . . . in other people [unclear 00:08:24]. But also, erm how to inform the research community about actually what matters, you know, to servicesGillian | Additionally the universities have not reached out into the workplace in primary care at all, and it’s, it’s working in that liminal zone, it’s the bridging, it’s the knowing who to go to as well as the actual insight that you gain, so that you can transfer knowledge and you can transfer skills, and I think [name] is a conduit in a similar way, she can bring her expertise and mesh it with the messy reality of the workplace and similarly the, the workplace. So OK well that doesn’t make sense, that’s not going to work, you, you, you then build it together by understanding one another’s needs and perspectives, because you’re living them as well. Not in exactly the same way, but you’re both sharing some of the journey and you’re both living some of the same tensions and at a very healing level, you, you get to know people, and you make the connections, it’s the networking approach as well. So through knowing [name] and understanding her work back when I was on the urgent care board, I’ve been able to say to other people, ‘Well actually, there’s this work and there’s this person’, and if, it sort of connects the system. I’m very much one for permeating boundaries and seeing the gaps and trying to bridge those gapsViolet | Karla:Yeah, I like to be in the thick of things and now that’s what I really, really enjoy about my role because through writing these narrative reports I’ve started to get a really, really good understanding of the service, I understand a lot more about how it works, what they deliver, how they deliver on it, how they collect information, what information they collect, so now when I kind of, I feel like I can be quite effective when I go into meetings that aren’t about research or evaluation because someone might say ‘well I think we do this and this’, whereas I can, because I’ve been in the thick of it, I can really . . . help themInterviewer:So that contextual knowledge . . .Karla:YeahInterviewer:. . . background of how the service is run is really important too?Karla:Really important and actually, I think, do you know, if they could have similar roles across the organisation within each directorate, I think that would be really, useful because then you’ve got someone that’s got a really good understanding of that service . . . that helps no end | So, I think the main way, or one of the main ways, they’re different, it is different is that if the researcher is really embedded, working really closely with the team, unit, organisation, where they’re doing research, and that sort of begs the question about what we mean by really embedded. Perhaps I’ll come back to that. OK, so they have, the researcher has, or through, over time, by being embedded, they have a very deep understanding of that team, unit, organisation, the way it works, the challenges, sort of warts-and-all look, if you like. So that, by its nature, is gonna be different from other ways of doing research where even if you sort of go into maybe for a week or if even a few weeks to an organisation, you just won’t get that level, that deep level of understanding. And I guess it’s modelled on the kind of old, or not old but old as in not old-fashioned, traditional anthropological type of research where researchers went and lived with [unclear: 0:03:00] for several years in order to have that really deep level of understanding. And through that understanding, asks different kinds of questions and interprets data in a different kind of a way than, shall we say, traditional, several other ways of generating knowledge . . .Julie | NHS contextual knowledge | Knowledge | Qualities of researcher/role | Process |
