A culture of research in the NHS: an aspiration in search of a story.

A spring showerSupporting, developing, working in, embedding, all terms applied on a regular basis to the culture of research being sought within the NHS. The ability of such a culture to improve population health and patient outcomes is taken as given. Expectations are placed on clinical teams, managers and individuals to engage actively in its development and growth. Frustration is expressed frequently about the challenges of embedding such a culture within clinical practice and I have lost count of the number of meetings I have attended where the barriers to achieving this are discussed and debated. It is indeed a focus of research in its own right.

So here’s a question I keep coming back to, what does a culture of research in the NHS mean to you? If someone was to ask you to describe it what would you say? When we talk about a culture of research how clear are we about what it is that we are striving to build? What would it feel like to work in such a culture, what would people be doing differently, what would people be talking about and importantly what story would they tell about it?

Key stakeholders driving this agenda are often external to the NHS Trusts they seek to influence. Established with a remit to deliver on specific agendas which, when combined, would indeed deliver a thriving culture of research and innovation. But here in lies the challenge, it feels like an elaborate layer cake with air, rather than filling, between the layers. Depending upon which networking event, workshop or meeting you attend as a clinician you will be encouraged to increase recruitment of participants to clinical trials, embrace the implementation of innovation, work collaboratively with academia and industry to innovate, engage in applied health research, work collaboratively with universities and industry on externally funded research projects and develop your own research skills and expertise. Each stakeholder tells its own carefully crafted story. Each story is told in the language of the respective organisation, accessible to those involved in its creation.

In storytelling there is a narrative structure called the composite story, described as:

a collection of short stories in which the narratives are specifically composed and arranged with the goal of creating an enhanced or different experience when reading the group as a whole as opposed to its individual parts. (S.Mann, (1989). The Short Story Cycle. New York: Greenwood Press.)

In my mind the development of a composite story about a culture of research within the NHS would enable each of the leading protagonists to craft their own story but, importantly, the layers of stories would not stand alone suspended in space as is the case currently. A layer of filling would be inserted between the layers to hold them together.

Anyone involved in undertaking qualitative research may see the obvious link with the process of making sense of data.  Actively listening to people as they shape and tell their stories, sometimes at a specific juncture in their lives, sometimes over a number of years as their lives unfold. Collecting them, exploring them and then weaving them together.

When I embarked upon my research journey in the 1980s the development of a composite story or master narrative from data was often the sole domain of the researcher. However 30 years on these stories are more likely to be co-created with the people whose stories are being told. The co-creation is seen as a mechanism for increasing the authenticity and authority of the story.

And this is where my thinking is at the moment, what would the composite story surrounding a culture of research in the NHS be if it was co-created? If we were able to work with the different stories being told currently to blend and meld them into something which was greater than the sum of its parts, co-created and written in a language accessible to all.

‘Cutting to the chase’ & ‘bottom lining’ your research?

Early spring blossom

One of the things I am loving about writing a blog is thinking in a bit more detail than usual about the words and phrases we use and exploring how they have come into common parlance. Why does the lens this week fall onto ‘cutting to the chase’ and ‘bottom lining’? Well a number of reasons really, firstly the British Library has announced the winner of its competition #sharemythesis and secondly I am in the midst of reviewing conference abstracts.

Both challenging researchers in different ways to be incredibly focused in the way they communicate their research. The former requiring you to summarise the importance of your PhD in a tweet of 140 characters or less, the latter being able to communicate your research in 250 words in a way which engages the reviewer, convinces them about the quality of the work you have undertaken and encourages them to select your work to present to a wider audience.

But cutting to the chase and bottom lining is not just about character or word count it is about being able to identify and distill the essence of your work. This is as much about thinking as it is about writing.

As researchers we are required to communicate our work in many different ways. The same plot, the same journey, the same end point but different representations. Some fast paced and direct with little time for sharing the nuances and subtleties of the landscape, others conducted at a more leisurely pace with time to pause and reflect on the way, to recount the detail and share the perspective.

For this post however, let’s think about the fast and direct route, the one that cuts to the chase and presents the bottom line. In case you are wondering, the etymology of cutting to the chase? The chase scene in silent movies was the bit where all the action took place, and screenwriters often tried to prolong the build up to the big scene. Studio executives used the phrase ‘cut to the chase’ to mean ‘get to the interesting bit’, stopping messing around and get on with it. Now we use it to as a means of communicating ‘get to the point’. And if you are interested in bottom lining – it comes from the word of accounting and refers to the profit left after everything had been calculated, so therefore the most important piece of information.

As someone who, at the start of their academic career, was in receipt of many a heavily edited text with comments like, ‘try to reduce the flowery language’ I know from personal experience the challenges associated with the ‘short version’.  We invest a great deal of time and energy in our research, we love the detail and nuance, we have thought about it a lot, and it is hard to let it go. We feel the need to explain the detail so that people can really understand what we are doing and why. Whilst we may find it hard to let go developing the skill of bottom lining is a valuable skill to develop so that in the situations when it is required we are able to ‘cut to the chase’ and not left floundering.

So if you want to test how good you are at cutting to the chase or bottom lining your research- can you summarise why your PhD or your research project is important in 140 characters? An interesting challenge.

Can I? So this in from my PhD: To understand how effective treatment for rheumatoid arthritis is we must understand & measure what is important to patients. Have a go it’s fun and it will challenge you to really think about the bottom line for your research.