Katherine E. Harding, Lauren Lynch, Judi Porter & Nicholas F. Taylor
The acquisition of new knowledge in healthcare and encouraging the uptake of this evidence into practice requires clinical environments willing to embrace a research culture. That is, a culture in which the application of evidence is valued, clinicians are encouraged to participate in research related activities, opportunities are available for staff to acquire skills in research and evidence based practice, research achievements are recognised and there is an investment of resources in research activity.
Investment and participation in research activities that contribute to a research culture are known to lead to measurable improvements in outputs such as journal publications, conference participation and receipt of grant funding. There is also evidence that direct investment in health and medical research is good value for money. For every dollar invested in health research and development in Australia between 1992-3 and 2004-5, an estimated $2.17 was returned in health benefits (http://www.asmr.org.au/ExceptII08.pdf).
However, these measures do not tell us what impact investments that contribute to a research culture have on organisational performance of health services. Do research activities distract from clinical care, reducing efficiency and productivity? Or conversely, do they have benefits for health service organisations? For example, can a strong research culture lead to a more stimulating workplace that attracts and retains quality staff and encourages the uptake of evidence based practice, with flow on benefits for improved service delivery? A systematic review published in Australian Health Review sheds some light on these questions.
Of 3014 papers identified in the search, only eight met criteria for inclusion in the review. That is, papers that measured the impact of research interventions at the organisational level (such as research investment, training, capacity building or participation in research projects) on organisational outcomes (such as productivity, efficiency, staff retention and satisfaction or patient outcomes measured at the organisational level, such as mortality rates).
Three of the included studies evaluated workforce interventions; the others used cross-sectional designs comparing the organisational performance of health services with high levels of research engagement or markers of ‘innovativeness’ with those that did not. All studies presented evidence of an association between activities that represent an investment in research culture and organisational performance. Improved organisational performance included lower patient mortality rates, higher levels of patient satisfaction, reduced staff turnover, improved staff satisfaction and improved organisational efficiency.
The relatively small number of papers that met the inclusion criteria for this review highlights a shortage of papers measuring ‘outcomes’ rather than ‘outputs’ in this area. There is an abundance of literature measuring research outputs (such as academic publications, conference presentations and receipt of research grant funding), but high quality studies directly measuring the impact of activities that contribute to research culture in terms of organisational performance are relatively scarce.
While this systematic review provides preliminary evidence that investment in research is associated with improved organisational outcomes, questions remain about how research culture and organisational performance might be related. Positive associations between research culture and organisational performance identified in cross-sectional studies do not tell us whether this relationship is causal. Many of the patient and staff benefits measured in the included studies such as mortality and staff retention are complex and multi-factorial and cannot be attributed to research culture alone. It is also likely that there are other factors that might contribute both to a culture of research and high standards of organisational performance; excellence in leadership, availability of resources, and attractiveness of an organisation to quality staff are some examples.
The available evidence suggests an association between investment in a research culture within health organisations and organisational benefits. However, the relatively small body of literature available addressing outcomes leaves many unanswered questions for health service managers and policy makers. What is the relative importance of investing in a research culture versus other priorities for the use of healthcare resources? What is the return on investment? These questions make interpretation of the current findings difficult for managers and policy makers and represent a potential focus for future research. More evidence is needed to help managers and policy makers to determine the return on investment in activities that contribute to a research culture, and the nature of interventions that best achieve this aim. In the interim, service providers should ensure that initiatives that aim to increase the research culture of the health workforce are evaluated in terms of their impact on the performance of their organisation.
This paper is available at http://www.publish.csiro.au/?paper=AH15180