Delivering the aims of the Collaborations for Leadership in Applied Health Research and Care: understanding their strategies and contributions

Abstract

BackgroundIn 2008, the National Institute for Health Research (NIHR) in England established nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) to develop partnerships between universities and local NHS organisations focused on improving patient outcomes through the conduct and application of applied health research.ObjectivesThe study explored how effectively the CLAHRCs supported the ‘translation’ of research into patient benefit, and developed ways of doing applied research that maximised its chances of being useful to the service and the capacity of the NHS to respond. It focused on three issues: (1) how the NHS influenced the CLAHRCs, and vice versa; (2) how effective multistakeholder and multidisciplinary research and implementation teams were built in the CLAHRCs; (3) how the CLAHRCs supported the use of research knowledge to change commissioning and clinical behaviour for patient benefit.MethodsThe study adopted an adaptive and emergent approach and incorporated a formative evaluation. An initial phase mapped the landscape of all nine CLAHRCs and the context within which they were established, using document analysis, workshops and interviews, and a literature review. This mapping exercise identified the three research questions that were explored in phase 2 through a stakeholder survey of six CLAHRCs, in-depth case studies of two CLAHRCs, validation interviews with all nine CLAHRCs and the NIHR, and document review.Results(1) The local remit and the requirement for matched NHS funding enhanced NHS influence on the CLAHRCs. The CLAHRCs achieved positive change among those most directly involved, but the larger issue of whether or not the CLAHRCs can influence others in and across the NHS remains unresolved. (2) The CLAHRCs succeeded in engaging different stakeholder groups, and explored what encouraged specific groups to become involved. Being responsive to people’s concerns and demonstrating ‘quick wins’ were both important. (3) There was some evidence that academics were becoming more interested in needs-driven research, and that commissioners were seeing the CLAHRCs as a useful source of support. A growing number of completed projects had demonstrated an impact on clinical practice.ConclusionsThe CLAHRCs have included NHS decision-makers in research and researchers in service decision-making, and encouraged research-informed practice. All the CLAHRCs (as collaborations) adopted relationship models. However, as the complexities of the challenges they faced became clearer, it became obvious that a focus on multidisciplinary relationships was necessary, but not sufficient on its own. Attention also has to be paid to the systems within and through which these relationships operate.Recommendations for researchFuture research should compare areas with an Academic Health Science Network (AHSN) and a CLAHRC with areas with just an AHSN, to understand the difference CLAHRCs make. There should be work on understanding implementation, such as the balancing of rigour and relevance in intervention studies; systemic barriers to and facilitators of implementation; and tailoring improvement interventions. There is also a need to better understand the factors that support the explicit use of research evidence across the NHS, and the processes and mechanisms that support the sustainability and scale-up of implementation projects. Research should place emphasis on examining the role of patient and public involvement in CLAHRCs and of the relation between CLAHRCs and NHS commissioners.FundingThe NIHR Health Services and Delivery Research programme.

Getting the most out of knowledge and innovation transfer agents in health care: a qualitative study

“…CLAHRCs are serviced-led partnerships that aim to contract high-quality applied health research, implement findings and increase NHS capacity to engage in research. [36][37][38][39] In 2008, nine CLAHRCs were established and a second wave extended the CLAHRCs reach with tapered funding (from NIHR) for 13 CLAHRCs. This is an indicator of the perceived success of the programme.…”

“…[39][40][41][42][43][44][45][46] The reports to date highlight similarities and differences between structural and content features of the CLAHRCs and point to early successes and challenges. For example, successes include strengthened networks and relationships; 39,44,47 new organisational roles that 'make sense to professionals'; collective action to improve practices; 48 and creating a culture of reflection and learning. 47 More specific successes have also been reported.…”

“…For example, the CLAHRC for Greater Manchester achieved success in improving patient services in chronic kidney disease. 41,49 Although such results demonstrate the impact of CLAHRCs and how the collaborations can change the approach of organisations for the better, 39,50 it is very difficult to demonstrate a causal effect given the complexity of what they are and what they are trying to achieve. Walshe and Davies 22 are more circumspect and conclude that 'promising lessons' can be distilled from the collaborations in England, which, among others, include 'the development of organizational capacity in knowledge mobilisation'.…”

“…Arguably, decision-makers and researchers differ in their view of research; 115,140 researchers look at the information for academic rigour, whereas decision-makers assess its local relevance. 140 At both the local and national level, new evidence may be supported or sidelined; it may address or be at odds with local needs; 39,141,152 it may require change that is demanding (transformational and rapid) or the change may be incremental and require only fine-tuning. Relevance and benefit to the participants is an important enabler.…”

“…The limitations of the role of bridging agent, disseminating information between two organisations, have been highlighted by Soper et al 39 and Long et al, 104 suggesting that collaboration between organisations or groups is more effective. These authors maintain that bridging agents risk becoming gatekeepers or holders of knowledge and that this limits cross-collaboration and imposes pressure on the agent.…”