Getting research into health care practice: General lessons and the case of genetics Sue Dopson Saïd Business School Templeton College

Virtuous Circle R&D Evidence Practice implement synthesise inform/ shape

Research Aims Interested in – what makes new knowledge credible and therefore utilised?; Why do actors decide to use new knowledge? What is the significance of the social context in which the innovation is to be embedded? Research has explored the complexities of implementing EBM. Undertook an overview of 49 cases involving 1400 interviews in healthcare organisations with colleagues Qualitative methodology; potential contribution to organisational studies

Key questions of the work together Would it be additive to ‘scale up’ or aggregate analysis by taking an overview across a suite of seven related studies of the diffusion of innovation? If so, what are the rules of method to be adopted? In what ways are ‘the rules’ different from those apparent within the conventional systematic review paradigm?

What constituted the databases, transcripts, final reports Reread of all final project reports Summaries of key points/themes Draft coding structure to examine reports Collective discussion/simultaneous analysis Process adopted

The varying theoretical approaches and values of researchers The varied interpretation of key terms in research design, methods and data analysis The importance of trust (structures/incentives) amongst researchers if sharing of knowledge is to occur Issues arising

Common Core Themes Robust evidence is not sufficient to facilitate diffusion The interpretation of evidence is socially constructed Evidence is differentially available for different professions Hierarchies of evidence exist Other sources of evidence are important e.g. tacit and experimental

Professional networks shape behaviour Professional boundaries inhibit knowledge diffusion Context as an influence on diffusion Opinion leaders as change facilitators and inhibitors Common Core Themes

Policy and Managerial Implications No magic bullets No magic targets Receptive context for change includes: –A favourable history of relationships between professionals and managerial groups and between professional groups –Sustained political and managerial support and pressure for change at a local level

Policy and Managerial Implications –A supportive organisational culture, clear goals for change –Effective and good quality relationships within and between local groups –Access to opportunities to share information and ideas within the local context –The introduction of organisational innovations to foster improved and effective interchanges between groups

Barriers to Knowledge Flows - Questions People – Can the relatively poor exchange of information between groups working within healthcare be improved? People – Why are the complex ways in which clinical practice is influenced ignored? Organisations – Are organisations structured to facilitate the sharing of fragmented information flows? Institutions – Are we yet to put in place the right frameworks for today’s knowledge flows?

Recent research – Scoping Exercise: Genetics knowledge Parks Bids put in to D of H and DTI 6 ‘parks’ funded Each park gets approximately £5 million over 5 years

Data collected in the first stage: 1.Expectations of Genetics Knowledge Park 2.Views on the two key objectives of the funding a)To ensure results of research translate to the NHS b)Commercialisation

Expectations of GKP A range of views. Extremes. + ‘bringing things together’ - ‘not much in practical terms’

Barriers to translation Some emerging themes The history of genetics research in Oxford The speed of the production of scientific knowledge The state of the Oxford Trust The role of the media Ethical issues Public understanding Clinical groups understanding

The capacity of the NHS to fund and deliver the results of the research The impact on roles, educational training The non awareness of purchasers Background, career paths, incentives The organisation and management of ‘genetic services’ Physical location of the actors involved What is NHS R&D Barriers to translation Some emerging themes

Commercialisation Range of views e.g. ‘markets are quite small, there is little money to make’ to ‘the commercial spin outs cover a wide spectrum’

Issues Implementation, what thinking is being done on this. Knowledge intermediaries Education and training How will this all impact on patients Other GKPs, how will the six ‘GKPs learn from each other The role of funding bodies

I need help..... please Significant research questions?