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Building on Success - Future Directions for the Allied Health Professions in Scotland
Shaping the Future
7. Clinical Governance, Research and Development
Clinical governance is now a corporate responsibility of NHSScotland. All professions, all grades and each individual working in health and social care has a personal responsibility for the delivery of good care. This chapter sets out how AHPs can continue to contribute to the delivery of clinical governance targets, both nationally and locally.
7. Clinical Governance, Research and Development
Trusts have developed local systems and structures to support clinical governance. AHPs are participating in these initiatives and expanding clinical governance activity within their own services. Research into aspects of practice provides AHPs with vital information on the impact of specific approaches or interventions. By collating, evaluating and implementing the research evidence, practice can become evidence-based and outcomes for service users can be improved.
Evidence-based practice and clinical networks
AHPs agree that there is a clear requirement to extend evidence-based practice across the disciplines. Like many healthcare professions, there is currently insufficient evidence to support many AHP clinical interventions. There is therefore a need to link leading-edge clinical practice more effectively to audit and research.
Progress has been made, with AHPs involved in a wide range of exciting research initiatives and clinical effectiveness projects at national and local level to determine health benefits and improve outcomes for patients.
Networking of good practice and achievements in clinical effectiveness have proved to be problematic for many of the professions. In 2000 the Clinical Resource and Audit Group (CRAG) funded the AHP Clinical Effectiveness Project for a period of three years to support improvements in this key area. The remit of the group has been to develop a national framework through which AHPs can share good practice and resources more effectively. The project is now in its second year and is on target to consolidate existing networks for Physiotherapists, Podiatrists and Dietitians, and establish networks for Occupational Therapists and Speech and Language Therapists. The final year will focus on consolidation of all five networks at both uni-professional and multi-professional levels.
The Scottish Executive is now committed to building on the achievements of the AHP Clinical Effectiveness Project, and is determined to ensure that more AHPs can take part in the networks.
Action |
The Scottish Executive will support the development of an e-based clinical governance network for all AHPs that will build on the achievements of the CRAG/AHP Clinical Effectiveness Project, with lead AHP clinicians in each area. Trusts and Local Authorities should ensure that AHPs are included in development plans for employee access to information technology, particularly in the community setting, to support their ability to take part in the e-based clinical and learning networks.
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Multi-professional guidelines and standards
AHPs have been fully involved in the development of multi-professional evidence-based clinical guidelines for a wide range of clinical conditions and services. These guidelines have been initiated through the Scottish Intercollegiate Guideline Network (SIGN) and are now used to underpin the work of the Clinical Standards Board for Scotland (CSBS) in reviewing services and supporting the development of quality health systems across Scotland.
The CSBS peer-review approach, which is multi-professional, has provided AHPs and other disciplines with valuable learning opportunities, networks to share good practice and a vehicle to identify areas for improvement. AHPs have also been involved in the development of the Scottish Health Advisory Service Quality Indicators for services such as Physical Disability and National Standards for Care Homes.
Quality Standards Board for Scotland
Our National Health: a Plan for Action a Plan for Change made a commitment to achieve better integration and co-ordination of those national organisations and professional bodies with an interest in quality. The consultation on the establishment of a new special Health Board for Quality was completed in June 2001 and plans to establish the Quality Standards Board for Scotland are now underway, with implementation scheduled for late 2002.
Research and practice development for AHPs
There is a range of mechanisms to support research activity within NHSScotland at local and national level. Many are available to all professions, while some are specific to AHPs and are available through the various professional bodies and national charities.
Allied health professions and other healthcare professions have in the past experienced some difficulties in negotiating these funding mechanisms, particularly where a co-ordinated support system does not exist at local level. Many, however, are overcoming the challenges and enhancing their research profile.
"Working as a researcher/practitioner between QMUC and Forth Valley PCT has been a great opportunity for me. I combine three days a week of clinical work with two days of research into the treatment of children with intractable speech disorders. It has had real benefits for the Speech and Language Therapy services in Forth Valley and my own personal development." AHP Researcher/Practitioner |
A range of systems supports multi-professional research activity that is relevant to national health priorities. Each of these resources offers opportunities for AHPs to develop their individual and corporate research capacities. The Scottish Executive is now putting in place a number of new measures to further encourage and increase AHP research activity and uptake.
Action |
A Fellowship Award for AHPs will be established to support developments in Clinical Effectiveness through the Clinical Resource and Audit Group. A National Award for the Allied Health Professions will be developed to support innovation and creativity in health improvement and patient-focused care. A professional secondment opportunity will be established within NMPDU to review and develop appropriate practice development support mechanisms for AHPs, building on existing multi-professional achievements and linking with NHS Education for Scotland and the Strategic Change Unit. Leaders of AHPs should work in partnership with ISD and Information Managers to develop a framework for better information management systems, making appropriate links with ongoing developments for Electronic Patient and Health Record systems.
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The Chief Scientist Office (CSO), part of the Scottish Executive Health Department, encourages and supports health-related research to improve the health of the people of Scotland and the services provided by NHSScotland. Much of the CSO budget funds research infrastructure within Trusts. The remainder is spent directly on core funded research units (of which there are seven), project grant applications by all relevant professional groups, capacity building initiatives and a variety of other research projects. Funding applications are accepted from all professions and a number of AHP projects have been supported by CSO. The main strand of the Scottish Executive's support for research in Higher Education Institutions is administered principally by the
Scottish Higher Education Funding Council (SHEFC). The Council supports basic research capacity in Scottish higher education institutions by distributing funding selectively on the basis of the quality of research in each institution (QR) as measured by the Research Assessment Exercise (RAE). SHEFC funding of research infrastructure also underpins and encourages investment in research projects by other funders such as Research Councils, European Union, research charities and the private sector. There is a continuing challenge for AHPs in getting into and being successful within this cycle of funding. The
School of Primary Care was established in January 2000 to develop the evidence base to support decision-making in primary care in Scotland and to increase the capacity of the research community. The School aims to provide the high quality research evidence needed to inform decisions made by service-users, practitioners, managers and policy makers, and increase research capacity and capability within Scotland through increasing the accessibility of education and training in primary care research. The Nursing Research Initiative for Scotland (NRIS) is one of the seven core units funded by CSO. The unit has a multi-professional team of health researchers including a Speech and Language Therapist, Psychologist, Statistician, Nurse and Midwife, who undertake specific projects that will inform and enhance patient care in areas of priority. There are currently four programmes of research: stroke, practitioner judgement and decision making, practitioner interventions, and patient-centred outcomes. The unit has created opportunities for AHPs to lead specific projects within the team and develop their skills as first-line researchers, as well as share in the development of research that has practical application and relevance across disciplines. The Nursing and Midwifery Practice Development Unit (NMPDU) has also adopted an inclusive approach to many of its work-based projects, which have been designed to review and lead improvements in clinical practice. This has provided mutual benefits for participants in areas of shared interest in learning and facilitating multi-professional practice development. The Information and Statistics Division (ISD) collects, validates, interprets and disseminates information on activity within NHS Scotland. There is recognition of the need to improve the information gathered on work undertaken by AHPs, and this is planned for later in 2002. Better information is essential to clinical governance and improved patient care, and will assist AHP leaders to evaluate and develop services appropriately to support clinical effectiveness activity. |
Growing research capacity and capability
AHP undergraduates learn to appreciate the importance of research methods and findings as part of their university courses. However, building research capacity and capability is still providing AHPs with significant challenges in practical settings.
"I have always been interested in research but working in a clinical setting it was difficult to become actively involved. I wanted to ask - and answer - questions that were relevant to my practice and to my clients. As a researcher in a multi-professional research unit, I have the time, facilities and support to develop a cohesive programme of research in an area of national priority, Stroke." AHP Researcher NRIS |
The desire to consolidate clinical skills on qualifying, conflicting clinical priorities for all grades, a lack of clarity of expectations of senior staff taking the lead and the need for better research support systems compound the difficulties for AHPs in developing their full research capabilities.
Further joint working between practitioners and universities is required to address these current barriers and devise further action to promote capacity and capability in research activity.
>> A Speech and Language Therapist has been able to take up a new joint role as a Researcher Practitioner between Queen Margaret University College and Forth Valley Primary Care Trust. <<
AHP leaders need to work collaboratively and within local clinical governance structures to consider priorities for research and clinical effectiveness activity and define how they can be achieved at local level as part of service development plans and performance management systems. Individuals wishing to become principal researchers should be supported to take advantage of existing and new opportunities such as studentships or researcher/practitioner appointments.
>> Occupational Therapy, Speech and Language Therapy and Dental researchers at the Nursing Research Initiative for Scotland (NRIS) are currently conducting a systemative review of the evidence for the effectiveness of oral care interventions for people who have had strokes. When completed, the results will be published in the Cochrane Database of Systematic Reviews. <<
Practitioners may need some support in becoming research aware and enhancing their critical appraisal skills. They should be supported to understand and utilise research information, contribute to the development of research initiatives and, where appropriate, participate in structured research activity. New graduates from all disciplines should also be encouraged and supported to publish final-year research projects that would contribute to an enhanced professional knowledge base.
>> A clinical effectiveness co-ordinator and research strategy group for Therapy Services was established in Lothian Acute Hospitals Trust to support local implementation of clinical governance. <<
>> AHPs in Glasgow Primary Care NHS Trust developed a training programme in research report writing skills and created opportunities for multi-professional mentoring of those interested in research activity. <<
>> Arts Therapists in Scotland have established a research network to support and co-ordinate Art Therapy research activity to underpin practice and link with the UK-wide network. <<
The Scottish Executive is now keen to widen access to research activity to more AHPs and accelerate progress on identifying areas where research activity is required to give AHPs the body of evidence they need to provide clinically effective care.
Action |
A short-term working group should be established to review AHP research and develop an action plan for building AHP research capacity and capability within health and social care. |
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