A few weeks ago James Faraday, a speech and language therapist, wrote a guest blog about his experience of applying successfully for research capability funding within his Trust. In this guest post Louise Harding, Clinical Tutor and reporting radiographer at Warrington and Halton Hospitals NHS Foundation Trust, shares the experience of developing a research team within a practice setting and the journey the team has travelled over the last few years.

The Team.

Pictured from left to right: Anthony Manning-Stanley (reporting radiographer, Royal Salford Hospital), Andrew England (University of Salford), Paula Evans (Clinical lead, primary imaging, Warrington and Halton Hospitals), E. Maureen Taylor (Clinical lead and reporting radiographer, AED, WHH), Louise Harding (Clinical Tutor and reporting radiographer, WHH), Paul Charnock (Medical physics expert, Integrated Radiological Services, not in picture)

The Journey

My name is Louise Harding and I’m a Diagnostic Radiographer, with a joint role as Clinical Tutor and Reporting Radiographer within the Radiology department at Warrington Hospital, Cheshire. I’m delighted to be able to share with you my experience of undertaking research within the clinical setting.

If you had said to me a few years ago that I would be actively undertaking research and would present the results at a global conference, I would have laughed and told you not to be ridiculous! However, that is indeed what we have achieved alongside five other members of a research team that was started several years ago. It is an experience that has truly inspired me.

We started our tentative steps into research via a quality group that consisted of three Radiographers: Paula Evans and Maureen Taylor, who are both lead Radiographers and myself. Our aims were to promote good practice, particularly focussing on the patient experience and image quality issues identified through audit and feedback from service users. At the same time, I was also involved in assisting one of my undergraduate students undertake his dissertation which required close involvement with the University of Liverpool. This led to several visits to the university, where we were very happy to discover we had many interests in common, which included how best to improve image quality and optimise patient dose. Because, as Radiographers we are clinically based and had limited experience in research, we were delighted when Andrew England, one of the academic lecturers, expressed an interest in collaborating with us – we had the equipment: he had the know how!

We already knew Andrew very well, as he had been an ex-student at Warrington: so we always felt that we could ask any questions…no matter how random. I have to confess that at times I have felt completely out of my depth!! But I also feel that because we are clinical, quite often our questions raised very good points that were relevant and current and that otherwise might not have been considered? Ultimately, this led to developing our research team further, and we were joined by Paul Charnock, a medical physics expert (Integrated Radiological Services Ltd, Liverpool) who gave invaluable advice regarding issues surrounding radiation dose optimisation. Our final member is Anthony Manning-Stanley, a fellow radiographer, who has worked closely with us to develop his idea on the effects of patient orientation on radiation dose and image quality for pelvis examinations.

And so our initial quality group evolved into a research group, with the continuing objectives being to look at imaging techniques in Radiography to reduce patient dose whilst maintaining or improving image quality. We all agreed that it was important that we present and publish our research in order to effectively disseminate our findings. Because Maureen, Paula and I had limited experience in research, Andrew made a huge impact upon our progress, as he provided us with the guidance and expertise required to keep us on track and gave us the confidence to push our research forward. As an academic and experienced PhD researcher (now at University of Salford), Andrews input has been really important to our team, resulting in a successful application in 2011 for a research grant of £2500, provided by the International Society of Radiographers and Radiological Technologists (ISRRT).

ISRRT lou paula and michael

Left to right: Louise Harding, Michael Ward ISRRT President, Paula Evans,

And this was how we came to present at the ISRRT global conference at Toronto in 2012. This was a really exciting part of the research process, not everyone’s cup of tea I know, but despite being nervous, we really wanted to share our research. Paula and I presented on the final day of the conference which was a really proud moment for both of us. We also had the opportunity to attend many very interesting presentations and to meet some truly inspirational people, which fuelled our desire to continue undertaking research.

And so to the present date: on returning from Toronto, we continued to collect further data for our research project and with close guidance from Andy and support from the team, I wrote up our data and in May 2013 we submitted our research article for publication in “Radiography”, which is an international journal of Diagnostic Imaging and Radiation Therapy. Our manuscript required slight revision and was re-submitted in August, accepted in September and published in February 2014.

The whole process took over 2 years, mainly due to gaps where we struggled to meet up and move our research forward, but we persevered through some difficult times, maintained our focus and eventually achieved our goal of publication. We have since implemented the findings of our research into practice which has led to a significant dose reduction for pelvis examinations. We have also presented the outcomes of our research as a poster at UKRC in 2015, and were delighted to win first prize for conventional poster! We, as a team, successfully published 3 articles in as many years and are currently collecting data within our department exploring different areas of dose optimisation.

From our experiences so far in research, I believe there are several things that are really important in helping you achieve your goals. The most important is to have a good idea: no matter how simple it may sound (you may wonder why no one has thought of it before!). If you have a good idea you can achieve something that can be put into practice and hopefully make a difference.

A supportive team is essential. We would not have progressed without the support and efforts from each member of our team: we worked together in an honest and friendly manner and never felt that you couldn’t ask a question or that your opinion wasn’t valued. I believe we have a strong team, made up of a diverse range of skills and characters who complement each other’s strengths and weaknesses. The team also needs commitment and an abundance of determination, which we drew from each other when we were struggling.

It is really hard at times to maintain progression due to pressures at work and time constraints: Radiography is a busy and demanding profession resulting in few opportunities during working hours to get together with the team. However we were offered support from our manager, Andrea Oxford, who believed in us and enabled us to have some flexibility with our time. We were always mindful of staffing levels and busy clinics, so where possible we met at lunch times, kept in touch though emails or had meetings after work. There were frustrating times when nothing seemed to happen, but we slowly but surely moved in the right direction.

Research, when undertaken alongside your usual clinical role requires patience and resilience and you have to be prepared to work around a problem where possible. I really could not have achieved any of this on my own; the team we have inspires and encourages an inquisitive mind and provides a truly supportive framework for research.

Would we do it all again? You bet we “are”!!

I’d like to thank Louise for taking the time to share this great illustration of how, over time, it is possible to integrate research into clinical practice and the ability to explore clinically relevant questions which impact directly on patient care and feed into the evidence base of a profession.

One thread which runs though this experience and the experience James shared a few weeks ago is that of networking and developing collaborations if you want to undertake research outside of formal academic study. The importance of this was flagged up in a previous post Do I need an MSc or PhD in order to ‘do’ clinical research and is one I’m sure we will return to.