Supporting, developing, working in, embedding, all terms applied on a regular basis to the culture of research being sought within the NHS. The ability of such a culture to improve population health and patient outcomes is taken as given. Expectations are placed on clinical teams, managers and individuals to engage actively in its development and growth. Frustration is expressed frequently about the challenges of embedding such a culture within clinical practice and I have lost count of the number of meetings I have attended where the barriers to achieving this are discussed and debated. It is indeed a focus of research in its own right.
So here’s a question I keep coming back to, what does a culture of research in the NHS mean to you? If someone was to ask you to describe it what would you say? When we talk about a culture of research how clear are we about what it is that we are striving to build? What would it feel like to work in such a culture, what would people be doing differently, what would people be talking about and importantly what story would they tell about it?
Key stakeholders driving this agenda are often external to the NHS Trusts they seek to influence. Established with a remit to deliver on specific agendas which, when combined, would indeed deliver a thriving culture of research and innovation. But here in lies the challenge, it feels like an elaborate layer cake with air, rather than filling, between the layers. Depending upon which networking event, workshop or meeting you attend as a clinician you will be encouraged to increase recruitment of participants to clinical trials, embrace the implementation of innovation, work collaboratively with academia and industry to innovate, engage in applied health research, work collaboratively with universities and industry on externally funded research projects and develop your own research skills and expertise. Each stakeholder tells its own carefully crafted story. Each story is told in the language of the respective organisation, accessible to those involved in its creation.
In storytelling there is a narrative structure called the composite story, described as:
a collection of short stories in which the narratives are specifically composed and arranged with the goal of creating an enhanced or different experience when reading the group as a whole as opposed to its individual parts. (S.Mann, (1989). The Short Story Cycle. New York: Greenwood Press.)
In my mind the development of a composite story about a culture of research within the NHS would enable each of the leading protagonists to craft their own story but, importantly, the layers of stories would not stand alone suspended in space as is the case currently. A layer of filling would be inserted between the layers to hold them together.
Anyone involved in undertaking qualitative research may see the obvious link with the process of making sense of data. Actively listening to people as they shape and tell their stories, sometimes at a specific juncture in their lives, sometimes over a number of years as their lives unfold. Collecting them, exploring them and then weaving them together.
When I embarked upon my research journey in the 1980s the development of a composite story or master narrative from data was often the sole domain of the researcher. However 30 years on these stories are more likely to be co-created with the people whose stories are being told. The co-creation is seen as a mechanism for increasing the authenticity and authority of the story.
And this is where my thinking is at the moment, what would the composite story surrounding a culture of research in the NHS be if it was co-created? If we were able to work with the different stories being told currently to blend and meld them into something which was greater than the sum of its parts, co-created and written in a language accessible to all.