A good conference leaves you wanting more… tantalising
glimpses of studies only presented in snapshot,
the parallel sessions you couldn’t attend, the brief but intense chats
when unlikely groupings of people form at coffee (`maybe there’s a project in
that?’), and all those darn philosophy books which Trish Greenhalgh makes you
feel are required reading. If only there
was more time.
This year’s HSRN symposium delivered all this and more. The highlights for me included a great
opening plenary with David Fillingham explaining the ethos behind the
incentivised improvement programme of Advancing Quality in the north west – and
Matt Sutton describing the HS&DR funded project which provides hard
evidence of impact (and an NEJM publication to boot). If there were any questions about the
relevance of applied research to the service, this alone would have justified
the entry price. This was followed by
another key plenary, where Martin Roland displayed his usual forensic powers in
exploding some of the myths around preventing emergency admissions, from a focus
on `frequent fliers’ to falsely positive evaluations. We then had four packed parallel sessions
exploring in more detail some of the evidence around service solutions to
reducing admissions, from evaluations of 111 to virtual wards to predictive
tools. In each strand, there was someone
providing a service perspective to reflect on what these findings meant for
those delivering and commissioning care.
So there was content, in terms of showcasing important
research. But there was also thinking
time. Trish Greenhalgh provoked,
challenged and entertained in equal
measure. Her contention was that new,
more engaged research approaches “are strangled at birth in the name of rigour”. She argued that the research establishment
was hostile to the kind of health services research which might make a
difference, providing insight into the complexities (or, in Wittgenstein’s term, `the rough ground’)
of the NHS. These threads were picked up
in the closing plenary on the future of health services research. Kieran Walshe gave us a panoramic sweep on
the funding landscape, pointing out the disconnect between what we spend money
on and our research effort. For
instance, the vanishing small proportion of funds on research into the
workforce, which represents 70% of the
NHS budget. The biomedical sciences
still hold sway despite many of today’s problems (complex chronic conditions
such as dementia) requiring fewer trials of drugs or technologies and more
insights into how organisations and clinical teams provide compassionate
care. Martin Marshall also spoke – with
authority as a clinician, researcher and policy-maker at the highest level – of
the ongoing difficulty in getting research into practice. He cited a trust meeting where he prepared a
short summary of evidence on reducing admissions, which was received with
thanks by the group who then went on to discuss the introduction of two interventions
which his paper had indicated as proven ineffective. Such is life in the NHS. Cathy Pope urged researchers to get stuck
into these kind of arenas, to be bolder in asserting what the evidence says
(she for one, from her research in this area, could account for many of the
perceived problems with the new 111 service).
Kieran Walshe urged health service researchers to align themselves
more closely with healthcare organisations – not just as study sites, but as
partners in the mission to bridge some of the key knowledge gaps. Martin Marshall also pointed to models of
embedded research, such as the modellers working alongside clinicians at Great Ormond
Street. In the audience, Sue Mawson
pointed out that this was what CLAHRCs were already starting to do, with matched funding underwriting true service commitments. Many speakers expressed optimism about the
opportunities provided by changes in the research landscape with the introduction
of AHSNs, cementing new relationships between service and research.
So this conference did not shy away from the big debates on future directions and positioning. But for me it was also about
the smaller moments. Hearing about an action research study on an
outreach mental health service with poor attendance from minority ethnic groups because of stigma which was turned around when rebadged as a “liveliness” project; ethnographic
work which uncovered the important “secret second handover” between paramedics
and nurses in emergency departments; a librarian at his first health services
research conference giving an impassioned plea to researchers to use overlooked
UK databases like the British Nursing Index bypassed by dominant (US-centric) search engines Medline or Embase;
the way in which involving patients changed the set of outcome measures used in
studies of rheumatoid arthritis, adding the key symptom of fatigue; learning
about the `process decoupling’ of operating teams using the surgical safety
checklist. There were a hundred more
moments like this for me. Here’s to next
year.
