Reflections from Health Services Research Network (HSRN) Symposium 2013

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.