BMJ 2013;347:f7431 doi: 10.1136/bmj.f7431 (Published 16 December 2013)
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Letters
LETTERS REFORM REFORM
Good research is essential for service improvement Martin Marshall lead, Dominique Allwood improvement science fellow Improvement Science London, London W1T 7HA, UK
Oldham describes “death by research” as one of the barriers to effective reform of health services.1 He is correct that established approaches to generating and using research often have little impact on efforts to improve care. But his assertion that the “culture of evidence” is incompatible with a culture of implementation is surprising. His off-hand rejection of the contribution of science to improvement mirrors the view of many NHS leaders: “we know what to do, health professionals and managers just need to get on with it.”
The problem is that too often we don’t know what to do. We know that improvement is difficult and that many promising projects are unsuccessful or fail to embed, spread, or sustain early gains. But our understanding of why this might be the case, or what we need to do differently, is in its infancy, and we need to show a little humility about what we don’t know. Oldham is right to challenge the academic community, but rather than rejecting the role of research outright, it would be more
helpful if he identified how he thought research could be more useful. Like creating new incentives to reward researchers who want to be useful, new ways of communicating research findings more effectively to decision makers, or encouraging novel ways of generating new knowledge through active partnerships between researchers and practitioners.2 Without good research, service improvement will go round in circles in the same way as Oldham claims NHS reform is doing. Competing interests: None declared. 1 2
Oldham J. Reform reform: an essay by John Oldham. BMJ 2013;347:f6716. (20 November.) Marshall M. Bridging the ivory towers and the swampy lowlands; increasing the impact of health services research. Int J Qual Health Care 2013; published online 17 Oct.
Cite this as: BMJ 2013;237:f7431 © BMJ Publishing Group Ltd 2013
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS REFORM REFORM
Good research is essential for service improvement Martin Marshall lead, Dominique Allwood improvement science fellow Improvement Science London, London W1T 7HA, UK
Oldham describes “death by research” as one of the barriers to effective reform of health services.1 He is correct that established approaches to generating and using research often have little impact on efforts to improve care. But his assertion that the “culture of evidence” is incompatible with a culture of implementation is surprising. His off-hand rejection of the contribution of science to improvement mirrors the view of many NHS leaders: “we know what to do, health professionals and managers just need to get on with it.”
The problem is that too often we don’t know what to do. We know that improvement is difficult and that many promising projects are unsuccessful or fail to embed, spread, or sustain early gains. But our understanding of why this might be the case, or what we need to do differently, is in its infancy, and we need to show a little humility about what we don’t know. Oldham is right to challenge the academic community, but rather than rejecting the role of research outright, it would be more
helpful if he identified how he thought research could be more useful. Like creating new incentives to reward researchers who want to be useful, new ways of communicating research findings more effectively to decision makers, or encouraging novel ways of generating new knowledge through active partnerships between researchers and practitioners.2 Without good research, service improvement will go round in circles in the same way as Oldham claims NHS reform is doing. Competing interests: None declared. 1 2
Oldham J. Reform reform: an essay by John Oldham. BMJ 2013;347:f6716. (20 November.) Marshall M. Bridging the ivory towers and the swampy lowlands; increasing the impact of health services research. Int J Qual Health Care 2013; published online 17 Oct.
Cite this as: BMJ 2013;237:f7431 © BMJ Publishing Group Ltd 2013
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
