More research; Better outcomes?
Is doing more research in an organisation a pathway to better outcomes?
Research suggests that when a health care organisation takes part in research, this may lead to better outcomes for all the patients cared for by that organisation, – and not just the patients who actually take part. In this blog, we explore whether this research finding is valid and if it is, how that might come about, and how it could be used to improve care across the NHS.
Most organisations know that research is good for patient care. Research can help us understand what treatments work, and why. We are also seeing more evidence of patients wanting to take part in research, and enjoying participation [1].
However, we also know that translating research to patient benefit - that is, engagement with research – is not easy. There is a long pathway between starting research and seeing care change and patients benefit.
However, there is increasing evidence that engagement in research also leads to patient benefit. That is, patients may have better care and outcomes, simply because the organisation caring for them is doing research.
A recent study by Amy Downing and colleagues explored participation in cancer research among hospitals [2]. They compared patient outcomes in hospitals doing more and less research, and found that patient survival was better in hospitals that were highly active in research. It is possible that those hospitals may be located in different places, or may serve populations that are generally healthier, so it might not be a fair comparison. However, the benefits of research remained, even when analyses controlled for all those differences. Not only that, but there was evidence that the longer a trust was highly active in research, the better the patient outcomes – a ‘dose response’ effect. These findings all suggest an important benefit of an organisation taking part in research.
We need to be careful in our interpretation of this single study, but there is wider evidence in support. A recent NIHR funded review found a number of studies, and many reported benefits. These were more often in relation to measures of the process of care (such as delivery of evidence based care) but a number of studies supported the Downing findings and showed benefits in terms of patient health [3].
Of course, teasing out these relationships and proving they demonstrate cause and effect is difficult – these issues are not amenable to trials. We are unlikely to ever have a definitive test, and it is more a case of assessing when the evidence is sufficient, rather than definitive.
Even if this finding is valid, key questions remains. First, how does this occur? We don’t actually know at the moment, although a variety of reasons have been discussed. Taking part in research may see the introduction of new technology or skills needed to do the research. It may reflect ‘softer’ effects such as motivating staff. Careful research would be needed to tease these mechanisms out, to help us understand how this occurs. Understanding may help us better maximise the benefits for all.
The second key question is: how can this relationship be used for quality improvement? Participation in research is something that is fairly easily quantified, and could be used in incentive or other quality improvement systems. There is potential to use this as a lever to generate patient benefit. However, caution is required, as a heavy handed application here could have important unintended consequences.
Frontline NHS organisations are under enormous pressure in terms of workload and funding, and research can sometimes be seen as a ‘nice to have’ rather than a priority, given other pressures. These new studies suggest that participation in research can have a real benefit for organisations that may impact on the lives of the patients they serve.
We’ll be taking this debate to a session of HSRUK to get wider views on this important area of work. Please join us at Workshop 9 (Hooley) at 10:05 on 5th July
[2] Downing A et al High hospital research participation and improved colorectal cancer survival outcomes: a population-based study. Gut 2017, 66(1):89.
[3] Boaz A et al Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open 2015, 5(12)
