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Written by a leading expert in the field, this practical and accessible book is an essential guide to knowledge exchange, impact and research dissemination in health and social care.
Providing the why, what, who, how and when of research impact, the book helps researchers turn raw findings into useful, high-impact evidence for policymakers, practitioners and the public. It includes insightful interviews from leading journalists, science communicators, researchers and influencers in health and social care, as well as practical exercises, insider tips and case studies. The book will help researchers at all stages of their career to maximise the impact of their work.
Florence Nightingale was prescient in noting the effort needed to promote and engage people in research. Evidence rarely speaks for itself or, in her words, is ‘self-executive’ (McDonald 2005). In her own work around the report to the Indian Sanitary Commission, she worked tirelessly and skilfully – ‘four heavy years’ – to create demand for the finished product. This included lobbying MPs and working with policymakers at all levels to improve health and hygiene of ordinary soldiers. The final report was a magisterial two-volume affair of over 2,000 pages, with data and statistics from a survey of all military stations in India.
Her genius was to add 23 pages of her own ‘observations’, essentially her commentary on the data, including free-text summaries and stories from the thousands of pages of survey returns. These were attractive, accessible and illustrated with woodcuts. Grouped under readable headings, from overcrowding to diet, they included her own acerbic analysis, pulling no punches – ‘There is no drainage, in any sense in which we understand the word. The reports speak of cesspits as if they were dressing-rooms’ (Cook 1913). These popular texts had mass circulation and were sent and promoted to public people of standing from John Stuart Mill to (even) Queen Victoria. Abridged versions of the whole report were distributed in advance to military and medical officers, with commendations and forewords from people of influence. She briefed journalists and sent early review copies to appear in periodicals, from The Economist to The Spectator. In effect, she created ‘pull’ for the report with recommendations for reform which was published in 1863.
This chapter starts with a brief overview of where we are in the history of understanding how health and social care research moves into practice (or not) and why it matters, including the time taken for research to have traction. I consider the mismatch between research which is produced and information which decision-makers want. Increasing volumes of information of all kinds now make it harder for research to be seen. There is a short account of scholarly debates on the way in which research influences practice and how our thinking has changed, from researchers broadcasting findings to more nuanced understanding of the complex interactions between researcher and user working in dynamic systems. This matters because it informs the practical steps and tactics needed to get your research noticed and understood. The chapter ends with five general steps for better engagement, which are tailored for different audiences in later chapters. There are also pointers to broader bodies of work on impact and implementation, which overlap but extend further than the scope of this book.
I was at a meeting discussing recent research we had summarised for ambulance staff and services on emergency care. The showpiece was a large randomised trial, one of the largest of its kind in an out-of-hospital setting, comparing mechanical devices with manual compressions in treating cardiac arrests (Gates et al 2017). The high-quality trial showed no real difference in survival rates between the two. Given the high costs of the automated devices, it suggested potential cost savings for the service. But discussion at this event became heated.
It is not always obvious what is seen as valid evidence. Different stakeholders have different needs and value different kinds of information. This might include surveys, local health needs information, general media coverage as well as published research. Even for published research, it is not always easy to judge what is most reliable or relevant. This has become more of a problem with the exponential increase in scientific and other outputs, accelerated by trends towards Open Access publishing. Readers need help to filter and prioritise the evidence which is of most value to them. At our evidence centre, we did this with a community of people working and using health services who told us what research mattered to them. Researchers need to involve their target audience at all stages of their projects to ensure their research stays relevant to their readership. Early engagement will help to stay focused on the problems and outcomes that matter to that audience and to understand the ways in which they might make sense of the findings. This will help to translate formal academic knowledge into evidence which will support and inform everyday practice. There are insights on making your research inclusive and reaching diverse audiences.
It seems obvious what we are talking about when we are talking about evidence. It is published research, right? Not always. Evidence means different things to different people. And asking for the ‘best evidence’ or ‘most relevant evidence’ may end up with very different kinds of information, depending on who it is for and the nature of the question. Let’s take just one example – social prescribing (Box 3.1).
This chapter looks at ways that research is used by practitioners and how this could be improved. Using the five steps of good engagement, it starts with examples of research which matter to frontline staff and considers how these might reach individuals beyond academic journals. This includes an account of shifts in scholarly debate and understanding, from linear models in which research is packaged and distributed in the form of guidelines and toolkits, to more relational ways in which practitioners might engage with research through communities and professional activities. It is not just about how practitioners use research findings but what that knowledge is, using practice wisdom to interpret research in the context of daily work. Rich insights are given from interviews with practice-facing journalists, social media influencers and those spanning the worlds of practice and research in nursing, physiotherapy and social work. The chapter ends with practical pointers for enhancing the relevance and use of your research for practitioners.
I once interviewed some health leaders and asked them which research, if any, had changed their practice or made them think twice. One example given by a senior nurse was research by Jill Maben showing that at the level of wards or clinical teams, high rates of staff engagement were associated with positive patient outcomes (Maben et al 2012). Put simply, happy staff equals happy patients. It helped this chief nurse to make the case for various initiatives to enhance staff wellbeing and team cohesion – from protecting space and time for ward meetings and debriefs to team social outings.
This chapter will look at ways of presenting your work to the general public, patients and service users. They may be people who have a condition you are studying, look after a family member or are just interested in how services are delivered or experienced in their community. The first step is about grounding your communication in the problems which matter to patients, service users and citizens. This is illustrated by three recent research studies which are focused on topics of importance, from using emergency services to the experience of living with obesity to parents understanding risks of their children undergoing cardiac surgery. Understanding the context, priorities and realities of patients and service users is critical, with useful insights from interview informants. Research examples in this chapter all involved people in meaningful ways throughout the study, the third step of good engagement. This includes individual contributors who may be part of your team, but researchers looking to extend the reach of their studies need to also think about the role of organisations and networks. These might be patient advocacy groups, peer communities, charities and others. Using vivid stories to bring the research to life is an important last step of good engagement. There is general guidance on making findings accessible for public readers, including examples of easy-read versions of research reports, with advice in later chapters on using the media and writing plain language summaries.
This chapter sets out a few examples of high-impact research which has changed and influenced policy as well as practice. I then look at the theoretical and empirical research which tells us how policymakers make decisions and use evidence in the real world. Researchers need to understand this context and the messy and dispersed nature of policymaking, in a world of competing demands. Policymakers may rely on their instincts when responding to and acting on research. They also depend on trusted individuals and organisations, like thinktanks, to make sense of evidence. Researchers need to understand these chains of influence in their field. I interview the head of a What Works Centre and share learning on effective mechanisms of evidence use. As policymaking is so diffuse, it is worth looking at managers and health and social care system leaders as well as central government. I consider recent studies on how managers use evidence which confirms the central notion that ‘evidence does not speak for itself’. The chapter concludes with research on packaging evidence for policymakers, with practical tips for writing effective policy briefs which may make your research more likely to be used by key decision-makers.
As well as the public, patients and staff, research can also make a difference to policy decisions and practice. This does not only mean understanding central policymakers in Westminster, Whitehall or Cardiff. In this chapter, when talking about policymakers, I mean those making decisions at a system or organisational (rather than team) level. This includes system leaders and managers. In health and social care, decision-making happens at all levels in a diffuse way.
Perfect research which comes too late is no good for decision-makers. The importance of timing is often underestimated. The starting point is to try to ensure your research is relevant when it finishes and understand any important recent changes in policy or service landscape which may affect the way your results land. Some factors can be predicted, but researchers can also find ‘hooks’ that play research back into the issues of the day. Some examples are given of research which achieved topicality, including researchers studying the ‘weekend effect’ in hospitals and centralising stroke services. The use of interim findings and estimates of ‘lives saved’ at a critical point helped researchers to influence important decisions about stroke reconfiguration at the right time. Other examples on COVID-19 services show how researchers can be nimble in responding to rapidly changing contexts. Some international examples show how the readiness of the environment often trumps the quality of research in terms of impact.
The health economist Martin Buxton once said that it is always too early to evaluate a health technology until, suddenly, it is too late (Drummond and Banta 2009). This is particularly true for complex health evaluations, like workforce or service models. They need to have had enough time to have bedded in and be stable enough to ensure that the approach could be adopted elsewhere and the way it works is understood. But waiting too long for an innovation to ‘mature’ may risk that an evaluation comes too late to change practice. New approaches, such as models of integrated care models, hospices at homes or virtual wards became widespread often in advance of formal evaluations. Landing your research findings at the right time can be critical to how many people it reaches and what difference it makes.
You need to understand how to tell the story of your research. This chapter sets out why narrative is important and explores in detail the mechanisms by which stories work. In health and care research, there is a risk that individual vignettes can distort rather than illuminate wider evidence bases. This is illustrated with some examples from patient safety. Tools from persuasion, advertising and marketing are described briefly. Social media can be used by researchers to engage wider audiences and to connect in different ways. Examples are given of use of Twitter and research projects using a range of media effectively. Interviews with leading journalists and communicators provide further insights in capturing the interest and attention of general readers.
An actor friend once told me of a time in his life when he was working in a regional theatre. They were visited routinely by the local fire department carrying out health and safety checks and each time were cautioned for blocking fire exits with stacks of flammable sets. The fire officer read out the regulations they were violating and the fines which could be incurred. The actors and theatre manager promised to move the sets and store them somewhere else but soon lapsed into old habits. The reproof became almost a ritual. One time, the fire officer changed tack. He brought with him real pictures of the charred and maimed bodies of children who had been trapped in a house fire.
This chapter looks at questions of style in reaching wider audiences. It starts with one of the most important aspects of communicating your research, using accessible language and writing effective plain language summaries. I consider some of the commonly agreed precepts of good writing style, drawing on work by recent academics to push the boundaries of what it means to write well as a researcher. I set out eight important features in good writing which go beyond grammar and basic style rules. This includes thinking about the title of your work; writing as you speak, avoiding the convolutions of academic thought; identifying main messages and expressing them clearly; being as true as you can to the science and avoiding over-claiming and spin; being playful; using tricks of persuasion; choosing words carefully; and finally, perhaps most importantly, finding your voice. More guidance and books on style are given in the Further reading section, and the chapter ends with three practical pointers to writing for impact. Finding the appropriate tone, language and idiom for different audiences and outputs is difficult and needs effort. The best way to learn is to take note of people and places which do this well and practise yourself.
This book is about how to communicate research findings to audiences who are not researchers. Perhaps the most important tool to do this is the plain language summary. This is likely to be the most read output and yet is often done as an afterthought. More time is needed to get this right, working with others – particularly people who know nothing about your research. This chapter looks at the language and format to reach wide audiences, starting with the plain language summary as a critical part of your pathway to impact.