Getting research going in emergency departments can be hard but it is vitally important for improving healthcare. This presentation gives tips and strategies for building a research culture. Taking the first step is often the hardest part!
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How to cultivate a research culture in the emergency department
1. Building a research culture in the
emergency department
January 2015
@kellyam_jec
2. Conflicts of interest & permissions
No conflicts of interest to declare
The content of this presentation may be used freely
for educational purposes
It was first presented at the Society foe Emergency
Medicine Singapore conference in January 2015
3. Objectives
To understand:
What a research culture is and why it is important
The barriers and enablers to building a research culture in
emergency departments
Strategies to build and maintain a research culture
4. Ideal emergency department activities
Clinical
care
Research
Education &
training
Quality and safety
improvement
5. ED activities – the real world!
Clinical care
Research
Education
& training
6. What stops ED having a research culture?
“Research is not core business”
“There is no time”
“It’s too hard/ complicated/ etc”
“Our ED is too small/ not university-affiliated/ etc”
“Research projects are complicated and need a special
team”
“Research does not directly impact my patients”
“There are no research questions that are relevant &
feasible for our ED”
“We get no credit for it”
“It’s a doctor thing”
“Research does not change the way I do things”
7. What is research culture?
Research: generation of new knowledge
Culture: shared values, attitudes, patterns of
behaviour and structures that give an activity
significance
8. Disabling words
‘Research’ is a disabling word for many ED team
members
An alternative perspective is that research is all
about evidence
Generation and/or application of evidence to do things
better
9. Why is a research culture important for an ED?
Facilitation of quality improvement by:
Assisting transfer of evidence into practice
Investigating clinical questions arising from local practice
By research
By search of literature and collation of evidence
Enhancing ED standing within an organisation or
system
Harnessing the creative/ innovative power of ED
team
Enhancing ED morale and teamworkThere can’t be a great ED without a research culture
10. What does a good research culture ‘look like’?
Values, attitudes and beliefs
Strive to do things better
Encourages questions and ideas for innovation AND has
a structure to process them
Focusses on important questions
Collaborative and supportive
Celebrates and communicates its success
Structures
Will vary depending on the environment
Examples
a research interest group
a ‘named’ research centre
11. Letting you into a secret..(Shh)
Joseph Epstein Centre for
Emergency Medicine Research
(JECEMR)
1 part-time research leader 0.2EFT
1 x 0.8 EFT research nurse/ co-ordinator
1 x 0.2 EFT admin officer
Internationally recognised
High publication output
>12 papers per year over last 5 years
Attracts higher degree students
Attracts international fellows
Attracts grants
12. How do we do it?
Supported by:
Small amount base funding by health service
Several emergency physicians who assist with projects
ad hoc in non-clinical and own time
A group of keen nurses who come up with questions and
assist with data collection
Several registrars in training who do a project (and get
published) – usually in own time
Ad hoc students from universities
Collaborations within and outside our health service
13. Why do they do it?
Variety of motivations
Individual
Career enhancement
Research interest but limited skills/ time
See the benefits in patient care change
Feel valued and included
Collaborators
EDs rich caseload
Different perspective to inpatient cohorts
14. Barriers to research culture in ED
Competing priorities, especially clinical service
delivery
Time
Skills
Funding
Structural barriers
Fear of change
Lack of recognition/ credit
15. Enablers for research culture in ED
Lots of important clinical questions generated from
clinical caseload
Lots of patients!
Large, well educated team (medical, nursing, allied
health, etc)
Well placed for cross-discipline & system level
research
Used to teamwork and collaboration
Relatively under-researched area
17. Structures to support a research culture
Will vary with environment
Aims:
Promote importance of research to EM practice
Encourage use of research/evidence to guide practice
Process questions and ideas from ED team
Build research skills (general and research management)
Communicate about research – internal and external; ‘up’
& ‘across’
Facilitate collaborations –internal and external
18. Structures to support a research culture
ED leadership team support
Literally, ‘on the agenda’
Variety of structures
Research interest group/ research
team
Named research group
Clarity about how to feed in ideas
and how they are handled
19. Activities of research group
Awareness raising
Regular research rounds
Rotating poster displays in ED
Research exchange events with other departments/ other ED
Display of publications in ED
Celebration of success – grant, publication, practice change
Recognition of contribution
Education and capacity building
Structures to support mentoring
Build relationships with other disciplines/ EDs for
collaboration
Host annual research forum (showcase)
20. Building and maintaining the culture
Changing culture is difficult and takes time!
The key is COMMUNICATION
Why it is important
What’s going on currently
That all ideas are valuable and welcome
That research is a team game and that everyone is part of
the team
That everyone’s contribution is appreciated
That research is core business because of its link to
quality
Of successes
Of value to patients and the organisation
21. An international parable
Heaven and Hell
In hell, all the people are seated around a long
dining table piled with delicious food. Each of them
has three-foot-long chopsticks. They are all starving
because they are only trying to feed themselves.
In heaven, same set up, long table, lots of food,
three-foot-long chopsticks, but everyone is eating
well because they are feeding each other.
22. Messages for research culture
Research culture’s top priority is good relationships
across the research team
Respect other members, elevate them, advocate for
them, celebrate their success
With good relationships, results will follow
23. Leadership and research culture
Building a research culture requires transformational
leadership
Influence
Inspire
Motivate
Stimulate
Disseminate
Encourage diversity of thought
Recognise and reward
Coach and mentor
24. The importance of influencers
What is an influencer?
Harnessing influencers
Inform and consult
Listen and acknowledge
Explain
Touch base frequently
Respect as an important part of your team
25. Leveraging off other research teams
Often more established research teams in your
organisation
Learn from them
Collaborate with them
Establish mentoring relationship with their senior
members
Use them to advocate for ED research team
26. ‘Research is a doctor thing’
Nursing practice is a major contributor to ED care
Emergency nursing very under-researched
Safer handover
Medication safety
Triage
Nurse-led models of care
Educational needs
Interdisciplinary teamwork in critical cases
End of life care in ED
Same applies to allied health/ other clinical groups
27. Importance of collaboration
Vibrant research culture is truly collaborative
All ideas for projects are welcomed and valued
When projects are being planned, there is meaningful
consultation with any clinicians impacted
During projects there is regular two-way feedback about
progress (and problems)
It’s not just about the lead researcher – all contributors
are appropriately acknowledged
News about presentations and publications in shared with
and valued by all members of the ED
Growing & mentoring is promoted
29. Question #1
A research culture requires some resources e.g.
non-clinical time, funding, etc. How do you convince
the organisation to give you support?
30. Question #2
When you collaborate with other groups within your
hospital or external groups there is the possibility of
being ‘used’ by the other party. How can this be
avoided?
31. Question #3
How do you get EM residents started in research in
a busy clinical environment?
32. Question #3
Research review
Journal club
Research round
Research project
Sell benefit to their career & to patients
Work in pairs with a nominated supervisor
Keep the project small and manageable but relevant
Provide active coaching and mentoring
Retrospective data collection is probably more
manageable for a first project
Meta-analyses are also a good option
33. Question #3
Examples of recent projects my residents have
done.
Validation of the Ottawa SAH rules (Emerg Med Austral)
Failed validation of predictors of surgery in renal colic
Do paramedics over-oxygenate patients with COPD?
Predictors of positive blood cultures in patients with
pneumonia (HKJEM)
The Relative Efficacy of Adenosine versus Verapamil for
Treatment of Stable Paroxysmal SVT in Adults: A Meta-
analysis.(Eur J Emerg Med)
34. Question #4
Is there a need for a formal research attachment (no
clinical load) in an EM residency program?
