Frontline impact


How health practitioners and academics can work better together was explored during the latest Health Services Research Centre seminar.

At our latest seminar guest speaker Martin Marshall, Professor of Healthcare Improvement at UCL, spoke about the experiences to date of the Researcher-in-Residence model that his university and others are developing in order to promote better working relationships between academia and managers.

As a practicing GP in East London who straddles both academia and practice, Prof Marshall – who was also formerly a clinical academic at the University of Manchester – is well placed to comment on the dynamics of this relationship. And he said that at the moment the gap between the two sides was often too large.

“Improvement in the NHS is very often insufficiently influenced by science, while at the same time the science and research is often insufficiently focused on the needs of clients. Academic research can be difficult to access, hard to use and sometimes fails to address the questions of greatest importance to practitioners.

“Academics will often tell you they are the experts, but I also spend a lot of time talking to practitioners who say they are. However practitioners are often more interested in relevance than rigour because time is their great enemy, especially on the frontline.”

Prof Marshall, who has had more than 200 published papers in the field of quality of care, said he believed the world was now shifting towards the practitioner view. “Why is this? Well, the government wants to fund research which has immediate impact with the REF increasing that focus, while researchers are rewarded for having been seen to make a difference. At the same time the public is questioning traditional researcher assumptions.”


He said the researcher in residence model had its roots in how you turn research into a practical model. “The idea was first developed in education and is all about the democratisation of knowledge. In healthcare this model can be used in a range of different environments where experienced researchers work as members of operational teams, sharing responsibility to address practical problems by negotiating their scientific expertise alongside the expertise of frontline practitioners.”

Prof Marshall cited the example of a project running at Great Ormond Street Children’s hospital in London which was initiated after the hospital identified a flow problem in getting patients through its theatres.

“UCL researchers with expertise in this area were literally sitting in a room half a mile away but had never met with the hospital. The researchers have now been at the hospital for the last three years helping develop the model and it has been very successful.”

Care homes study

Another project has looked at improving the safety of residents in care homes across Essex. Prof Marshall said the project had led to significant improvements in both care processes and safety. “By the end of the study we had seen a small but significant reduction in both falls and in pressure ulcers among the elderly. More than half of the care homes are still participating in the study across the county and Essex Council is expanding the programme.”

However he added that the model doesn’t work for everyone. “Around 30% of care homes in this project did not feel they gained any benefit from participation which shows that not everyone wants to be engaged. However the model does seem attractive to many health commissioners and providers.”



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