Respondents
Fifty-seven individuals expressed an interest in taking part in the semi-structured interviews. Twenty-eight individuals were interviewed (18 female, 10 male) and the remainder either did not respond to the researcher’s request to set up a date (n = 25) or were too busy to participate (n = 4). Respondents included a mix of staff: 7 nursing/midwifery, 6 medical/dental, 3 allied health professionals, 3 other therapeutic and 9 admin/support staff. Some staff had research written into their job descriptions whilst others did not. Some staff who claimed not to undertake research did take on activities that were associated with research. This non-recognition of what research entails was more noticeable in professions that traditionally see themselves as ‘patient-focussed’ only and non-researchers.
Research Findings
All the respondents identified similar facilitators and barriers to undertaking research activity within the organisation, irrespective of their role or experience with research. The degree that these factors affected the individual respondent varied according to their circumstances, but to a lesser or greater degree all respondents identified: Time, Resources, Culture, and Communication, as themes that influenced research activity. We also asked respondents about their thoughts on how the SARS-CoV-2 pandemic had affected their perception of research. Within these broad themes, there were intrinsic as well as extrinsic factors that were found to be indicators of research facilitators and barriers amongst NHS staff (Table 1). Individuals who had research as part of their professional role (primarily medical staff and psychologists) had more accepting views to undertaking research than those job roles which have not traditionally been involved in the research process (all other respondents).
Insert table 1 here…..
Although we identified 4 themes affecting research capacity and capability during this study, many of the themes did not have distinct boundaries and points raised by respondents were often relevant to more than a single theme.
Identified Themes:
Time:
The impact of time on research capacity was a re-occurring theme which had an important bearing on an individual’s consideration in undertaking research. This was often the first aspect mentioned when discussing barriers to engaging in research and, clearly, was a prominent consideration by the respondents. Those individuals who had protected time to do research valued this, enabling the individual to fit research activity into their work schedule.
R20 “in order to do anything productive from a research point of view, you’ve got to get something like the NES [NHS Education for Scotland] fellowship ...and then you do get some ring-fenced time”
When asked what could be done to facilitate the organisation’s research activity, individuals cited ring-fenced time as a key consideration.
R6 “So giving people funded time to do research is important”
R10 “I think the way of making a session where you could do a research session, that would be fantastic”
Protected time for research was not available to many staff and this made the thought of research daunting:
R28 “in clinical work that you’re employed to do isn’t research, you are employed to see people on a one-to-one basis and to fulfil that role, that clinical role”
R18 “It [research] is not something I’ve looked into seriously, and I think the - the reason for that is time”
Additionally, it was considered that research would require staff working in their own time and that was not possible or desirable for some respondents.
R25 “People obviously live busy lives, they may not have—not have time to undertake research and all that”
R1 “…and then previously we had an employee who was doing some research initiated by himself and he was trying to do that within the lab time, and he did it on his own time, so it was less than perfect and less than ideal”
It was noticeable that staff in professions traditionally associated with undertaking research activity, such as medical and psychology, were less likely to cite access to research time as a barrier when compared to other professions such as nurses who, traditionally, have not had research integrated into their role. This may be because some professions have the concept of research time built into their professional role whilst others do not.
R15 “I think it’s easier probably for medical staff to take part in research possibly because they’ve got protected study time, et cetera. I think it’s a lot harder for nursing staff to be involved”
Resources:
Resources to enable research was mentioned as either a facilitator (access to) or barrier (absence of) when undertaking research. Research-active respondents were more aware of and more likely to have accessed available resources through the R&D office than those who were not research-active.
Although staff motivation to undertake research does require external resources to foster it, motivation itself is a resource that can be utilised by an individual and therefore should be encouraged by the organisation. Personal motivation was the main driver for people to undertake research, often driven by improving patient or staff care, professional development, or job/team satisfaction.
R6 “I'm interested in research 'cause I think it helps you drive better care for your patients”
Additional educational resources were cited as a prerequisite to become research active.
R15 “I think there’s need to be upskilling of us to be able to be involved in research”
Respondents who identified the need for resources and recognised that support departments were available within NHS Fife were positive about their value.
R6 “I have found the R&D department to be really helpful and they've been very supportive to our aspirations to try and expand the research portfolio”
R2 “I think my experience of the Research Department is that it is very accessible and approachable”
R28 “There’s help available, librarians available as well to help with things like your systematic review even as a trainee is just so, so helpful”
Not everyone in the organisation was aware of the presence of these departments, or found them accessible.
R6 “One of the problems potentially is linking people who have an aspiration to do research when they start”
R18 “I wonder whether some kind of information regarding how to do an effective [literature] search. Perhaps that might be helpful if people want to engage in it that way”
Research active individuals were generally aware of the support within NHS Fife, whereas those who were not active in research were not.
Respondents were keen to have a research facilitator/mentor to help them with studies. There is a research advisor within the R&D department though this study suggests that it is not widely known throughout the organisation. Additionally, some individuals mentioned that having staff within their area who were dedicated to research would be a valued resource.
R15 “Whether there’s some way in each area you can have somebody who doesn’t necessarily carry out research but it could be that linked person with the research and development, so if anything came up, they could be the person to disseminate, you know, for dementia champions and all these things, and it might be you that you want to have somebody who’s a research and quality improvement or something sort of champion in each area, and then they could be that link”
One individual identified that without the support of others they would feel isolated undertaking research themselves, further illustrating the value of resources and a supportive environment around research building.
R2 “Definitely interested and liked to know more but a bit concerned about being isolated the first time that you do your own research”
Culture:
In addition to awareness of, and availability of resources to facilitate research, the use of these resources also needs to be acceptable to the potential researcher within the culture of the organisation and their team. The culture, or perception of the culture, of an organisation, can act as a support or a barrier to research activity. To understand this impact on NHS Fife employees we asked respondents about the impact of the culture on an individual, team, and organisational level. A positive culture of the department towards research was seen to be beneficial.
R15 “I think you have to have a manager, your direct manager has to be supportive and encouraging and make that part of their ethos whether it would be ward or team-based”
But a perceived obstructive, counter-culture of the organisation was seen as a barrier.
R11 “The thing that I think is most difficult is trying to get somewhere like the, well, the MDT [Multi-disciplinary Team] on board. It can be quite difficult to even just get small changes and patient care made so in terms of like new evidence for things”
Medical staff spoke about an established research culture and how to grow it in the future.
We're pivoting what we do to suit the current environment but still grow our research interest in, you know. It’s about bringing resource involvement, experience and work
Clinical psychologists also had a positive attitude to research in the organisation.
(In referring to medical staff and psychologists we have excluded the respondent number as it would have identified their profession)
I think it is…it [research] is fundamental just in the way we think and the way we operate
Furthermore, research is integral to some trainee posts and this normalises the activity in those groups.
R10 “I think trainees are more encouraged to think about research”
However, when those healthcare staff outside of medicine, dentistry, and psychology (Nurses, Midwives, Allied Health Professions, Healthcare Scientists, and Pharmacy staff, NMAHPs) discussed the acceptability of research in their culture they appeared less supported. An advanced nurse practitioner who acknowledged that “one of the pillars of practise is research and education” appeared less comfortable in the supportive culture for them to undertake research generally. Furthermore, staff who worked in non-patient facing support departments were likely to use research to inform practice, but did not consider their role would be to undertake the research themselves.
R12 “But generally, it [research] is not something I think that nurses do”
R15 “And a lot of our doctors are very involved in research but as a [profession deleted], I found it extremely hard”
Unsurprisingly, a supportive manager was seen to make research more acceptable to NMAHPs.
R15 “I think you have to have a manager, your direct manager has to be supportive and encouraging and make that part of their ethos whether it would be ward or team-based”
R20 “It [research] is still highly valuable and seen as an integral part, particularly from your high ups than a leadership team”
In addition to the culture of the individual within their workplace, the organisational pressure and culture within NHS Fife was seen to have a strong impact on research activity. Some of the respondents who were research active within their role considered that the organisation could do more to build research into the staff role.
R20 “So, yes, it [research] is valued but the infrastructure, the kind of framework for being able to do it is not there”
R6 “I think there's a will to do research, but I'm just not totally convinced that they [the organisation] have an overarching strategy and a way promoting it effectively”
Many of the respondents reported a lack of visibility of ongoing research projects and activity, or research resources (including the R&D department) within the organisation. If staff were more aware of research within the organisation that visibility would also embed it into the culture of the workplace as it would seem a standard part of the organisation’s ethos.
Defining what is, and is not research activity is subjective and may be reflective of the culture of the individual involved. Staff who are familiar with being researchers were happy to define themselves as such, but nurses and others where research is not seen as part of their role appeared more reluctant to put themselves into that category, even if, as in some cases, they had done postgraduate degrees or had engaged in research being run in the organisation.
Communication:
A common criticism raised by respondents concerned communication within the organisation about research activities, opportunities, and the dissemination of findings. Although it was difficult to measure the level of awareness of research activity within the organisation, comments made by many respondents suggested that research visibility was low amongst individuals who were not themselves research active.
R2 “I'm not aware that I would know very much about what research is actually going on in the hospital or across NHS Fife”
R6 “What we don't do very well is signpost who is research active”
R12 “I know obviously we’ve got a research department, I’m not aware of what they do, what research they kind of generate, how that has then impacted on practise”
Comments gave the impression that you needed to be actively doing research to be aware that it existed. This then became a barrier to other people in accepting that research activity was possible within the organisation. Some respondents were aware of the publicity about research distributed via the NHS Fife staff communication tool (‘Blink’) and in regular newsletters from the R&D department. But these were seen as passive, impersonal methods of communication that did not inspire staff to seek more information about ongoing research projects, or in opportunities to engage in research in the organisation.
R12 “Usually there’s a sort of blurb connected on Blink for you to read it but it’s not connections as such, it’s just basically informing you of what separate teams are doing”
R10 “I get the bulletin [from R&D] and I usually have a flick through it, just to see what’s going on but I’m not really aware of anything specific was happening”
A more proactive approach to communication, with personal interaction was suggested to increase communication between researchers, research departments and other staff.
R1 “It [communication] could definitely improve, for example and maybe it's what I need to do. Maybe I need to call up R&D say ‘come and have, you know, come and look round come and chat to us’. ‘Come and tell us what you do’ or coming up a TEAMs meeting or something, but I don't feel it should be my job to do that”
R15 “It might be good if it [research] was part of some sort of mandatory induction or something like that, that it was a bit more visible”
Furthermore, targeting the communication in a way that made the research more relevant to staff was seen as beneficial, especially when examples of how, or why research was undertaken.
R12 “It’s making the research team more visible about these are all the research projects that we’ve done, this is what we found, this is why your job is easier, this is why… this is the benefit for you, for all these projects. So once people see tangible benefits, I think they’re more likely to buy into the research in the first place”
It was suggested that a ‘champion’ could also act as a visible way of communicating ongoing research to others in the organisation.
R15 “I was talking about having almost a link. If you got some people, whether it’d be a consultant or nurse, an OT [Occupational Therapist] or somebody in each team who can be that link, then they can bring these ideas to the home and encourage”
Some staff described supporting research activity for others but not getting any feedback about the final conclusions. This lack of communication did not make the individuals feel valued or involved.
R1 “But then don't know what happens after that, you know? And we don't know if there's anything published and we don't know if anybody was acknowledged. Or so it is very much the Mushroom Syndrome”
Communication about all forms of research is vital for making it part of the accepted culture of the organisation, and a positive endeavour for individuals. The respondents’ comments suggested that the organisation was not very active in communicating research activity in a way that engaged the staff working within it. Although there were some processes to publicise research activity, these were not very engaging to staff who felt a more personal approach was likely to be more successful.
SARS-CoV-2 Pandemic:
A specific enquiry was made into perceptions of the impact of the SARS-CoV-2 pandemic on research interest and activity. During this period most respondents had become more aware of the value of research to improving healthcare to tackle the pandemic.
R15 “that when you see it [research] actually in action, it does make a more of a priority”
R15 “I think maybe it’s been more apparent to people, the evidence, you know, of what research means”
R18 “the engagement with research has been quite high or with, because, because things are changing all the time. So, we’re needing to keep up with it so we know what to tell people and we know what to look for….. I think there’s certainly this slight shift in wanting to engage with research and recognising the importance of it.”
Some respondents spoke about how they would take research forward from the lessons learnt from the pandemic, including new areas to study.
R25 “can adapt to the situation, learn lessons, and before it, planning, future planning for any similar events. I think, yeah, I think it’s vital to research, it’s vital going forward”
R10 “we’ve been moved to consulting in a completely different way, which we’ve never researched before”
This shows that putting clinical research in context (in this case, relating to an emerging health issue) made it more relevant and accessible to staff, and more valued as a priority in the organisation.
R15 “I definitely think it [research] should be a lot higher up than it is. I think COVID has shown that, you know”
Although there were many examples of a positive impact of SARS-CoV-2 on the research landscape, for a small number of respondents, the pandemic negatively impacted on the ability to engage with research. An increased workload during the SARS-CoV-2 pandemic made participation in research unfeasible.
R1 “it [COVID] is just the straw that broke the camel’s back. Our ability to support research is severely hampered by our staffing, uh status, and the requirements being placed on us”
Additionally, the constantly evolving information that came out from the research into treating SARS-CoV-2 also felt overwhelming to the staff working during this time.
R18 “But I think the - the myriad of it has just made people a little bit tired perhaps, unfortunately”