This article introduces a series that follows the lifecycle of a research project, with the aim of explaining how large research studies happen and how they may influence practice
In the wake of the Francis inquiry, the National Institute for Health Research commissioned five studies investigating ways of designing services that provide dignified and compassionate care. This six-part series follows one project, the Creating Learning Environments for Compassionate Care (CLECC) study. The series aims to explain how large studies take place and influence practice. It will cover study design and planning, how to read results, plans to take the project further, a nursing director’s reflections on its findings, and how such research can influence policy.
Citation: Maxwell E, Lamont T (2019) Lifecycle of a research project 1: why research into care matters. Nursing Times [online]; 115: 2, 43-44.
Authors: Elaine Maxwell is clinical adviser; Tara Lamont is director, National Institute for Health Research Dissemination Centre, Southampton.
Over 10% of the NHS budget is spent on nurse pay and pre-registration training but relatively little research has studied the care nurses give, and that which does exist is often not widely known. This was the conclusion of a report on the future of nursing and midwifery published almost 10 years ago (The Prime Minister’s Commission on the Future of Nursing and Midwifery in England, 2010); the same can still be said today.
Not all nurses conduct research, but all need to understand the research process as well as how to access, and make sense of, findings relevant to their practice. For many, how decisions are made about which research is funded and what happens to the findings remains a mystery. This article introduces a series that will shine a light on the whole research cycle, explaining why specific areas of practice receive central funding, and how this affects practice and policy. It will follow the journey of a study funded by the National Institute of Health Research (NIHR) as part of a call for research proposals in response to the Francis inquiry.
Context of the call for proposals
The NHS has transformed the health of the population over the last 70 years. However, the tensions between the need to demonstrate cost efficiency and provide an environment that meets the needs of older people were highlighted by what happened at Mid Staffordshire Foundation Trust.
The public inquiry into the failings at Mid Staffordshire found shortages of nurses, and call buttons went unanswered when patients were in pain or needed to use the toilet, particularly on medical wards (Francis, 2013). The report highlighted that the most painful memories for families concerned communication breakdown, loss of respect and loss of dignity.
While some problems at Mid Staffordshire were localised to certain units, the underlying challenges and pressures are universal. The Health and Social Care Act 2012 places a statutory duty on the health secretary to promote research, and the NIHR was ideally placed to support the government’s response to the Francis report. The NIHR felt it was important to commission studies that would test specific interventions that could help policy makers and service providers design services that ensure dignified, compassionate care.
Introduction to the NIHR
The NIHR was established in 2006 and is funded by the Department of Health and Social Care in England. It receives additional funding from Northern Ireland and Wales. It funds individual studies and the staff needed to conduct research in the NHS in England (including clinical research nurses). The research programmes engage a wide range of stakeholders to set priorities and identify key areas where research could make a difference.
A particularly important NIHR programme for nurses is the Health Services and Delivery Research (HS&DR) programme. It focuses on questions relating to the organisation and quality of services and systems, with a particular interest in workforce. This applied research uses different designs ranging from large-scale evaluation of system changes (such as the configuration of stroke services) to deep qualitative studies on the lived experience (such as the experience of dementia support staff). Researchers with good ideas can apply at any time; the HS&DR programme also issues up to six calls a year.
Francis (2013) made 290 recommendations grouped into 17 themes, each requiring a different evidence base. Within a month of the report’s publication, the HS&DR programme put out a call for research on how to strengthen capacity to deliver compassionate care in the NHS in three key areas:
- Strengthening patient voice;
- Improving frontline care;
- Changing culture through leadership.
Strengthening patient voice
The Francis inquiry highlighted the weak representation of patients and carers at all levels of the organisation. The HS&DR programme identified a need for research to develop and test valid measures of patient experience, with a focus on compassion and dignity, and to evaluate the way such tools could be used to influence staff behaviours and systems.
Improving frontline care
The Francis report made a number of recommendations to improve compassionate care, but there was no research evidence to support them. The HS&DR programme sought bids to identify organisational features that support ward staff, including training and systems to promote relational aspects of care (such as kindness, empathy and respect). It also invited evaluations of other ward-based interventions, such as intentional rounding.
Changing culture through leadership
As the Francis inquiry highlighted failings of the board and senior trust leadership, the NIHR decided to fund the evaluation of tools to measure organisational culture and their use, and understand the relationship between organisational culture and performance.
Selecting the projects
Although anyone could submit proposals, the focus was on robust study design and the potential for findings to be generalisable and scalable to the wider NHS. Bids were considered in two stages. A panel of NHS managers, clinicians, patients and researchers scrutinised all proposals for the importance of the research question and relevance to NHS needs. Shortlisted teams were invited to present full proposals, which were externally peer reviewed and assessed by a full board looking at scientific quality, integrity, and likely impact. Five bids were successful (Box 1), each receiving £300,000-£833,000 over three-to-five years. More details on the projects are available on the HS&DR webpages.
Box 1. ‘Post-Francis’ studies
Information Systems: Monitoring and Managing from Ward to Board - Assessed the extent to which trusts can integrate information to enable ward teams to manage services effectively and improve them over time, and the extent to which this data is valuable to others. Also evaluated the impact of the information systems on practice at ward level and decision making at board level.
A Longitudinal National Evaluation of Schwartz Centre Rounds - Investigated the extent to which Schwartz Rounds were associated with enhanced staff wellbeing and social support, and improved relationships between staff and patients – including compassion and empathy.
Intentional Rounding in Hospital Wards - Investigated the impact of intentional rounding on the organisation, care delivery and experience of care from the perspective of patients, their relatives and staff.
An Evaluation of a Real-time Survey for Improving Patients’ Experiences of the Relational Aspects of Care - Explored the processes of real-time patient experience data collection and its impact on care delivery.
Creating Learning Environments for Compassionate Care - Developed and tested a practice development programme in hospital wards that aims to promote compassionate care for older people.
Lifecycle of a research project
This series follows the journey of the Creating Learning Environments for Compassionate Care (CLECC) research project. In part 2, the lead researcher discusses the impetus for the funding call, why the bid was submitted and how the study was designed and planned. Using CLECC as an illustration, part 3 considers how to read research findings to ensure they are robust and reliable. Research does not end when the first report has been published so part 4 will discuss how the research team would like to take the research further. In part 5, an NHS director of nursing will reflect on what the findings might mean for her trust. Finally, part 6 will describe how such research might influence policy.
Through this series, readers will gain a better understanding of how research projects develop and how researchers (and research funders) ask the right questions in ways that can bring about change. With improved insight into the research process, nurses at all levels will be able to better engage with all aspects of it and, ultimately, help improve patient care and outcomes.
- All nurses need to know how to make sense of research findings that are relevant to their practice
- How research funding decisions are made and what happens to research findings sometimes appear mysterious
- Following a study throughout its journey can improve nurses’ insight into the research process
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: Stationery Office.
The Prime Minister’s Commission on the Future of Nursing and Midwifery in England (2010) Front Line Care: The Future of Nursing and Midwifery in England.