Going for growth: improvement in the infrastructural and management support for clinical academic research.

Our objective was to implement a directorate research strategy to improve and grow clinical academic capacity and capability and ensure that the organisational systems and processes enabled clinical staff and managers to increase grant capture, undertake clinically relevant research, including the adoption of NIHR portfolio sites and established a culture in which research was an accepted part of professional practice. An initial evaluation of senior and middle manager attitudes and understanding of the research infrastructure and benefits of research identified that the directorate had a deeply segmented view of research and only a partial view of how research could benefit patients and improve their services. A significant number of staff claimed to be research active but this activity was not contributing to the service knowledge or being translated into grant capture, leading to income that could be used to invest in patient facing research. Few managers had appreciated the challenge of implementing the research strategy or the potential of enabling research active staff to generate clinical academic careers. A quality improvement methodology was adopted, based on four equally important elements [1]; involving people (staff and patients) in research, developing people's research knowledge and skills, promoting an understanding of the complex systems and processes associated with research, and using an organisational research strategy with leadership to drive change. This improvement method suggests an equal and proportional range of activity to engage staff, amend and adapt processes and systems, carry out organisational change and "make it a habit". The improvement measures were selected by a number of managers who acted as "research champions" and shared these with all staff across the directorate; the focus was on delivering sustained improvements in performance targets agreed with the organisation. The interventions were introduced to assist managers in each professional group to champion research and undertake the organisational change that would be needed. The two cycles of improvement over 14 months were used to achieve "academic status" within the organisation, to include clinical staff in the delivery of the research strategy and to create a clinical academic infrastructure that incorporated a well organised public and patient involvement (PPI) panel. Additional measures included the level of participation of clinical academic staff in grant capture and the level of income from research to sustain the growth in activity.