Title: Mobilising evidence on stroke service organisation: co-design, implementation, and evaluation of a knowledge mobilisation bundle
Funder: Department of Health and Social Care

Abstract: In this fellowship, I aim to draw on current evidence and knowledge mobilisation activity healthcare and other settings to co-design a ‘Knowledge Mobilisation (KM) bundle’, addressing the organisation and provision of stroke care. I will work in partnership with key agencies (including the National Clinical Director for Stroke, Royal College of Physicians, and Stroke Association - all of whom are eager for this work to be carried out). I will use this bundle to facilitate these agencies’ KM efforts to influence organisation and provision of acute stroke care, in terms of national policy and regional service organisation, including service user involvement. I will use ethnographic evaluation methods to build understanding of how the various components facilitate knowledge mobilisation in these key contexts. My research questions are: 1. How do key agencies in the context of stroke mobilise knowledge about organisation of stroke services in terms of national policy and regional service organisation, including service user engagement? 2. How might these agencies’ KM activities be supported by a ‘KM bundle’, incorporating verbal, visual, and online resources, and featuring a range of facilitation activities? Much has been written about the nature of KM (ranging from the more traditional ‘linear’ view through to more complex ‘relational’ and ‘systems-based’ interpretations); and there exist many frameworks that describe the journeys between discovery and common practice. [1] However, few of these frameworks have been tested empirically to any great degree, and little is known about how specific techniques support KM. There is therefore much potential for in-depth analysis of KM approaches, with reference to their ‘logic models’ and their interplay with different contexts. Stroke is one of the main causes of death and disability in the UK and internationally.[2] Recent and ongoing research provide a number of lessons that are likely to support improved care provision and outcomes of acute stroke care. Key lessons relate to: potential benefits of centralising services, in terms of improved care provision and clinical outcomes; [3, 4] factors influencing planning, implementation, and sustainability of change;[5, 6] current research will soon provide important lessons on achieving 7-day working in hyperacute stroke services.[7] My proposed fellowship will be designed around the recently introduced i-PARIHS framework, which conceptualises implementation of evidence into practice in terms of the evidence, its recipients, context, and facilitation. I will address my research questions in the following ways. First, I will interview people from key agencies mentioned above about their approaches to knowledge mobilisation, and observe these approaches in action. Second, I will work with key agencies to co-design KM approaches that are accessible to a wide range of stakeholders, including the general public, stroke patients and carers, clinicians and managers, commissioners, and politicians. Because people have different learning preferences, we will co-design a selection of approaches, including text briefings visualisations - e.g. infographics or cartoons web-resources more active approaches, including workshops and group discussions Third, I will study how the ‘bundle’ worked in practice. Stakeholder interviews will address whether and how the bundle supported KM, and observations will examine stakeholder responses to the bundle components. Finally, I will hold focus groups with end-users who experienced the bundle (general public, stroke patients and carers, clinicians and managers, commissioners, and politicians). In these discussions, we will consider the extent to which the components supported KM as intended, and examine factors influential in this. The fellowship will thus develop and evaluate novel KM approaches, and provide important lessons on the processes of co-design.

Lay abstract: Stroke is one of the main causes of death and disability, both in the UK and across the world. Therefore, it is important that people who have a stroke get the right care at the right time, so that they have the best chance of surviving and recovering from their stroke. In this fellowship, I aim to develop new and accessible approaches to communicating research evidence to help ensure stroke care in hospitals is organised in ways that are most likely to ensure patients receive appropriate care and have the best outcomes. To do this, I will work in partnership with key agencies, including the National Clinical Director for Stroke (NHS England), the Royal College of Physicians, and the Stroke Association - all of whom are eager for this work to be carried out. The evidence I want to work with relates to how changing stroke services might be carried out, and how such changes might help patients get better care and have better outcomes. I also aim to study how this evidence is used, and examine whether new ways of presenting evidence help make a difference in national policy or how local hospitals organise their stroke services. The questions I propose to address are: 1. What do key agencies do so that evidence about stroke service organisation influences both national policy and how hospitals organise their stroke services? 2. How might different ways of sharing this evidence help these agencies in this work? First, I will interview people from key agencies, and observe what they do at the moment to help people make use of evidence. Second, I will work with the key agencies mentioned above to co-design ways to present evidence that will make sense to a wide range of people, including the general public, stroke patients and their carers, doctors and nurses, hospital managers, and politicians. Because these people might prefer to hear about evidence in different ways, we will develop a selection of approaches, including - short lists of important information - information presented more visually, for instance diagrams or cartoons - information on the internet - more active approaches, for example workshops and group discussions Third, I will study how our new ‘bundle’ of approaches worked in practice. I will interview people about whether the bundle helped people to make better use of the evidence. Also, I will observe and study how different groups of people respond to the different parts of the bundle. Finally, I will hold a series of discussions with different groups of people who experienced the bundle (including doctors and nurses, hospital managers, politicians, stroke patients and their carers, and the wider public). In these discussions, we will talk about whether and in what ways the bundle helped people to use the evidence. Over the course of my fellowship, I will undergo training in relevant research methods and in how best to work with stroke survivors. In addition, I will have two ‘mentors’, who will support my work and my professional development. Professor Naomi Fulop has an international reputation for healthcare research, working with key agencies, and sharing evidence, while Professor Tony Rudd is the National Clinical Director for Stroke, and is recognised globally for his success in leading successful changes to stroke care in London, and in sharing evidence about how stroke services should be organised. Both Professor Rudd and Professor Fulop will support me in developing my ability to support people’s use of evidence, and manage the complex relationships that might be involved in this task. My proposed fellowship has strong support from the key agencies who will take part in this fellowship. There is clear recognition of the urgent need for evidence to be used in national policy and local stroke services. Further, it is agreed that there are many ways in which evidence might be shared differently, so that more people make use of it. In addition, my fellowship will provide valuable lessons for people who wish to help people use evidence in the future. Lessons will include how to collaborate in designing accessible ways of sharing evidence, and how to study whether new ways of supporting people to use evidence actually make a difference.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: STROKE