Lost in co-production: to enable true collaboration we need to nurture different academic identities

Involving stakeholders directly in the research process and co-production have become common features of research designs aimed at delivering impact. However, in practice co-production often comes into conflict with more conventional research methods and understandings of what constitutes ‘academic’ research. Based on the findings of a recent study of co-production as part of an EU research project, Annette Boaz, suggests efforts to facilitate co-production should focus on the practice as an epistemological, rather than methodological challenge, and focus on enabling the creation of academic identities that allow for authentic collaboration with research stakeholders

Drawing straight lines along blurred boundaries : qualitative research, patient and public involvement in medical research, co-production and co-design

Biomedical research policy in many countries has adopted the principle of active involvement in research. However, how different approaches to involvement such as patient and public involvement/engagement (PPIE), qualitative research, participatory research, co-design and co-production sit alongside each other, is contentious and unclear. There has also been a subtle shift in the discourse, with the language of co-design and co-production used more widely in debates about involvement. This shift has surfaced once again debates about what counts as meaningful involvement. In this paper we seek to contribute to this debate by exploring boundaries and overlaps between them. We suggest that they share some underpinning philosophies and all are prone to be challenged on the grounds of tokenism despite avowed good intentions. We argue that these different approaches are not necessarily as distinct as is often advocated and question whether there is merit in this family of marginalised approaches working more collaboratively to give patient voices greater traction. At the same time, we recognise that this creates challenges and tensions

The hard labour of connecting research to policy during covid-19

The worlds of policy and academia are often distant and can be difficult to span. In this post Kathryn Oliver and Annette Boaz reflect on their experience of working in the Government Office for Science to help produce the government’s new Areas of Research Interest and the particular challenges involved in establishing and mobilising networks of researchers and policymakers to work towards shared goals

The role of the research assessment in strengthening research and health systems

Research Impact Assessments are regularly regarded as a tiresome part of the research process. However, Annette Boaz and Stephen Hanney find that taking a systems approach to health research demonstrates the value of assessing impact. Drawing on examples from a new review for the WHO Health Evidence Network, they highlight the role that impact assessments play in securing research funding and strengthening the health system

Building new bridges between research and policy during a national lockdown

Annette Boaz and Kathryn Oliver are social scientists with expertise in production and use of evidence for, policy. In this blogpost, they reflect on their recent experiences putting their knowledge into practice at the heart of government during a national lockdown. They describe the significant changes they had to make to their planned programme of (face-to-face) engagement work and how it was possible to build relationships and get a significant programme of work underway online to mobilise existing evidence in response to the COVID-19 pandemic and the UK government’s Areas of Research Interest framework

‘Holding the line’:a qualitative study of the role of evidence in early phase decision-making in the reconfiguration of stroke services in London

BACKGROUND: Health service reconfigurations are of international interest but remain poorly understood. This article focuses on the use of evidence by senior managerial decision-makers involved in the reconfiguration of stroke services in London 2008-2012. Recent work comparing stroke service reconfiguration in London and Manchester emphasises the ability of senior managerial decision-makers in London to 'hold the line' in the crucial early phases of the stroke reconfiguration programme. In this article, we explore in detail how these decision-makers 'held the line' and ask what the broader power implications of doing so are for the interaction between evidence, health policy and system redesign. METHODS: The research combined semi-structured interviews (n = 20) and documentary analysis of historically relevant policy papers and contemporary stroke reconfiguration documentation published by NHS London and other interested parties (n = 125). We applied a critical interpretive and reflexive approach to the analysis of the data. RESULTS: We identified two forms of power which senior managerial decision-makers drew upon in order to 'hold the line'. Firstly, discursive power, which through an emphasis on evidence, better patient outcomes, professional support and clinical credibility alongside a tightly managed consultation process, helped to set an agenda that was broadly receptive to the overall decision to change stroke services in the capital in a radical way. Secondly, once the essential parameters of the decision to change services had been agreed, senior managerial decision-makers 'held the line' through hierarchical New Public Management style power to minimise the traditional pressures to de-radicalise the reconfiguration through 'top down' decision-making. CONCLUSIONS: We problematise the concept of 'holding the line' and explore the power implications of such managerial approaches in the early phases of health service reconfiguration. We highlight the importance of evidence for senior managerial decision-makers in agenda setting and the limitations of clinical research findings in guiding politically sensitive policy decisions which impact upon regional healthcare systems

Does the ‘diffusion of innovations’ model enrich understanding of research use? Case studies of the implementation of thrombolysis services for stroke

Objective To test whether the model of ‘diffusion of innovations’ enriches understanding of the implementation of evidence-based thrombolysis services for stroke patients.Methods Four case studies of the implementation of evidence on thrombolysis in stroke services in England and Sweden. Semistructured interviews with 95 staff including doctors, nurses and managers working in stroke units, emergency medicine, radiology, the ambulance service, community rehabilitation services and commissioners.Results The implementation of thrombolysis in acute stroke management benefited from a critical mass of the factors featured in the model including: the support of national and local opinion leaders; a strong evidence base and financial incentives. However, while the model provided a starting point as an organizational framework for mapping the critical factors influencing implementation, to understand properly the process of implementation and the importance of the different factors identified, more detailed analyses of context and, in particular, of the human and social dimensions of change was needed.Conclusions While recognising the usefulness of the model of diffusion of innovations in mapping the processes by which diffusion occurs, the use of methods that lend themselves to in-depth analysis, such as ethnography and the application of relevant bodies of social theory, are needed

Adult social care research and practice collaboration evidence synthesis

This document was produced based on the POSTnote approach (please see here for more information) to synthesising academic literature and stakeholder insights on a topical issue within policy and practice. This document was written by Hannah Kendrick (Care Policy and Evaluation Centre, LSE) with support from Juliette Malley (Care Policy and Evaluation Centre, LSE) and Annette Boaz (King’s College London) – members of the Creating Care Partnerships project. The intention was to develop a resource on behalf of the adult social care partnership community as a whole and so draws on a wide range of insights and expertise from all contributors (names & affiliations listed on p. 27 of the document). The document draws on studies funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (Grant Reference Numbers: NIHR31335, NIHR131373, NIHR131345, NIHR 131358, NIHR13110, NIHR133629). The views expressed in this document do not necessarily reflect the views of the NIHR or the Department of Health and Social Care

Whose voices? Patient and public involvement in clinical commissioning

AIM: This paper aims to explore patient and public representation in a NHS clinical commissioning group and how this is experienced by staff and lay members involved. BACKGROUND: Patient and public involvement is believed to foster greater public representativeness in the development and delivery of health care services. However, there is widespread debate about what representation is or what it should be. Questions arise about the different constructions of representation and the representativeness of patients and the public in decision-making structures and processes. DESIGN: Ethnographic, two-phase study involving twenty-four observations across two types of clinical commissioning group meetings with patient and public involvement, fourteen follow-up interviews with NHS staff and lay members, and a focus group with five lay members. RESULTS: Perceptions of what constitutes legitimate representativeness varied between respondents, ranging from representing an individual patient experience to reaching large numbers of people. Consistent with previous studies, there was a lack of clarity about the role of lay members in the work of the clinical commissioning group. CONCLUSIONS: Unlike previous studies, it was lay members, not staff, who raised concerns about their representativeness and legitimacy. Although the clinical commissioning group provides resources to support patient and public involvement, there continues to be a lack of clarity about roles and scope for impact. Lay members are still some way from constituting a powerful voice at the table

Filling the gaps - can research play a more innovative role in adult social care?

The interface between research and the contexts in which it is used are often taken as a given. Discussing findings from a study into research use in adult social care, Annette Boaz, Juliette Malley and Raphael Wittenberg suggest that in areas where research use is low, researchers would benefit from developing target organisations’ ability to use research findings and linking their work into existing innovation and evidence use practices