- To evaluate and report on the process of implementing a collaborative multidisciplinary research capacity building model in one regional health service district.
- To identify how the RRGP structured mentor role contributes to research capacity building of clinician-led multidisciplinary teams.
- To identify key factors at the organisation, team, and individual levels that facilitate successful implementation of the research capacity building intervention in one regional health service district.
The study site is one Hospital Health Service (HHS) located in regional Queensland, Australia. This HHS provides public health services in hospitals and communities across an area of 117, 000 km2 and in 2017 published their long-term healthcare strategy for the region. The strategy, titled Destination 2030: Delivering Great Care for Central Queenslanders, articulates a need for sustainable research partnerships between the hospital and local universities to promote translational research and mutual training focused on innovative health care practice (29). The strategy recognises the increased demand for health services in the region, and the corresponding need to have the right health service infrastructure, in order to provide evidence-based health care to effectively respond to the populations’ health needs. Promoting sustainable research partnerships is recognised to enhance community health outcomes. The RRGP is a three- year initiative that emerged from the strategy and is embedded within the strategy’s vision and objectives. The RRGP, led by Central Queensland University, has been developed as a partnership between the HHS, Central Queensland University and the University of Queensland’s Rural Clinical School.
Participants and participant recruitment
There are five convenience groups:
Group 1 comprises of people directly involved in the development, delivery and implementation of the RRGP. Group 1 includes the RRGP project manager, project officer and members of the RRGP working party. The RRGP working party comprises senior researchers from participating universities and the hospital as well as a senior decision makers from the hospital.
Group 2 consists of Research Facilitators - academics from participating universities and health service staff with research expertise. Research Facilitators are responsible for facilitating weekly workshops to the research teams of clinicians (maximum number of 4 teams per Research Facilitator), over a period of eight weeks. Eligible Research Facilitators have research expertise and experience that align with the proposed research topics of the teams assigned to them. Research Facilitators are invited to participate by representatives from the RRGP working party and must meet pre-determined criteria (PhD qualification) to be eligible. As the Research Facilitator positions are funded, there is capacity for a maximum of six Research Facilitators to be recruited each year the program runs.
Group 3 comprise the Research Mentors - academics from participating universities and HHS staff who are suitably qualified (PhD, research outputs and grant income). Research Mentors are specifically recruited (by the RRGP working party) to align with the research topics of the RRGP teams who successfully matriculate from phase 1 of the RRGP to phase 2. Phase 1 being the 8-week education workshops and phase 2 being the operationalisation of the successfully funded projects. Each Research Mentor is responsible for providing one team with ongoing support for the duration of their project, usually limited to ten to twelve months. A memorandum of understanding is drawn up between the Research Mentor and the RRGP working group that sets out the level of support that is agreed upon and expected from the Mentor. The Research Mentor position is funded, with Mentors only able to claim payments once specific (agreed upon) milestones are met. Milestones include proof of ethics submission, and submission of an interim, midway and final project report. Eight projects are allocated for in the annual budget, so therefore, up to eight Research Mentors are recruited annually. The RRGP have developed specific criteria that researchers (both academic and industry) are to meet before they are eligible to fulfil the Research Mentor role.
Group 4 consists of weekly guest lecturers, topic experts from the university or hospital, who are tasked with developing and delivering the weekly lectures throughout phase 1 of the program. See table 1 for details around topics covered. This cohort are required to be suitably qualified according to existing RRGP criteria (tertiary qualified educators) and are recruited by the RRGP working group to fulfil these funded positions.
Group 5 comprises of clinicians who are interested in doing research and have enrolled in the RRGP. Participation in the RRGP is open to all staff employed at the regional HHS. Staff are recruited via internal emails and social media snowballing. Potential participants are required to complete an application form in which they outline a specific clinical issue, quality improvement idea or a patient safety issue that they are interested in researching. In addition, participants are required to self-select into multi-disciplinary research teams prior to commencement of the program. If potential participants express interest to participate but do not have a specific research topic, they are encouraged to join other research teams. The submitted applications are assessed against selection criteria presented on the application form. Clinicians whose applications are successful will be invited to participate. Successful applicants are also required to commit to having at least one team member present for each of the weekly workshops. The workshop presentations are offered outside business hours once a week over an 8-week period.
The RRGP combines a structured education program with a research mentorship model that supports the development, implementation and evaluation of small research projects. The RRGP is a peer-reviewed, merit-based program with aims that align with Cooke (1)’s research capacity building principles. The program aims to: (1) build the research capacity and skills of clinicians at one Queensland Health Hospital Health Service; (2) strengthen partnerships between tertiary learning organisations and health services; (3) promote evidence-based practice; (4) facilitate development of quality research; (5) disseminate research findings; (6) encourage novice researchers and clinicians in developing a research career. The program comprises of two phases: skills development lectures and workshops (8 weeks) followed by successfully funded teams’ operationalisation of their research project (10 – 12 months).
Phase 1 Skills development workshop
Phase 1 comprises eight skills development workshops designed to increase research knowledge. The workshops are delivered weekly over eight weeks with the participants engaging face-to-face in one-hour long lectures followed by two-hour workshop sessions. The lectures are delivered by experienced presenters who are chosen by the RRGP working group for their topic expertise. Following each lecture, the participants, along with their respective research teams, attend a two-hour workshop which is facilitated by Research Facilitators. The Research Facilitators assist the research teams to apply information presented in the weekly lecture to their specific research topic/idea. The Research Facilitators help to refine research questions and methodologies, guiding the participants in the development of a final research proposal.
The skills development workshops cover key topics related to the research process and formulating a research proposal. Table 1 presents an outline of the weekly topics and articulates the learning outcomes. The content for the skills development workshops captures the steps involved in the ethics submission process resulting in detailed project proposals.
At the conclusion of the eight weeks, research teams are expected to have been presented with sufficient information and support to develop a grant application for their specific project. While optional, the teams are encouraged to submit their research proposal to the RRGP working group for merit-based funding up to the value of $7000 AU per group. The applications undergo a blinded, peer review process, and are assessed according to pre-determined criteria that is shared with the participants. Funding is awarded to the top eight applications and these groups are then assigned a dedicated Research Mentor for the duration of the research project phase.
Phase 2 – The Research Project
Research teams whose proposals get approved proceed to phase 2 where they conduct their research over a period between ten to twelve months. As research supervision and mentorship are intrinsic to the successful completion of research projects (30), the research teams work with a dedicated Research Mentor. The role of the Research Mentor in the second phase of RRGP is to support the implementation, evaluation and reporting of the final research project.
The successfully funded teams, as grant recipients, are required to meet ongoing project milestones including ethics submission, project progress reporting and dissemination goals. Teams are also required to deliver a final report to the RRGP working group. The grant recipients are also expected to present their research at the annual HHS Research Showcase Day and are encouraged to disseminate findings through publications, conference presentations and/or to influence policy change. The Research Mentor, as a team member, is offered a pre-negotiated authorship position on any publications arising from the research. Authorship order on papers will be negotiated at the outset of the project and will reflect the relative intellectual contribution to the project by all parties as outlined by National Code of Conduct for Research.
The Cooke (1) framework for RCB will be employed to guide the evaluation process. The framework has been shown to be useful as an evaluation framework of RCB initiatives (15). Table 2 shows the application of Cooke’s framework to the RRGP. As can be seen, the RRGP interventions and the measurements through which they will be evaluated are directly linked to the six RCB principles proposed by Cooke.
The RRGP will be evaluated at different stages of the project cycle. First, the initial RRGP applications will be examined to gain a sense of how the program can develop skills and confidence of clinicians to conduct research. At the completion of the skills development workshop, the developed research proposals will be assessed in relation to whether the RRGP training and the respective opportunities to apply research skills in practice contributed to development of the basic research skills. A document review will be conducted of applications developed by the participants.
The participant responsiveness to the RRGP will also be measured. An audit of the de-identified attendance sheets will be undertaken to calculate the number of participants who completed the skills development workshop. In addition, program records of the composition of research teams – their disciplines and research topics will be examined.
Individual semi-structured interviews will be conducted with RRGP participants and above-mentioned Groups 2, 3 and 4 after each annual cycle of the RRGP. The development of the interview schedules will again be guided by Cooke’s RCB framework. The interviews will explore participants’ perceptions and experiences of the workshops with a focus on how the workshops enable the novice researchers to develop skills and confidence, as well as linkages, partnerships and collaborations. Open comments will also be encouraged related to the program and participants’ expectations.
Participants will also complete a survey at the end of the program which has research capacity building measures. The survey adopted in this study is the validated research capacity and culture (RCC) tool developed by Holden et.al (14). This survey is specifically designed to measure research capacity and culture across three domains: organisation, team and individual. The RRC tool has been successfully tested in Queensland Health facilities and has a reported good internal consistency for organisation, team and individual domains (alpha = 0.95, 0.96 and 0.96 respectively). It consists of a series of statements where participants rate their response on a Likert-style scale of 1-10 with 1 being the lowest skill or success level and 10 being high success/skill. The final survey used in our study consists of demographic data, 51 RCC domain questions (organisation n=18; team n= 19 and individual n=14) and an open-ended response section, designed to elicit specific contextual information.
During the first round of the program, we will evaluate the structure and content of the program to inform the quality of its subsequent delivery. Vijn et al (31) assert that the design-based research can be risky due to uncertainties in participant behaviour and circumstances in the learning environment. The plan-do-study-act method (PDSA) (32)will be applied to evaluating and optimizing the workshop. PDSA as a quality improvement strategy, enables fast implementation and quality improvement of health care interventions in healthcare (31). During a PDSA-cycle, the program will be planned, performed, evaluated and improved. The process will be evaluated through three rounds of focus groups with the expert researchers who fulfilled the role of Research Facilitators, to be conducted in the beginning (after the workshop has started), middle and the end of one round of the RRGP. The focus will be on assessing the aspects of the workshop that are working well and those that require improvement. The topic guides of the focus groups will revolve around the experience of the Research Facilitators guiding groups of novice researchers to prepare research proposals. The reiterative nature of the focus groups will also enhance respondent validation (33). The results of the evaluation will be used to improve the design of the skills development workshop.
At the later stage of the program, the impact of the RRPG will be examined. Dissemination of the research findings, continuity and sustainability of the research projects will be assessed through the number of grants awarded, as well as conference presentations and journal papers. A review will also be conducted of the potential media reports documenting the research projects
This study will adopt an exploratory concurrent mixed-methods approach designed to evaluate the implementation of the RRGP. The study comprises both quantitative and qualitative data collection methods for each 12-month period that the program runs. Data triangulation has been adopted to capture the complex issues associated with implementing collaborative multidisciplinary practice-research partnerships. Data triangulation will also enhance the confirmability and credibility of the findings (34).
Descriptive data will be used to report the participants’ demographic responses which include age, professional stream, employment status. Statistical analyses will be performed using SPSS. The RCC domains (organisational, team or individual) will be summarised using descriptive statistics (median, interquartile range (IQR)) and median scores categorised as low, medium or high. Friedman test (35) will determine difference in success/skill between the three domains and post hoc analyses will be conducted to determine where differences have occurred. An exploratory factor analysis will be conducted to determine underlying themes of the three domains. Correlation analyses will be performed to identify any relationship between demographic data and the identified factors. To determine the internal consistency of all domains and identified factors Cronbach alpha analysis will be completed. The level of significance will be set at p<0.05.
Open-ended responses and interviews
Open-ended responses will be transcribed, word-for-word and entered onto an Excel spreadsheet for analysis. Research team members will independently read and analyse the responses using content analysis (36, 37). Researchers will meet to reach consensus of first level analysis. This approach was selected as it is a practical approach that permits the presentation of results in everyday language, facilitating accurate interpretation and adoption by wider audiences (38). Finally, findings will be presented to other team members, not involved with the initial stages of analysis but who are familiar with the topic, who will evaluate the findings to ensure they match reality.
Thematic analysis will be conducted on the de-identified transcripts from interviews and focus groups (36). Again, the researchers will independently read and analyse the transcripts. They will then agree on a coding framework that will be developed. Qualitative data analysis will be performed with the assistance of NVivo.
An audit will be conducted of a range of documents that will be developed in the course of RRGP.