For HTN Now, we were joined by academics and experts from the health tech space to discuss some of the challenges and best practice approaches around translating research into practice. Our panel shared insights and key findings from their current and past research, as well as any impact or potential impact on healthcare delivery, and some of the barriers to translating that work into healthcare practice.
Joining us from the University of Edinburgh were Professors Robin Williams, director at the Institute for the Study of Science, Technology and Innovation; and Kathrin Cresswell, Professor of Digital Innovations in Health and Care. Robin and Kathrin shared a presentation focusing on their work in evaluating digital transformation in health and care.
Key messages included that technology is situated in “complex social, organisational and health system environments that impact the way it is implemented and adopted”, that scaling across contexts can be “particularly tricky”, and that “a top-down technology push will not work”. A balance between local and national involvement is important, and measuring impact and value is “particularly difficult” for complex technological upgrades like new EHR infrastructures, they shared. Technological innovation can be limited by structural factors, Kathrin told us, voicing her frustrations around the “lack of learning” often preventing knowledge transfer, as well as the repetition in lessons surrounding transformation programmes and limited learning opportunities as a result.
Veronica Blanco Gutierrez, NHS Clinical Entrepreneur, midwife, and EPSRC-funded doctoral researcher in digital health at the University of Bristol, next shared a presentation with us on her current doctoral research looking at fetal heart monitoring and hypoxia. Looking at CTG limitations and maternal and neonatal health inequalities, Veronica presented her research question: “Should we use ethnicity and other social determinants of health in AI-driven cardiotocography decision-support tools in labour to predict adverse events in babies?”.
Talking us through how the research was conducted and some of the preliminary findings and outcomes, Veronica also highlighted the impact of this in practice, including in reducing unnecessary interventions, improving health outcomes, and promoting health equity. She also touched upon some of the main barriers to realising this impact, including competing interests within the NHS, staff fatigue or work overload, and issues around cultural change.
Next up to present was Andrew Bateman, Professor in Rehabilitation, Interdisciplinary Research and Practice Divisional Lead at the University of Essex. Andrew offered us an overview of some of his research around rehabilitation following brain injury, presenting a holistic interdisciplinary model he developed to help people understand the relation between cognitive impairment, its effects, and how pain might interact with those to present with “functional consequences”. He also highlighted patient engagement efforts around using an app to offer patients support when returning home after a brain injury, networking events for stroke and brain injury survivors, and the need to interact with social media platforms, “because that’s where the patients are”.
Andrew finished by talking about the “steep learning curve” required to engage with technology, the need for a supportive organisational culture to help combat this, and the need for user involvement in the design and development process. “I think it’s important when having these technology meetings that we remember our most valuable technology is our people – we need to equip them and give them the confidence to follow their careers into the NHS,” he said.
Overcoming barriers around translating research into practice
“Myself and Kathrin have been trying to do that practice-oriented research for a dozen years,” Robin said, “and it’s been quite slow to establish that trusted expert status that makes it possible – in our case what really helped was the formation of the NHS Digital Academy, because many of those who are active change agents in the NHS are familiar with us and understand our concerns. So at the end of the process things are happening well, but at the beginning it was hard work.”
The other thing Robin and Kathrin have found is “the NHS isn’t very good at organisational memory”, Robin noted, “and with reorganisations that often follow changes in secretaries of state and senior leadership, relationships have been disrupted, strategies have been replaced, and a lot of the core people find themselves applying for their own jobs, resulting in the loss of a lot of internal capability.”
There’s a need to “link the needs in healthcare with research capabilities”, said Kathrin, “and often we see a mismatch between the shiny stuff like AI and the boring but important stuff like infrastructure”. The lack of focus on disseminating what works and scaling is also a detriment, she continued, “and I think we need to draw on these communities of practice and establish links between researchers and the frontline”.
“What I’m hearing from technology innovators,” Andrew said, “is that the ones who get it have really worked out how it integrates into a service”. Because of the pressures on the system, “people often don’t have the brain space”, he went on, “and I think that really thinking through whether we’ve made it easy to use, or whether it meets the right criteria, is integral”. The organisational culture is “the thing we need to keep coming back to,” he finished, “and understanding the stresses and strains people are under which might prevent them innovating”.
Veronica also highlighted the need to evaluate the purpose of research and what need it is meeting, saying, “across the NHS we’ve gathered a lot of data on the determinants of health and the causes of inequality, but we haven’t really done anything with that; I think it’s about marrying one with another, because health data on its own isn’t going to solve the problem, we need to consider the context and conditions that can make people sick in the first place.”
Establishing a culture that prioritises innovation
Kathrin talked about the need in health and care for “risky money”, to encourage staff to innovate. “We don’t know how these things play out,” she said, “but we need to try them out and learn from them”. We all “want to improve the way health and care works”, Kathrin shared, “but we need to align better on that”.
“Often we end up with the first implementation happening when people don’t really have any idea how to implement it,” Robin told us, “like in AI – in five years’ time that won’t just be something that’s plugged in by radiologists – they will have come up with better ways to exploit it; but there aren’t funding projects which run for long enough”.
Andrew recommended engaging with resources and bodies such as the NIHR, agreeing with Kathrin’s point about the need for “risky money”, but telling us how during his time as an NHS manager he experienced “researchers parachuting in with a solution and there not being much in it for me as a service manager other than taking time out of my clinic – I think researchers and innovators often underestimate the impact of these things.”
Veronica also shared her perspective as a midwife, saying “it would be nice to do more, but it’s a matter of time, money and resources; if someone comes to you with a research project and wants data, you need to do everything plus that on top of your working hours, on top of your salary, but that’s extra. I think having incentives to do that and time protection, coming together with both sides and seeing where we can meet in the middle, is essential.”
To watch the rest of the session, please click below. We’d like to thank our panellists for their time in sharing their insights with us on this topic.
