The EPIC Model: implementing research in practice

unspecifiedNot exactly a leap into the New Year with this component of the EPIC framework, more of a splutter. Having covered Explore and Promote in previous posts attention turns to the third component Implement which is proving to be a bit of a slippery character.

Before we progress any further let’s clarify what we mean by implementation, defined in the Oxford English dictionary as, ‘the process of putting a decision or plan into effect’. Within a health context this can be seen as the process of transferring knowledge from a research setting into mainstream clinical practice.

I have been pondering why this component has caused a writing block and much procrastination. On reflection I think it’s because on one level the implementation of research is so fundamental to 21st century clinical practice that saying that it needs to be done feels a bit like teaching your grandmother to suck eggs; people undertake research to increase knowledge and improve patient care and therefore once we have a robust evidence base we transfer that knowledge into practice. Given that all healthcare professionals enter clinical practice with the requisite skills and expertise to undertake evidence informed practice this should be straightforward and yet on another level we all know that it is so much more complex.

We know that the process can be long, we know that it is complex and we know that multiple factors influence it at the levels of individuals, teams, organisations and systems. It cuts across behaviour and attitudinal change, skills and expertise, access to resources and infrastructure. Add into the mix the fact that many interventions delivered by healthcare professionals have a limited evidence base and the challenge becomes even greater.

The consequences of failing to implement research are that: patients not benefiting from advances in healthcare; they are exposed to unnecessary risks of iatrogenic harm; healthcare systems are exposed to unnecessary expenditure, Grimshaw et al.

The imperative to speed up the adoption and spread of research, and indeed innovation, across a whole system is a major policy agenda which informs the work of the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) and the Academic Health Science Networks (ASHNs).

The recognised need to understand the process of implementation and how it can be facilitated better has led to the development of a field of research in its own right called implementation research whose focus is described as being: to understand what, why and how interventions work in ‘real world’ settings and to test approaches to improve them. It has also led to the emergence of personal knowledge mobilisation fellowships from NIHR and in some medical research charities like Alzheimers Society funding stream focused specifically on implementation research.

As healthcare professionals and service users we all understand the need to ensure that practice is based on the best possible evidence but we may not be so familiar with some of the financial implications. I want to flag up just one.

In 2015 the UK Clinical Research Collaboration published UK Health Research Analysis 2014 (a good resource for anyone wanting to find out detailed information about expenditure on health research in the UK). The analysis identifies that £8.5bn was spent on health research in the UK and whilst a proportion of this was allocated to basic research significant funds were allocated also to prevention, detection and diagnosis, treatment, disease management and welfare, economic and policy issues. It is worth pausing for a moment and thinking about this a little more. Of the £8.5bn £1.2bn was generated by medical research charities.

If, as a healthcare professional you are involved with supporting a medical research charity you will appreciate what this means in terms of the time and effort put into fund raising activities. Of course the funds raised contribute also to providing welfare services and educational material and of course some of the £1.2bn will have come from returns on investment but even so significant funds will have been raised by individuals running marathons, families and friends holding coffee mornings and undertaking all kinds of fund raising activities.

The motivating force for many? The aspiration that the money raised for research will make a difference and guess what that relies – not only researchers undertaking robust high quality research but also practitioners being prepared to drive change in service delivery when evidence becomes available.

The bottom line is that one of the most effective ways of engaging with research as a healthcare professional is to ensure that your practice is evidence informed, that where national guidance does not exist you use your skills to evaluate what evidence is available  and that by doing so you deliver on the NHS Constitutional commitment to ‘use research’.

The raison d’etre for people funding, conducting and participating in applied research is to improve patient care. Healthcare professionals are the linchpin to making this a reality.