Steven Ariss , Jo Cooke, Christine Smith Jennifer Read, Sue Mawson , Susan Nancarrow

1. NIHR CLAHRC for South Yorkshire SCHOOL OF HEALTH AND RELATED RESEARCH Levels and Types of Partnerships for Improving Health Systems: Involvement and Engagement in UK CLAHRCs Steven Ariss, Jo Cooke, Christine Smith Jennifer Read, Sue Mawson, Susan Nancarrow National Institute for Health Research

2. Outline • CLAHRC, quick guide: What? Where? Why? How? Who? • Evaluation methods • Partnerships: Levels of Involvement & Engagement • Case study: NHS & Universities • Aligning priorities across organisations • Next steps

3. What are CLAHRCs? • Collaborations for Leadership in Applied Health Research and Care The NIHR collaborations are innovative communities of health professionals, academic researchers, technologists, voluntary agencies, industry and the public aimed at improving patient outcomes through applied research, knowledge adoption and diffusion.

4. NIHR CLAHRCs • Funded by the National Institute for Health Research • £50M total over 5 years • 9 pilot sites • £5M-£10M each • 100% matched funding

5. NIHR CLAHRCs: aims • Conduct high-quality applied health research • Translation of research evidence into practice • Focus on chronic disease and public health interventions • Impact on patient outcomes within three to five years • Culture change: collaboration amongst stakeholders

6. Why CLAHRC? Key influences • Best Research for Best Health (DoH 2006) • 5-year R&D Strategy for the NHS in England • Cooksey review (DoH 2006) - delays in translating evidence into changed health care practice '2nd translation gap‘ • Tooke report (DoH 2007) - identified the need to revisit the evidence based clinical effectiveness agenda using the science of behaviour change at an individual and organisational level • Canadian Health Services Research Foundation, Knowledge Brokering Program (2004-2007) - linking researchers with health decision-makers, match funding • Canadian Institute of Health Research Act (2000) - both health research and knowledge translation

7. Where? South Yorkshire, UK - 1.8 million people, 1 million economically active (of which 100k in the public sector) - Average wage 87% of national average - Above average prevalence CHD, COPD, diabetes, obesity - Sheffield:14 year difference in life expectancies between the best and worst off neighbourhoods

8. How?

9. Who? • 11 NHS Trusts • 2 Universities • Charities/Not-for-profit • Industry • 4 X Local government/Social Services • Commissioning bodies • Comprehensive Local Research Network (CLRN) • Research Design Services (RDS) • Medipex • Etc.

10. How? Organising Network: Levels of cross-organisational engagement & decision-making • Organisational strategic levelbuy-in • Programme level: Core & Theme • Theme level • Project level • Individual level

11. Methodology • Realist Evaluation (Pawson & Tilley, 1997) • Developmental Evaluation (Patton, 2011) • Utilization-focussed Evaluation (Patton, 1986) Pawson • Theory driven • Focus: academically robust or Patton? • Complex, pragmatic • Focus: usefulness for stakeholders • Reflects tensions between priorities of academics and practitioners

12. Methods • Interview schedules developed from a Realist Evaluation framework • Semi-structured interviews (27) with people in formal positions within CLAHRC SY • To aid development of the whole programme

13. 5 Critical Factors for Cross-Organisational Partnerships • Available time to devote to being engaged • Organisational support for CLAHRC activities • Epistemological agreement • Organisational compatibility • Ability to contribute to tasks and activities • Difference between involvement & engagement

14. Barriers and Facilitators: involvement/engagement

15. What Are The Issues? Case study: Collaboration and coproduction between health services and Universities

16. View From The NHS Prior to CLAHRC respondents described: • A research environment driven by collaboration rather than coproduction • A ‘disconnection’ between university led health research and the NHS • The NHS agenda and priorities were not generally considered or represented in research

17. View From The NHS • Locally service providers felt disenfranchised, they didn’t have their agenda represented in research which meant that they didn’t get out of research what they wanted. • The university research team approaches us because they need someone from the NHS on the team. Sometimes this aligns well but sometimes they just want a name ... What’s the benefit to us? • Emphasis on collaborative partnership, not ‘co-production’

18. View From The Universities There was a perception that the value and utility of research was previously not recognised within the wider health service: • Research funding was not ring-fenced • Research knowledge was not valued, prioritised or used effectively • Data systems were not ‘research ready’

19. View From The Universities • Money went into the NHS and got lost • Pilots not taken any further • Before CLAHRC…didn’t have time to evaluate… just moved from one target to the next • Routine data collection was terrible…hopeless as a research tool

20. Lack of NHS Support for Research • Their managers didn’t see the benefit from the project and made it more difficult to release them. They themselves began to feel guilty • Nobody in the PCT will pay for tools like SPSS (it’s seen as an Ivory Tower piece of software) that’s an indicator of attitudes towards research...‘just use excel’ • Frustrated by concentration on academic outputs, prematurely writing papers and conference presentations on how things are going to be done, rather than actually doing them

21. Lack of University Support for Implementation • The perception more generally, is that research is done for the selfish benefit of the researchers, they choose areas that they are interested in or that will help their career and it’s foisted on the rest of us • CLAHRC isn’t seen as ‘research’ by the university. But this is what research should be about- it should be ‘applied’

22. Developing Shared Understanding • Lack of understanding on both parts around why research does things like it does and why services require it done differently • At the beginning we didn’t understand what was going to happen in the organisations, this understanding came with the operationalizing of the projects

23. Developing Shared Understanding of Priorities Academic priorities (viewed from NHS): • Academic attitude pervades, it’s not that detrimental and does give some credibility NHS priorities (viewed from University): • They're delivering on such tight targets in Trusts, if activities take Trusts away from core business it’s difficult to align goals... They need to maintain quality but save money

24. Consultation & Negotiation • Working on a bid which was halted due to lack of consultation with NHS partners, they felt that it was academically led and not asking the questions that they wanted answering • Whole ethos of consultation: going in and asking not just saying what we are going to do • Making explicit we have all got different priorities but are there areas of priority that we can all agree on

25. Project LevelPriorities and Benefits Pilot Study: Community Rehabilitation Impact Data (CRID)

26. Organising Network: Levels of cross-organisational engagement • Organisational strategic levelbuy-in • Executive programme decision-making: Core & Theme • Theme level • Project level • Individual level Visible Resources Needed for Negotiating Priority Setting Potentially Conflicting Priorities

27. What Do We Know? • Maintaining aligned priorities requires: • Identifying organisational priorities & incentives • Accepting that priorities are different and changeable • Negotiation/coproduction (visible time & effort) • Shared understanding and language (boundary spanners) • Flexibility whilst avoiding drift (timescales, funding, goals, processes…) • Trust & commitment Organisational tensions manifest at project level

28. Where Do We Go? • Cross-organisational priority-setting is a knowledge translation challenge • Need for accessible tools and guidance that can be easily adapted for the local environment and understood by all participants

29. NIHR CLAHRC for South Yorkshire SCHOOL OF HEALTH AND RELATED RESEARCH Levels and Types of Partnerships for Improving Health Systems: Involvement and Engagement in UK CLAHRCs Steven Ariss, Jo Cooke, Christine Smith Jennifer Read, Sue Mawson, Susan Nancarrow National Institute for Health Research