In total 18 individuals participated, with seven individual interviews held with board members (n=2), members of the organisation’s executive (n=4) and operational management (n=1). Eleven health staff, comprising a mix of clinical and non-clinical staff, participated through focus groups (n=8 face-to-face and n=3 in the virtual focus group). To preserve anonymity the responses have been simply assigned an interview or focus group number.
From the analysis of the interviews and focus groups three themes emerged:
- Fragmentation of research activity
- A need for supportive structures
- Collaboration for expertise
These themes are explored in greater depth below.
- Fragmentation of research activity
Currently research is viewed as an individual activity rather than part of a staff member’s work role or contribution to the organisation overall. This reliance on individual agency to drive research leads to research activity that is fragmented and has little connection to the organisation’s strategic direction.
“Because people were coming and saying I want to do this and I want to do that and it's like that's got no relevance to where our strategic build is going and our workforce build and whatever”. Focus Group 1
There is a need for supportive structures such clear strategic direction for research and leadership within the organisation’s priorities which will allow staff to align their preferred research activities to the organisation’s greater goals.
The current perception within the organisation is that there appears to be little research activity, with low visibility of existing research. This lack of visibility acts as an inhibiting structure. As a result local research is not seen as leading clinical care or service priorities.
“It should play a large role and it should drive a lot of clinical practice. However, I don’t believe that that's the case. I don't believe we have much capacity for research… it just is one of those things that are good in theory and we like to talk about it. But we don't actually put the infrastructure or the resources into doing it”. Focus Group 1
One of the perceptions about the organisation is that as a rural health service they are poorly placed to undertake research and poorly resourced for research activity.
“[Our organisation] has always thought that we are too rural and too poor to do research. And I think this is the thinking in most rural organisations or rural and regional organisations. But recently, say in the last 1 or 2 years, the thinking has been gradually shifting and changing”. Interview 7
This perception has a real effect in that staff within the organisation have traditionally not pursued research activity.
There is a tension within the organisation when considering appropriate targets for research training. One perception is that the way to build research activity and capacity is to start with those with an interest and desire for research, regardless of their position or status within the organisation. This egalitarian approach recognises that any individual or group within the organisation may have a viable and important research idea.
“I think it needs to be available to any employee that … have a – a level of interest in it… it could be someone in administration, it could be clinicians, research skills can be applied in lots of different settings”. Focus Group 2
Balancing this idealistic view is a more pragmatic approach; that the organisation has limited resources and these should be targeted to those best placed to maximise the organisational benefits of this training. These individual targets include those with an existing teaching and training role or those with existing responsibility for research.
“I guess the Utopia would tell you as many as possible [receive training]. In reality is that if that costs money you have to be selective about who does that, then I believe that the process of being selected can actually be quite discriminatory depending on where you sit in the organisation”. Interview 4
The limited amount of funding acts as an inhibiting structure, leading to potential indecision for deciding who, if anybody, should receive opportunities in the research and research education. This indecision, in conjunction with an overall fragmentation of activity and a lack of alignment with organisational strategy makes developing a research training strategy more difficult.
- A need for supportive systems
“If we start encouraging research then from our perspective we have to put systems in place so that people will know what is available, how to do it, what kind of support and what kind of funding is available”. Interview 7
At present there is a lack of systems and structures to support research within the organisation. Ideally the organisation would have one or more individuals with a diverse skillset who would be placed to help facilitate research and develop researchers.
“I think somewhere in the district you have to identify one or two people… who has got good communication skills, good liaison skills, good problem solving skills, to work with these people that are actually doing that, to enable them to concentrate on their research”. Interview 4
The level of knowledge about research is low within the organisation and people have been reluctant to engage with research due to a perception that research is complex, secretive and difficult, with systems that are obstructive and unhelpful.
“…it’s a little bit too hard, it’s almost a bit like secret research business … I think there’s a little bit of a perception it’s secretive, it’s complicated and it can be, depending on what you’re doing, but the main practice doesn’t have to be”. Interview 1
One structural support system required is the adequate resourcing of research activities. At present there is little resourcing for time, funding or research equipment. This leads staff to pursue options outside of the organisation or to view research as unsupported.
“I think the challenges for us are get the institution right, the culture right for individuals, to get the training right. Both in terms of people who do research and people who facilitate research and then we've got to get the last part which is the money”. Interview 5
Institutional or structural barriers to research and research training create a perception that the organisation is actively discouraging budding researchers from learning about or undertaking research.
“I think there are a number of barriers which probably I think characterise as institutional. So… how does an institution encourage people to think innovatively, to be looking for questions and to encourage it without becoming weary of change or resistant to change or uncaring about change? Sometimes I think good ideas get through the health institution by good luck rather than good management”. Interview 5
One structural barrier is the geographical spread of the organisation. This may inhibit activity at some of the outlying sites and create a tendency for all activity to be centred on the organisation’s largest facility.
“The other thing that is probably a little bit of a barrier for those people is because some of those people are in isolated areas. And we can talk about technology and we can talk about networking and all that but sometimes that isolation inhibits them from moving forward”. Interview 6
It is essential that supportive structures acknowledge and attempt to address these known barriers.
- Collaboration for expertise
There is a recognition that research is a specialist skillset that requires expert knowledge and expert input that does not currently exist within the organisation. In the absence of this expertise within the organisation, there is a need to build partnerships with universities and other health organisations to access this level of skill. Thus we can see a structural solution in the form of a partnership used to address a structural deficit in terms of research skill.
“That’s where a partnership with a university would be beneficial, if you have got someone that has a high level of training in the best way to conduct research... because it’s not a focus [of a rural health organisation]…” Focus Group 2
This collaboration with university partners was seen as a means of securing such expertise, provided that the organisation retain ownership of the strategic direction for research.
“That’s about setting the agenda, and if you’re not necessarily owning the research, being a part of the lead in the process of that research. Again, not being a passenger but actually being involved in driving where we are going”. Interview 2
These training strategies should acknowledge existing workplace cultures and the influence of competing priorities for the education and health care sectors.
The means of education and training saw participants recognise a place for online training, but felt face-to-face training may be more effective in terms of acceptance.
“I think face-to-face, project-based and over a period of time rather than a one-off. Project-based is… a lot more engaging and they can actually practice the skills as they go, plus they get encouraged to identify a project and then the training is about supporting them to work through that and they get the practical skills rather than just - when they learn about it in a classroom environment”. Interview 3