Laura Eyre, Research Associate and Martin Marshall, Professor of Healthcare Improvement at UCL give an inside perspective on moving improvement research closer to practice.

1. Researchers-in-Residence;
moving improvement research closer to practice
Laura Eyre, Research Associate, UCL
Martin Marshall, Professor of Healthcare Improvement, UCL
Nuffield Trust; Evaluation of complex care 2015

2. What problem is the researcher-in-
residence model trying to solve?
1. There’s a lot of useful Health Services
Research out there but it doesn’t have
sufficient impact on practice
2. Evaluation findings are rarely of much
use to those being evaluated
3. Researchers aren’t scratching where
decision makers are itching

3. Defining features of the in-residence model
1. Core member of an operational team
2. Bring specific expertise in:
• the evidence base and its interpretation
• theories of change
• evaluation, both formal and informal
• use of data
3. A focus on negotiation and compromise rather
than imposition – ‘a meeting of experts’

4. “The scientific man has been too scientific and the
practical man too practical and the result has been
unfortunate for both”
WM Barton, quoted in JAMA, 1912
“Evidence-based practice needs practice-based
evidence”
Larry Green, 1974
Origins (1): separation of academia
and practice

5. Origins (2): use in other sectors
Barnsley FC
Poet-in-residence
British Library
Innovator-in-residence
Department for Education
Researcher-in-residence

6. Adapted from Canadian Health Services Research Foundation, 2003
Problem
Knowledge
transfer
Solution
Improved dissemination of
evidence to users (‘Push’) or
demand for evidence from users
(‘Pull’)
Knowledge
production
Work together to define, refine,
generate and implement
evidence (‘Co-creation’)
Nature of
evidence
A product
A process
Nature of
decision
process
One-off
event
Iterative
social
process
Origins (3): knowledge mobilisation

7. Origins (4): participatory research
• Collaboration across a range of relevant stakeholders
• Desire to solve practical problems
• Focus on initiating change through greater understanding
and shared learning
• Emphasis on reflection and collective inquiry
• Willingness to find common ground through negotiation
and compromise
• Grounded in experience and sensitive to context
• Orientation to agency and democracy
• Reject polarised epistemologies

8. Examples of UCLP’s R-in-R models
University College
Hospital
Great Ormond
Street Hospital
Waltham Forest,
East London
And City (WELC)
Newham
General Practice
Whittington
Health
Setting Acute provider Acute provider
Collaborative made
up of CCGs, acute
providers, mental
health provider and
AHSN
General
Practice/Primary
Care
Acute
Provider/Integrated
Care Organisation
Type of
expertise
Social Science -
Anthropology
Operational
Research
Social Science –
Critical discourse
Social Science -
management
Health Services
Research
Seniority Senior Mid-level Early Post-doc Mid-level
Research Fellow
with MSc
Workforce
model
Full time 3 years Part time 3 years Full time 2 years Full time 2 years Part time 1 year
Positioning in
the
organisation
Executive Team
With front line
clinicians
Across levels Across levels
Service
Improvement team
Funding
Organisational host
funding
Organisational host
funding
Organisational host
funding
Organisational host
funding
External funding
(through a
fellowship scheme)
Types of
projects
OD, strategy on
clinical leadership
Improving patient
flow
Evaluation,
implementation
Evaluation,
implementation
Evaluation, data
analysis, strategy
development,

9. Early learning
• The model seems attractive to commissioners and
providers
• Some academics like the idea – particularly those at
the beginning and end of their careers - but many
have concerns
• The required skill-set is becoming clear: credibility;
ability to listen and reflect; excellent communication
skills; negotiation and influencing skills; resilience
• The current service environment is a challenging one
in which to build relationships
• It takes time to develop trusting relationships – initial
suspicion that the researcher is ‘just another
management consultant’
• Some conversations are very sensitive – knowing
when to intervene can be challenging
• The role of patients in the model is not yet clear
• The ethical dimensions are uncertain

10. Applying the Researcher-in-Residence
model in East London
Evaluating the Waltham Forest, East
London and City (WELC) integrated care
pioneer programme

11. Waltham Forest, East London and City (WELC)
integrated care pioneer programme

12. WELC integrated care pioneer programme

13. The role of the Researcher in Residence in WELC:
stakeholder expectations
“…the executive group want a more embedded and process oriented evaluation…focuses
less on whether the programme ‘works’ and more on how to use research evidence to
optimise effectiveness of the programme…”
“…hold up a mirror to the implementation of the integrated work on the ground…. the role is
wide ranging…expected to negotiate their contribution once in post …likely to include :
• being a visible and accessible resource for evaluation…
• working with stakeholders to interpret international evidence for the WELC context…
• examining engagement and understanding of stakeholders…
• examining implementation of interventions on the ground…
• comparing approaches to implementation across WELC…
• exploring facilitators and barrier…
“…expected to utilise established social science methods … including analysis of documents,
participant observation of meetings and implementation, interviews with stakeholders...”

14. The role of the Researcher in Residence in WELC:
my contribution
• Critical and interpretive approach to policy analysis
• Critical discourse analysis
– Language as social practice
– Importance of context
– A focus on the processes of recontextualisation  the vision and objectives of
integrated care are translated through phases of development,
implementation, and delivery from a centralised perspective to a local
perspective and from a strategic to an operational perspective
• Optimising delivery of the programme objectives
• Responsive, relevant, useful  an exciting opportunity!

15. Challenges: getting embedded and engaging with key
stakeholders
Friday 3rd October 2014
This week has been almost overwhelmingly full of new
and increasingly complex seeming information. The
complexity of the WELC programme combined with what
feels like my own ignorance (?) or naivety (?) around
aspects of the programme can feel very frustrating. No
amount of reading has, to date, prepared me for
the often impenetrable language and complex
practices of the people, workgroups and teams
engaged in the IC programme.
The process is slow and often bewildering.
Nonetheless I am, slowly but surely, making
connections with a wider network of people involved in
IC not just at a WELC programme level, but also,
increasingly, at a local borough level and at a provider
level…there is hope…!

16. Strategies: Getting embedded
• Be prepared to get uncomfortable (!)
• Networks and contacts:
– In the programme (‘gatekeepers’ and ‘key informants’  ‘sponsors’)
– Outside the programme (UCL, embedded researchers, mentors)
• Be visible (physically and electronically)
• Use key forums to negotiate your role and your position within the
programme (Evaluation Steering Group)
• Develop key contact points, i.e. meetings, and attend regularly:
– IC board meetings in Newham/Tower Hamlets/Waltham Forest
– WELC wide workstream meetings
– IC steering group/board/delivery group/operational meetings in provider
organisations
• Research diary – this is valuable learning!
Not physically embedded in one organisation/place but embedded in
the space between strategy and delivery

17. Defining the scope of the research
• Challenges:
– One researcher in a complex, large scale programme that is conceptualised centrally,
delivered locally
– Demands and expectations
– Negotiating a critical and qualitative approach in a traditionally positivist field
• Strategies:
– Be clear about my skills (and limitations) from the beginning
– Evaluation Steering Group and executive stakeholders defined expectations of the
evaluation prior to starting the role
– Be clear about my position within the programme  between strategy and delivery
– Discussion and negotiation of research design and methodological approach leading to
collaborative development of protocol – agreed through Evaluation Steering Group
– Continuous communication, negotiation and reflection based on emerging findings,
programme developments, etc.  reflective discussion and action planning sessions
– Clarity re. milestones, timelines, processes, etc.
Defining the scope of the research = an ongoing process

18. Getting evidence into practice
• Challenges:
– Demonstrating value
– Influencing development across WELC with limited time and resources and
multiple responsibilities
• Strategies:
– Communication and regular updates to all stakeholder partners
– Negotiate expectations and timelines – be honest
– Phased approach to data analysis and negotiation  start with high level analysis
for quick feedback and early discussions; buy time for more detailed analysis
following negotiations
– Be reflexive and embrace interpretivism  knowledge and learning are co-created
so don’t be afraid to share early and emerging findings – but do caveat
– Find tangible areas to demonstrate value and impact – i.e. MDT development
across WELC
– Be flexible about the approach – negotiate approach for specific
context/practice/person

19. Getting evidence into practice: emerging findings
A highly complex programme in which complexity is often underrepresented (and
therefore underestimated?)
Contradictory discourses around IC:
• ‘scale and pace’ vs. it takes time – there is no
quick fix
• Innovation and transformation vs. existing
structures and risk averseness
• Empowering patients vs. this is not the right
time/place to engage them
A continuum of engagement – full buy in to
vision/ethos of IC regardless of role,
background, length of service, etc. – “this is
the right thing to do” BUT fragmentation at
level of interventions and enablers, i.e. service
delivery

20. Any questions?