Peter Bower dips in to HSR UK's first ever online conference...
The HSR UK conference is quite the summer fixture for the applied health scientists among us, so it was gratifying that ‘the events’ of 2020 did not lead to cancellation, but saw the whole shebang uploaded and delivered online – and for free.*
I doubt many conference veterans would prefer the new format, but it has its upsides – including the ability to dip into sessions throughout an extended conference period and engage in ways that suit you. So that is how I found myself sat in my shorts at home on a humid Friday afternoon, entering the HSR UK 2020 Zoom meeting with a Labrador puppy flapping excitedly (but unhelpfully) at the keyboard (we take multidisciplinarity seriously at Manchester).
‘A’ for Innovation
My first session was ‘Update on research and innovation infrastructure’ run by the AHSN network. This was an excellent introduction to the Alphabetti Spaghetti that is the current ‘infrastructure’ – AHSC (Academic Health Science Centres), ARC (Applied Research Collaboratives), AAC (Accelerated Access Collaborative) and AHSNs (Academic Health Science Networks).
This complex structure has arisen from a basic truth – that we are good at innovation, but less effective at implementation at scale. This infrastructure is designed to help – but it IS complex. I work in an ARC, which is embedded in an AHSN, and linked to an AHSC. I know what they are and what they do, but articulating this in a clear and easy way would be a challenge.
So the presentations by Mike Roberts, Gary Ford, Eileen Kaner and Zoe Lelliott were helpful in describing each organisation, their functions and their links – and it is clear that collaboration (across these units, and across the country) is a big part of their future.
We also heard a rerun of the interesting results of the AHSN survey on NHS priorities for research and innovation. Many will be familiar (mental health, digital, integration), but the interesting result for HSR UK watchers was the priority afforded to workforce (at number 1 no less). We have heard several talks at HSR UK events (such as the excellent work of Anita Charlesworth) bemoaning the lack of focus on workforce, given that it is absolutely fundamental. More on that later.
In the pipeline
Underlying all this is the concept of the ‘innovation pipeline’ – from discovery to upscaling, with these various organisations having a role at each step – for example, AHSCs at the discovery end, and AHSNs more involved in upscaling, with ARCs sat between them doing evaluation and implementation science.
The pipeline is a nice image and has some utility, but can cause hackles among some. Partly this reflects concerns about anything so ‘linear’ - we love complexity like politicians loves expediency. It also seems to assume a priority for some types of research (‘discovery’) and a trajectory (from small scale innovation to upscaling) which does not always apply. System-level work may not fit this model, and quite a chunk of applied research may be a poor match. That doesn’t mean the pipeline model is wrong – but it is important that it is seen as a shorthand, not a map. Workforce is another issue that doesn’t really fit the pipeline model – which should be cause for reflection given the results of the AHSN survey.
May the workforce be with you
Luckily, other parts of HSR UK 2020 have workforce covered. Imelda McDermott drilled down into the concept of skill mix, critical to managing new types and patterns of problems entering services – and suggested adoption of a discursive approach (i.e. skillmix as a process) rather than the static concept which is often assumed in policy.
Pauline Nelson delved into the grubby issue of workforce data, highlighting the problems and challenges in making use of such data to support change. These reflect both practical and political issues (such as GP’s independent contractor status). She suggested that PCNs might be a platform for a cultural shift in how workforce planning is done (and here is Judith Smith with the latest on networks).
Frances Wu explored the concept of ‘informal organisation’ in inpatient settings - defined as repeat interactions without ‘conscious joint purpose’. She explored how the formal (e.g. HR policies) and informal organisations interacted and identified inconsistencies in how formal policies are communicated and applied.
Jon Gibson explored determinants of variation in primary care workforce and found both demand and supply side factors impacting on team composition. New roles (such as advanced nurses) are more highly clustered in bigger practices serving older and more deprived populations – which suggests many more interesting questions as to how that plays out in terms of quality and outcomes.
Jeremy Jones and colleagues compared different models of ward staffing. Their work suggested that high baseline establishment set to match peaks in demand was most cost-effective – whereas a minimal safe establishment (with redeployment and temporary staff to respond to increased activity) could be cost saving, but at higher risk. The results might be as expected, but their detailed quantification sharpened the analysis, and highlights the tension between costs and cost-effectiveness that bedevils much health care decision making.
The abstract for the work of Jonathan Benn and colleagues detailed a qualitative study of ambulance personnel wellbeing and highlighted a key finding - that limited feedback and debriefing was frequently referred to as a barrier to learning and ‘closure’. We await their video presentation for further details.
The final presentation from Nicola Hancock detailed a mixed methods evaluation of a large (and I mean large) programme to develop supported self-management skills in professionals. Having cut my teeth on this issue in previous years, this remains a fascinating challenge, with multiple complex patient and professional layers under those high flying policy pronouncements on the ‘fully engaged scenario’. The evaluation identified changes to professional language and interactions, and also longer term changes in terms of service delivery and design. Quite a positive message in a tough area to generate change.
A fascinating line up of presentations in this most critical of areas, displaying some crucial health services research strengths – mixed methods, multidisciplinary and theory based. However, it might also hint at some of the reasons for why workforce research gets less emphasis, as it lacks a little of the comforting structure of the ‘innovation pipeline’ – and (if I can be harsh), it lacks a little of its pizzazz. Crusty military types say that ‘amateurs talk tactics and experts talk logistics’. I think ‘innovative interventions’ and ‘workforce’ have a somewhat similar relationship in our world.
There’s plenty more on offer from HSR UK 2020 – do dive in!
Peter Bower is a health services researcher and National Speciality Lead for health services research with the NIHR Clinical Research Network. Other blogs and materials can be found at the CRN HSR Toolkit.
*For transparency, I am on the conference committee, but was only a spectator to the massive work involved to make the change. As anyone who has organised a conference knows, they are a beast to deliver – so changing format halfway through is an immense challenge. Kudos to the conference team