By Dr Nicky Eddison, Salma Benyahia, Kate Pugh, Ndana Mupawaenda, Sharon Scott, Jo Billin and Dr Ros Leslie
A research-active healthcare workforce contributes to improved quality of care1. Organisations that engage in research have higher rates of patient satisfaction, reduced mortality, improved Care Quality Commission performance, improved organisational efficiency and reduced staff turnover2. Individuals who engage in research benefit from increased perception of skills and confidence in practice and ultimately improved job satisfaction2.
Although research-informed practice is a core pillar of allied health practice, access to carry out research should not be restricted to clinicians. Research is for everyone. However, taking the first steps into research can be daunting. Staff require support, training, access to expertise and guidance, and an infrastructure which allows them to take the first steps, make mistakes and learn. Clinicians are already capable of applying early research skills, such as critically questioning and appraising care, but often don’t realise these are skills that can be applied to research. Other ways staff can gain early research skills include carrying out local audits and service or quality improvement projects helping them to become research confident.
The orthotics service at the Royal Wolverhampton NHS Trust is a research-led service and although it is the smallest allied health profession (AHP) service in the Trust it has a higher number of research publications than all the other AHP services combined. Part of its success is due to encouraging and supporting staff to engage in early research skills.
Kate Pugh – Orthotic Clerk
When given the opportunity to conduct a service improvement project in the Orthotics department I started with designing a new in-patient referral form which would assist orthotists and orthotic clerks when triaging and processing in-patient requests. Having never done anything like this before I had the full support of my manager, Dr Nicky Eddison, who listened to my ideas, encouraged, and supported me through the process. I collated information from the whole team so it would be beneficial to all. The referral was a success and is now implemented throughout the Trust and is used for all orthotic in-patient referrals.
It gave me insight into the process of getting a project from the “idea” stage to completion. Having the support of my peers and colleagues gave me the confidence to develop other “ideas” on a larger scale. I did not think being in a clerical position these opportunities would be open to me. It also provided me with an insight into the time and work put into reaching the final stage of a project. I have since gone on to lead larger projects within the department which has developed my skills further. The opportunity has given me a wider knowledge of the department, it has given me the confidence to speak to a range of professionals and collaborate with new people. It ensured I accurately recorded my findings and responses so that I could take the necessary steps to progress. I also learnt that sometimes things don’t go the way you expect, and you must go back a step to progress again. Something that can be incorporated into all work.
If there was an opportunity to learn or be involved in anything research-based again, I would be interested to get involved. It gave me a real sense of pride in achieving something like this.
Sharon Scott – Senior Orthotist
Throughout my career, I have not had much exposure to research. Recently I undertook the task of a clinical note audit for the clinicians in our service. The audit was based on the standards of our professional body and our regulating body. It was a time-consuming task, to obtain randomised data for 10 patients for each clinician. I worked with a member of the administrative team to collaborate on the data and present the findings to our team and later to clinical governance. We had the support of our manager, Nicky Eddison, which gave me the confidence to carry out the task.
The anonymised data was available to the whole team, and everyone was advised of their results. This allowed us to support one another to raise the standards of note-keeping within the service, improving standards and patient care. We discussed the results, providing tips to each other and agreeing on strategies to improve. We have since implemented changes in our records system to allow easier data capture for the future.
The completed audit gave me a sense of accomplishment which made the hard work well worth it. It has also given me the desire to extend my skills further for future audits and the confidence to access the world of research. I have since taken the lead in establishing a journal club where we can support one another to continue our journey into gaining research skills. I look forward to continuing to raise the profile of our department within our Trust and beyond.
Jo Billin – Orthotist
The audit process is a hugely important part of any clinical setting to ensure that standards within a workplace are being met. I was fortunate to have the opportunity to complete an audit with one of our administration team last year.
We audited the completion rates of our Skin Integrity Tool Proforma. This is a document which requires completing whenever an orthosis is supplied to any in-patient in our Trust. The proforma must be completed to ensure we are regularly considering tissue viability when prescribing orthoses.
I was grateful to have the support of my team and my manager as I had never completed an audit before, nor any type of formal research. I was given a structure in which I would need to present my findings, and the guidance I required on how to tackle the task. I found that I was pushed out of my comfort zone as I started working on the audit without a clear idea of how to begin but found that the project helped me develop my early research skills in obtaining important information and organising and presenting it in a way which was informative and useful to the other members of my team.
This audit highlighted some areas that we could improve on as a team and we were able to focus more clearly on issues surrounding the completion of this pressure tool which we had not realised was a barrier before the audit.
I feel that the initial audit and the guidance I was given have given me the confidence and skills to complete further audits and the desire to be involved in any future research-based projects.
Ndana Mupawaenda – Orthotic clerk
I had the opportunity to pilot a project for the orthotics service which I felt would improve our service and ultimately improve the experience of our service users. I attended the Trust training programme for the ‘Shared Decision-Making Panel’. Once I better understood the model I approached my manager, Dr Nicky Eddison, who supported me in coming up with a document to communicate my project proposal to the wider orthotics team to get staff engagement. This was the biggest challenge, getting the team members interested in the project as they could not initially see the potential benefits.
I had to learn how to engage people, how to answer questions that put me outside of my comfort zone and how to manage expectations. The Shared Decision-Making Panel explores issues or concerns that could be a barrier to service efficiency and patient satisfaction.
Once I gained confidence, I volunteered to work on other projects including the department’s ‘Going Green’ project. Which aimed to review our service via a green lens, to reduce our carbon footprint. I used the skills I learned on the previous project and was delighted when the orthotics service was used as an example by the Trust’s sustainability team and won a sustainability award.
Being able to take part in these projects has helped me to learn new skills including critical thinking, communication, organisation, and planning. I now look forward to taking up opportunities that help me to improve my early research skills.
Salma Benyahia – Orthotist
Getting an article to publication was a thoroughly enjoyable experience, however not without its challenges. Working within a team and publishing alongside others meant that not only was I able to learn and gain invaluable skills from more experienced researchers, but also split the workload and time it took to get the article to publication. Carrying out a literature search was a long and arduous, but necessary process. Requiring me to hone my research skills and my time management skills. Working within a team allowed the workload to be shared, ensuring that no data got overlooked and all relevant research was included allowing for a well-researched and thorough literature review. I was conscious of ensuring the research was done as thoroughly as possible as my goal was not just to publish an article, but to publish an article of excellent quality that would add to the current body of literature and ultimately help improve patient care.
Working with a team of well-seasoned and excellent researchers allowed me to develop my research skills and explore the process of publication within a supportive framework, knowing that anything I may overlook would be picked up on, whether that was in the research or the actual formulating of the journal article. This enabled me to work with confidence.
Getting our research3 accepted into an international peer-reviewed journal was amazing and being able to look up my work and know that a university student somewhere may one day be quoting it in one of their assignments fills me with a lot of pride and confidence to continue researching.
Summary
Understanding that research is for everyone, and not just for clinicians, is essential to creating an inclusive research-ready workforce and these real-world examples are an effective way of sharing innovative practice. Local audits and service improvement projects are a valuable way of supporting the wider workforce to become research-ready and empowering them to challenge current practice and expand horizons.
Managerial support is clearly key to success. The rewards for staff are clear – advancing knowledge; improving problem-solving skills; improving communication and teamworking skills; contributing to the evidence base and improving patient care; the opportunity to publish. By encouraging and supporting staff to gain early research skills we can create a fully inclusive research and innovation culture for our entire AHP workforce.
References
- Iles-Smith H, Burnett C, Ross DH, Siddle HJ. The clinicians’ skills, capability, and organisational research readiness (SCORR) tool. Int J Pract Learn Heal Soc Care. 2019;7(2):57-68. doi:10.18552/ijpblhsc.v7i2.644
- Harris J, Cooke J, Grafton K. Shaping Better Practice Through Research: A Practitioner Framework.; 2017.
- Eddison N. Benyahia S and Chockalingam N. The effect of spinal orthoses on immobilising the cervical spine: a systematic review of research methodologies. J Prosthetics Orthot. 2021;April 2022(Issue 2):p e93-e98. doi:doi: 10.1097/JPO.0000000000000382
