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Allied Health Professions Research and Development Action Plan

SECTION 2 DEVELOPING AN ACTION PLAN FOR RESEARCH AND DEVELOPMENT IN THE ALLIED HEALTH PROFESSIONS IN SCOTLAND

2.1 Developing infrastructure

In relation to infrastructure, the focus falls on four key areas:

• developing partnerships

• funding and funding bodies

• developing capacity

• clinical/academic career pathways.

Developing partnerships

AHPs are key members of multi-professional teams and are now beginning to work more effectively together following the publication of Building on Success (SEHD, 2002a). The Scottish Executive has emphasised the need for effective partnerships between professions, service users and carers. Strengthening these relationships is essential for AHPs to enable them to use their expertise to best effect, engaging the skills and experience of professional colleagues in all sectors of health and social care service provision, service users and carers to develop excellence in service provision.

Partnerships in research and development will be equally critical in ensuring expertise is harnessed and resources used effectively across Scotland. In the past, AHPs have often had to forge these relationships with limited support and infrastructure. Enhanced infrastructure will be key to enabling the professions to maximise their potential as researchers and develop consensus on evidence on which to base practice in health and social care environments.

Research alliances or 'consortia' will be central to the development of partnerships and to the effective use of resources (Box 2.1.1). They have the potential to enable novice researchers to develop confidence and experience through working with more experienced investigators and collaborators, eventually ensuring a 'critical mass' of active researchers with the knowledge and expertise to develop focused programmes of research.

Funding and funding bodies

The main non-commercial funders of research in the UK are the Health Departments in the four countries, the research councils and research charities. The Scotland-wide scoping exercise (see page 11) demonstrated that funding was secured from a diverse range of funding bodies, including CSO, charities and research councils.

Funding streams for AHP research and development need to be diversified and expanded to ensure that capacity can continue to expand to meet service-users' and carers' needs. The data from the scoping exercise will be used to inform the development of potential funding models.

Potential funders of research should be encouraged to take a broad view of the range of research projects needed to underpin effective health and health care. For instance, research into health-related quality of life issues and the effects of long- and short-term morbidity or disability are important to service users and the public and lend themselves to AHP perspectives and investigations. They are relatively under-represented in funded research, however, which consequently presents opportunities for increases in current levels of funding for well-focused studies aiming to improve outcomes for service users and carers.

Developing capacity

If robust evidence to underpin practice is to become a reality for AHPs, a number of challenges in service and academic settings need to be overcome. These include:

• increasing the numbers of AHPs with the knowledge and training to undertake research

• increasing the numbers of practitioners who are informed consumers of research

• increasing the numbers of AHPs participating in and leading research

• developing more effective networks among the professions to link AHP researchers with the wider research community

• managing workload and 'backfill' pressures which impinge on experienced practitioners' opportunities to undertake training to develop research skills and expertise.

Research awareness and understanding of methods are integral to the under-graduate and graduate-level entry AHP academic programmes, but acquired knowledge and competencies are likely to erode over time if not used in the workplace. Further development of research awareness, competencies, knowledge and skills requires training at post-graduate level, both for newly registered practitioners emerging from training programmes and those AHPs who have been practising for some time. HEIs and other education providers should establish networks to support the development of relevant research training packages. They should also seek to develop opportunities that link with their identified research themes and programmes (UKCfGE, 2003).

Good supervision is vital for students undertaking research training at post-graduate level. HEIs should facilitate academic staff development to ensure they achieve the appropriate level of knowledge and skills to support AHPs undertaking study at Masters, doctoral and post-doctoral levels.

Developing clinical/academic career pathways

It became clear during the consultation exercise that many practitioners would like the opportunity to become further involved in research. For AHPs to maximise capacity, practitioners need a clinical/academic career pathway model that defines leadership roles and sets out a route for novice researchers (Box 2.1.2).

A range of opportunities (such as joint researcher/practitioner appointments and the creation of the AHP consultant role) has begun to be developed across Scotland, but the options for contracts that allow movement between clinical and academic positions are limited at present. This needs to be explored further. A wider range of creative opportunities that supports individuals in pursuing research careers and enables flexible training between health and social care services is required. Research training initiatives need to be matched with enhanced career opportunities within NHSScotland and other agencies.

This poses a significant challenge to health and social care services in Scotland to show how they can enable AHPs undertaking research and development training to remain in practice with options in career development. Employers and HEIs also need to provide the appropriate infrastructure to avoid those in clinical/academic roles becoming isolated from colleagues in either practice or academic settings.

Individuals will be able to decide to become involved in research at a variety of levels, from principal investigator to clinical collaborators. Those who wish to become immersed in research may do so as principal investigators. Developing these future research leads in the AHPs will be vital. The framework of roles and levels of research involvement is outlined in Box 2.1.3.

2.2 Adopting a focused approach

The scoping exercise (see page 11) found a wide range of topic areas being researched in the four HEIs providing AHP programmes, with similar diversity in the service setting. Many of these projects were small studies not linked to wider research programmes nationally or internationally, and may have limited potential for generalisation.

A clear understanding of how AHPs can best contribute to achieving the national research priorities for NHSScotland is essential. Current research and development strengths need to be identified to allow emerging research consortia to access them when planning programmes of research. HEIs, in collaboration with NHSScotland, need to develop existing strengths to maximise opportunities for AHPs to develop their evidence base.

HEIs tend to generate a strong body of knowledge when they can develop programmes of research that reflect their particular areas of interest, which can be wide-ranging. AHP departments should build their research portfolios on their current expertise and resources, identifying opportunities for collaborative work within research consortia as they do so. Developing the body of knowledge and research relevant to the portfolio will strengthen the ability of the higher education sector to influence and encourage focused post-graduate research.

By matching their research interests to the identified research portfolio of individual HEIs, AHP post-graduate students (and potentially those from other disciplines within the higher education sector) will be assured of access to the best available supervision and expertise.

One of the challenges is that much of the work undertaken by AHPs remains unpublished, reducing its potential to increase the knowledge base for practice. HEIs and NHS Boards should work together to support and facilitate the publication of sound under-graduate and post-graduate research that contributes to the body of evidence required to underpin practice interventions.

The further development of research portfolios at HEI and research consortia-level raises exciting prospects for bi- or multi-centre collaboration on a UK and/or international basis, potentially increasing the influence and standing of Scotland's AHPs in the international research community.

The recent re-naming of the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHPRU) demonstrates in a very tangible way its commitment to advancing AHP research. The unit offers an excellent model of collaborative, focused research on key issues such as practitioner decision making, practitioner interventions, patient-centred outcomes and stroke - all issues that are important to the work of AHPs.

AHPs, working together and with other professionals involved in providing care, should enhance their understanding of local support systems and opportunities to participate in research activity at all levels. Models that provide forums through which AHPs can, for example, explore opportunities to develop their research expertise and leadership potential and engage in discussions with research consortia and established stakeholders should be deployed.

2.3 Building an evidence-based culture

Evidence-based practice is integral to the clinical governance agenda in NHSScotland, and efforts to base health and health care on the best available evidence have gained momentum over the last five years (see Box 2.3.1).

Clinical effectiveness and evidence-based practice are strong driving forces behind Managed Clinical Networks (MCNs), which have become the recommended vehicle for delivery of services to patients with defined needs throughout the country (SEHD, 2002d).

The evidence to support many AHP interventions commonly relies on a combination of sources of knowledge. These sources include evidence gleaned from research work, but might also acknowledge the importance of expert opinion, clinical experience and the perspectives of service users and carers. The challenge is how best to combine these different types of evidence to inform clinical decision-making.

An evidence-based culture is one in which there is strong clinical leadership at organisational level actively promoting, though a variety of mechanisms, the integration of best evidence into practice. But all in NHSScotland - practitioners, managers, educators and researchers - in combination with SEHD, HEIs, professional bodies and others associated with research and development activity, can contribute to the creation of a culture that endorses and promotes evidence-based practice.

Individual AHPs will need access to opportunities to update their knowledge and skills on evidence-based practice through focused educational activity, in accordance with their personal development plans as agreed with managers and supervisors. Those with management responsibility for AHPs, as senior professionals, should be able to support AHPs to develop evidence-based practice. This should include clarification of key result areas for senior practitioners and others on their contribution to developing an evidence-based culture, and appropriate performance management of these objectives.

Building an evidence-based culture in the AHPs should begin with students. Developing an evidence-based philosophy among students is likely to lead to a career-long evidence-based focus among the qualified practitioners of the future. Under-graduate curricula should continue to reflect the importance of evidence-based practice to the delivery of clinically effective, safe and resource-efficient health, health care and social care services.

The Research Governance Framework for Health and Community Care (SEHD, 2001b) defines standards for good and ethical research practice and stresses the importance of partnerships in developing research activity. It describes the roles and responsibilities of the main individuals and organisations involved in initiating, conducting, evaluating, funding and disseminating research. Careful planning by research teams and monitoring from R&D Leads are necessary to ensure that AHP research activity complies with the standards and is of the highest quality.

2.4 Dissemination

Dissemination is the vital link between research and development. New knowledge generated from research which has the potential to improve care delivery needs to be made accessible to the practitioners who can utilise it and the managers who can facilitate change in practice and policy. Barriers to research dissemination and implementation in practice areas have been identified, however, and in many instances, the information generated by research is not disseminating through to the people who would be able to implement it in practice.

HEIs and research consortia have a responsibility to ensure that high-quality, peer-reviewed research carried out within institutions is presented for dissemination to the wider AHP community. This can be achieved through a variety of portals, which includes scholarly publications (paper and web-based), but also involves conference presentations, in-service education events, summary sheets, public and professional meetings, organisational newsletters and the local and national press. Increasingly, electronic means of disseminating research findings and information are being exploited.

The NHS QIS Practice Development Unit has a multi-professional remit to develop and promote clinical excellence and encourage networking in NHSScotland through the sharing of good practice underpinned by evidence. One of its main strengths is its ability to make links and develop networks involving a variety of professional bodies and organisations of relevant stakeholders. It must continue to offer this facility as a mechanism to ensure that reliable research evidence and good practice guidelines are disseminated to areas where practitioners can easily access them.

The ability to identify gaps in the research evidence is as important as the dissemination of evidence. Through this process, data to inform the development of future research questions can be identified for the research community in Scotland.

NHS QIS Practice Development Unit, working in partnership with relevant organisations, has the capability to build on existing initiatives to further utilise networking models and develop new ones to facilitate the dissemination of evidence generated from research to AHPs in NHSScotland and elsewhere.

The Clinical Effectiveness project (Holdsworth and Blair, 2004) (see Box 2.3.1, page 25) scored the building of significant networks among its biggest successes. Hosted within NHS QIS, these networks will now be extended to include all nine AHP groups. In addition, the focus will extend to multi-professional care group developments (such as stroke and cancer).

The drive to increase the body of knowledge has gained great momentum. Where work done by students is adjudged to be of good quality following HEIs' rigorous review and quality assurance mechanisms, stakeholders such as employers and HEIs should actively encourage and support individuals to publish.

2.5 Moving forward...

The action plan sets out a challenging agenda for progressing research and development among the allied health professions. Its successful implementation will depend on a strong ethos of partnership and collaboration involving many services, agencies, organisations and individuals. And its recommended actions call for focused activity across a wide range of research and development fields.

But the allied health professions have shown that when they combine their individual strengths in common purpose, they are a strong force for change and progress. The huge strides that have been taken by AHPs in key areas since Building on Success (SEHD, 2002a) - driving service redesign, introducing new models of care, developing new and extended roles, and supporting recruitment and retention in the professions - demonstrate clearly that when AHPs put their collective energies into a task, they deliver.

Now, the AHP research and development agenda is in place. Moving forward in partnership with this action plan, AHPs have the opportunity to develop as research- literate, evidence-based professions at the cutting edge of health and social care practice and research. And while the professions will reap many rewards from carrying the action plan through to implementation, the ultimate winners will be the service users who will benefit from increasingly excellent and effective AHP services.

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