Research engagement and improvements in healthcare outcomes are positively associated (Boaz et al, 2015), and significant correlations between clinical research activity, academic output and reduced mortality are evident (Bennett et al, 2012; Ozdemir et al, 2015). For clinical academic research to flourish the development of staff who understand the importance of research and innovation and the role of an embedded research culture is key (Olive et al, 2022). A strategy for nursing, midwifery and allied healthcare professional (NMAHP) research had been developed in 2019 in a Trust in the South West of England. This was created as part of the National Institute for Health and Care Research (NIHR) 70@70 initiative to foster a culture of innovation and implement research activity within organisations (Castro-Sánchez et al, 2020). Targeted positive action was provided to support NMAHPs in realising their research potential, through three key projects: a Chief Nurse Research Fellow (CNRF) programme, an Embedding Research In Care (ERIC) unit and a Clinical Academic Network (CAN), designed to support at individual, team and department level (Shepherd et al, 2022). The CNRF programme is a secondment, 1 day every fortnight for 12 months, for clinical staff interested in research with funding allocated to their department to provide clinical cover in their absence. The CNRFs undertake training in research, learn more about research being conducted within the organisation and undertake a small-scale improvement project based on a clinical question from their area. The ERIC unit had a dedicated research facilitator to work with staff in the department to raise awareness of research and promote research activity. The CAN is a virtual network of staff within the organisation who are interested in and engaged with research at many different levels and provides a forum for peer support, providing feedback on research initiatives, sharing opportunities and providing mentoring and assistance with research funding applications (Shepherd et al, 2022).
In 2022 the Royal Devon University Healthcare NHS Foundation Trust was established, bringing together the expertise of the Royal Devon and Exeter NHS Foundation Trust and Northern Devon Healthcare NHS Trust. The Trust became the largest employer in Devon with more than 15000 staff, providing acute, community and primary care services to more than 615000 people. Alongside the merger the first national research strategy for nurses was launched by the Chief Nursing Officer (CNO) for England. This provided a policy framework with an ambition to ‘create a people-centred research environment empowering nurses to lead, participate in, and deliver research for public benefit’ (NHS England, 2021). Having widely disseminated the Trust's learning from the development and initial delivery of the original 2019 strategy, the first author was appointed co-chair of the South West Clinical Research Group supporting the Director of Nursing Leadership and Quality Improvement at NHS England/Improvement, tasked with delivering the CNO research strategy.
Challenges for institutions in progressing the national CNO research strategy have been highlighted. These include recommendations to improve knowledge and skills to implement, apply, and undertake research, share good practice and incorporate nursing research into core business through use of a toolkit (Foster, 2022). There was widespread recognition of the need for different approaches to build capacity, capability and confidence of staff in research. Enablers included: use of role modelling, celebration of existing work to increase the visibility of NMAHPs leading research-based care (Whitehouse et al, 2022) and the development of research networks to bring interested people together to increase research capacity (Wolstenholme et al, 2022). Organisations have begun to establish portfolios of initiatives including: research ambassadors, designated research leaders and clinical practice research leadership so research could become part of ‘business as usual’ (Sanders, 2022).
The Health Education England allied health professional research strategy was launched shortly after (Health Education England, 2022) and release of both initiatives prompted a review of the existing Trust strategy. This was in order to realise the benefits of the national vision for the professions and the local imperative to increase research for the benefit of the resident population and healthcare community. This article describes the development and implementation of the Trust's revised strategy, along with an evaluation of the initiatives designed to embed this plan in the organisation after the first year.
Aims
To implement and evaluate a strategic plan for research within a South West Foundation Trust.
Methods
A review was undertaken of the newly launched CNO strategy to identify which elements were not already a feature of the Trust's NMAHP research or other strategies. The 2019 strategy was redesigned accordingly alongside a 1–6 year implementation plan using an iterative co-production approach. Key internal and external stakeholders included the organisation's CNO, assistant directors of nursing, the Trust's CAN and a professor of nursing from the University of Plymouth South West Clinical School (a collaboration that includes a regional network and supports development and delivery of research) to ensure this met the needs of the nursing profession and addressed the intent of the national and local visions.
It was clear that in order to implement the national CNO research strategy most traction would be achieved atTrust level by having a combined strategy for NMAHP and healthcare scientist research. Within the organisation NMAHPs are professionally overseen by the chief nursing officer, while healthcare scientists are overseen by the chief medical officer who is the executive lead for research. A combined strategy ensured executive oversight across professions embedded in existing care delivery and supportive structures, for example the learning and development and the research and development departments and alignment with other Trust strategies including the clinical strategy. The ongoing requirement for a joint strategy approach was also underpinned by external supporting infrastructures, such as the Clinical Academic Roles Implementation Network (CARIN). CARIN supports the development and implementation of joint clinical academic roles for health professionals and the Trust joined this network during the implementation period of the original strategy.
The previously existing initiatives (CNRFs, ERIC and CAN) were evaluated to determine effectiveness to date and to inform revision of the new strategy. A new 6-year plan, separated into 2-year targets for implementation, was defined, which included specific deliverables, actions and nominated leads. Defined measures of success and progress against these deliverables were evaluated at the end of year one.
Results
Four key pillars aligning with the national CNO vision (Building the best research system, Releasing NMAHP research potential, Developing future leaders of research and Aligning NMAHP research with public need) were key to the revised research strategy. There was widespread agreement that these four pillars should be underpinned throughout by the fifth pillar of the CNO strategy, which focused on ‘digital innovation in the development and delivery of research’ (Figure 1). A mission statement was approved with equality, diversity and inclusion at its core. Evaluation of the Trust's existing initiatives to embed research into clinical care provided useful information for the revised strategy.
Three cohorts (17 individuals) have completed the CNRF programme, which has been positively evaluated with improvements in the CNRF's self-assessment of research experience (Smith et al, 2002). There was an increase across all three cohorts combined, from a median score pre-secondment of 1.9 indicating no/little experience to a median score of 3.2 post-secondment, indicating some experience across 10 different dimensions (Figure 2). The CNRFs have presented work at international research conferences, and many are considering future careers combining research and clinical care.
The ERIC pilot within the respiratory department, instigated to integrate research within clinical care, provided invaluable learning with support for question generation, staff development and research delivery. Evaluation was through a combination of staff self-assessment at baseline and 12 months (Smith et al, 2002) and online questionnaires. However, effectively introducing the initiative at ward level was particularly challenging during the COVID-19 pandemic with difficulties in the appointed research facilitator accessing the ward, frequent staff changes and clearly more pressing priorities for the ward-based nurses. This led to a revision of the original ERIC unit concept to an ERIC model with future initiatives planned across, rather than within, departments. Despite the challenges, two members of the ward team within the ERIC unit completed the CNRF programme and three other specialist staff (two nurses and one physiologist) were successful in gaining internships or research associate funding.
The CAN links research-interested NMAHPs and healthcare scientists across the Trust and successfully provided a collaborative network for peer support, mentoring (of CNRFs) and a platform to share experience including developing research proposals and applying for funding. The CAN was also included in the co-production of the new Trust strategies to increase NMAHP research activity and continues to grow with more than 60 members, including nurses, midwives, physiotherapists, physiologists, dietitians and occupational therapists and has supported an NIHR biomedical research centre senior fellowship, a professional doctorate, NIHR pre-doctoral clinical and practitioner academic fellowships (PCAF) and internship applications.
Eleven specific objectives were proposed within the new strategy (Table 1) to be delivered within the first 2 years, including continuation of the CNRFs and the CAN and a revised ERIC model. In addition, progress within the first year on the other objectives included an organisational readiness assessment conducted among AHPs on the north site. The Trust's 11 academic departments were tasked with increasing NMAHP engagement and student nurse placements were established within the research teams. Funding towards the fourth cohort of 13 CNRFs was leveraged from within the organisation and R&D capability funds have supported the appointment of a clinical research information officer to assist with the digital enablement of research and a PhD is being funded for an NMAHP within the organisation. Research has not yet been included within the Trust's induction programme but this element is currently a focus of national work so will be pursued once that work has concluded. The Self assessment Organisation Readiness Tool (SORT) developed by the University of Sheffield will now also be introduced.
Table 1. Revised NMAHP and HCS research strategy with defined objectives for years 1–6
| Year 1–2 (2022-–23) |
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| Year 3–4 (2024–25) |
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| Year 5–6 (2026–27) |
|
HCS=healthcare scientist; NMAHP=nursing, midwifery and allied health professional; NIHR=National Institute for Health and Care Research; PCAF=pre-doctoral clinical and practitioner academic fellowships (NIHR programme); UoE=University of Exeter; UoP= University of Plymouth
Discussion
Invaluable learning and insights were gained by having initiated a Trust NMAHP strategy ahead of the release of national strategies and having embedded evaluation in initiatives from the outset. In reviewing the national strategies and local evaluation, important revisions have been made and following extensive consultation a revised strategy was launched in December 2022. The updated strategy has continued focus on NMAHPs but now also specifically includes healthcare scientists. It was agreed delivery against the implementation plan would be monitored via the Trust CNO senior leadership group meeting. Impact will continue to be monitored through continued evaluation and impact cases. Further opportunities will be explored in future years as the strategy evolves and delivers on the plans indicated in years 3-6 of the strategy. This will include opportunities to more actively engage advanced care practitioners and consultant nurses within the organisation who have research clearly defined within their job description. Future visions include the launch of a Research Academy at Royal Devon University Healthcare NHS Foundation Trust to further opportunities for NMAHP and healthcare scientist staff in combining clinical academic roles and furthering research for patient benefit.
Mentoring, leadership and role modelling are key elements required to successfully ensure the integration of research into practice (Fry and Dombkins, 2017; Hafsteinsdóttir et al, 2017; Bramley et al, 2018; de Lange et al, 2019). There is growing evidence for the impact of mentoring in aiding career development as well as supporting nurses to provide optimal evidence‐based, high‐quality care for patients (de Lange et al, 2019; Hafsteinsdóttir et al, 2020). These have been central to the local initiatives.
Conclusion
Although evidence-based practice is an established element of professional training and practice, integrating research within clinical care for all practitioners is an evolving process. As described in the CNO strategy, it will require a step change for the nursing profession and the organisations where they practise to embed research within everyday clinical care.
Engagement with staff from professions and departments across a Trust, alignment with other Trust strategies and excellent collaboration with external partners to leverage additional support seem key to progress. The strategy and model described here illustrates the benefits of approaching the challenge of ‘making research matter’ by harnessing cross-professional collaboration, recognising the unique professional perspective this achieves and using the economy of scale achieved through joint working, coproduction and learning with and from each other.
The Trust strategy has been shared across the South West Peninsula so ideas can be adopted as appropriate and joint working with colleagues across the SouthWest Clinical Schools continues. Having a clear approach with measurable objectives and evaluation embedded in all initiatives is essential in assessing impact and responding and revising accordingly to ensure a strategy remains responsive adaptable and relevant to current care delivery in evolving care providers with an evolving workforce.
KEY POINTS
- Research-active organisations have better patient outcomes
- Embedding national research strategies in clinical care requires engagement at all levels
- Specific objectives can be identified to ensure, and measure, integration of research
- Chief Nurse Research Fellowships provide excellent opportunities for clinical staff interested in becoming more research active
- Identifying internal and external enablers can be effective in supporting the integration of research strategies
CPD reflective questions
- What can you do to increase research awareness/engagement in your area?
- How have the national research strategies been implemented in your organisation?
- What barriers exist to embedding research in clinical care in your area/organisation? How could these be addressed?
- What clinical problems or clinical questions do you have that may be addressed through research?