I have been thinking about the direction for research and development and the role of this small unit in the big picture of the whole health and care system on the Island. Although I have grand aspirations for what research and innovation can achieve, at times I also have to sit back and take stock – we are very small, making small changes. However like a pebble in a pond, it is the hope that small changes can cause larger ripples of impact.
One thing which causes me to gain heart is looking at the research strategies I recently received from attendees of the Leading Cultures of Research and Innovation workshops ran in conjunction with the fabulous Gillian Southgate and her wonderful associate Taravanda Lupson, both from NHS R&D NW. These workshops were delivered to middle managers across the DHSC to encourage them to create a culture within their team in which research and innovation could flourish. The very idea of these workshops was that in order to have an impact, the importance of research needs to be understood across the organisation.
There is support for this idea of change occurring from small numbers of people. As much as we like to think that excellence in healthcare and quality improvements are led from the front, most research has indicated that this isn’t true. Change is always emergent, granular and often unpredictable. That is not to downplay the role that leaders have in an organisation. Leaders set the direction and provide the compass. However the movement itself is always from the people.
The strategies received reflect this idea of change on a small scale, and offer ideas for how individual teams can better encourage research and innovation. Despite being at different grades, and having differing amounts of influence over practice, all attendees were able to commit to actions which would facilitate research and innovation.
They all recognised that such a vision starts with that mythical beast ‘culture’.
Culture is oft discussed but rarely defined, and even more rarely is a definition agreed on. Some may see this as a weakness. We love definitions. How can we hope to influence what we can’t even define? It is an acknowledged truth within academia that if you want a paper cited (a key metric for measuring the equally elusive ‘impact’) you write one about definitions. Definitions are reassuring, comforting – something to cling to. However not having a ready definition is not necessarily negative. I personally choose to see this as strength. The very fact that we cannot easily define culture speaks to the complexity within. It is by recognising and embracing the messy reality of culture that true change can happen.
It is because of ‘culture’ and the sheer complexity of the health and care system, that change is not a linear scripted process. Therefore to make the most difference we have to try lots of different approaches and see what happens. If we are able to effectively start with small changes across the whole organisations, and effectively use the information we glean from these approaches to adapt them, make them better and then try again, we have an excellent change at achieving something. This approach is not for everyone. The more scientifically or logically minded will hate the fact that there is not predetermined plan or fixed outcome measure. However, taking an iterative approach without a particular goal in mind can also be freeing. We don’t always know what ‘excellent’ looks like until we see it, and we certainly don’t always know how to get there.
Essentially, ‘change is always unpredictable’.
In support of this approach, the attendees on the leading cultures of research course discussed a broad range of approaches to a research strategy. These approaches not only reflected their own thoughts and ideas about what was important, but also the peculiarities of their own practice, discipline, team, area and patients. It is this individuality this makes these strategies most likely to succeed. Whether it is journal clubs, leading by example, collecting and better using data, encouraging collaboration, integrating research into job roles, creating an audit plan, using technology or championing ‘good news’ within teams – each approach was different, tailored and truly supported by the individual.
A main challenge to these initiatives was discussed time and again – once again ‘culture’. For some this challenge presented an insurmountable obstacle at times. This was particularly true in the early workshops during which all conversations led down the same path of ‘we can’t do that because...’ However as we continued working together, the apparent peril of culture instead became a promise.
It was understood that as employees within an organisation, we are the culture. If we change, it changes.
This new attitude was effectively summed up in one of the presentations in the form of a rap entitled ‘question, challenge, change!’ a musical treatise I truly believe could become the anthem for the R&D Unit. This sentiment was also captured within one of the written strategies which stated:
‘The short answer to this is to stop whinging about the problems and to get on with things’.
I couldn’t agree more.
- Dr. Becky Rowley
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