Title: Optimising the impact of health services research on the organisation and delivery of health services: a study of embedded models of knowledge co-production in the NHS (Embedded)
Funder: Department of Health and Social Care

Abstract: Managers and clinicians in the NHS are under growing pressure to improve and redesign services in a way that both optimises health outcomes and controls costs. There is huge potential for health services research to make a larger contribution to this process but there is a disconnect between the theory and empirical evidence underpinning how best to design and deliver high quality health services and what actually happens in practice. This has challenged policy makers, academics and front-line staff for several decades. This 30 month multi-method study builds on previous knowledge mobilisation research funded by the HS&DR programme. It aims to increase the influence of health services research on decisions about the improvement and redesign of NHS services in two key ways; firstly by substantially developing the evidence base underpinning the nature and effectiveness of co-production models of knowledge mobilisation in which researchers are embedded within NHS service settings, and secondly by co-producing practical guidance on the design and implementation of embedded models of co-production for managers and clinicians in the NHS, its academic partners and people who use services. We propose four interlinked work streams (WSs): WS1: a critical narrative review of the literature in the fields of co-production and embedded research; WS2: an environmental scan of embedded researcher initiatives across the UK, such as a sociologist evaluating an integrated care programme or an operational researcher improving patient flow in a children's unit; WS3: four in-depth qualitative case studies of NHS embedded researchers and their associated networks, activities and impacts; and WS4: a concurrent co-production and active engagement and influencing strand to ensure that the study achieves maximum impact in the NHS. Data collection and analysis will be informed throughout by methodological best practice, underpinned by the principles of co-production through engagement of stakeholders and supported by an international project advisory group. The main non-academic outputs from the project will be a range of practical tools (including training materials, detailed guidance, indicative job descriptions and person specifications) so that NHS organisations can learn about how to use embedded co-production in the most effective ways in order to improve the delivery of high quality research-informed care. We will also contribute to addressing significant gaps in the current international research literature on knowledge mobilisation. The NHS will gain the following benefits from the project: • The NHS and its partner organisations that are currently using embedded co-production initiatives will be able to use evidence-based guidance, person specifications, training templates and training resources that we produce in order to optimise the effectiveness of their work and its timely impact on patient care; • NHS organisations that have not yet considered models of embedded co-production will be given the resources to explore how they could use this approach to improve decisions that impact on service delivery and will be given the tools to enable them to do so rapidly; • The NIHR HS&DR programme will have a better understanding of the potential benefits and risks of embedded co-production and related models of research, and how they might contribute to increasing the impact of health services research in the NHS.

Lay abstract: A large amount of public money is spent on undertaking health research but there is a substantial gap between what is known from research and what is put into practice when patients receive care. This means that patients often don’t receive the best possible care and the NHS is likely to spend scarce resources on services that are not as effective as they might be. This is a study of how to make better use of research knowledge and expertise in the field of health service improvement and service redesign. The emphasis is on encouraging researchers, clinicians, health service managers and patients to share their knowledge and to work together on the implementation of new solutions to improve the organisation and delivery of care for patients. A number of different approaches have been devised to increase the impact of research on patient care. This proposal focuses on an approach that has been used extensively in areas outside the health sector – placing or ‘embedding’ researchers into front line teams of managers, clinicians and service users. One example is an anthropologist who is helping a hospital to design new approaches to clinical leadership. This allows people to work closely together creating and using knowledge, a process known as ‘co-production’. What is currently known in this field is poorly summarised and few of the practical approaches in use have been properly evaluated. We are proposing a study with four linked work streams (WSs), each addressing a clear objective. WS1 will review and summarise the literature describing what is currently known in the field. WS2 will use the internet, our networks and telephone interviews to seek out and describe examples of these models in practice. WS3 will examine four of these existing examples in detail, looking at the researchers themselves, together with their networks, activities and impacts. WS4, running throughout the duration of the project, will focus on working with people from the NHS and academic communities to develop a range of practical tools for use in the NHS. We will produce the following outputs: •Guidance for NHS organisations who want to use an embedded researcher to help them to improve their services •Guidance for researchers who want to pursue a career as an embedded researcher •Guidance about how best to involve members of the public in embedded research initiatives •A job description for an embedded researcher and a description of the attitudes, skills and knowledge required to be effective •A series of case studies and an animation to explain how the embedded role works in practice •A network of people interested in developing the idea of bringing researchers and practitioners closer together •A social media presence using blogs/tweets to raise the profile of the potential of embedded research •A series of publications in professional and academic journals, and presentations at conferences/seminars in the UK and internationally, to help share the learning from the project The 30 month study involves leading researchers, managers, practitioners and service users. An experienced service user is a member of the project team and leads a PPI group which will contribute to all phases of the project. In addition, we will draw on patient input from the service-based organisations involved in the work. The study has been designed in a way that allows learning to be shared with the NHS and partner organisations from early on in the project.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE