Building a research culture in the emergency department

January 2015

@kellyam_jec

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

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

Ideal emergency department activities

Clinical care

ResearchEducation &

training

Quality and safety

improvement

ED activities – the real world!

Clinical care

Research

Education & training

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”

What is research culture?

Research: generation of new knowledge

Culture: shared values, attitudes, patterns of

behaviour and structures that give an activity

significance

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

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

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

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

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

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

Barriers to research culture in ED

Competing priorities, especially clinical service

delivery

Time

Skills

Funding

Structural barriers

Fear of change

Lack of recognition/ credit

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

Strategies

Culture

Leadership

Structures

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

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

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)

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

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.

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

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

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

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

‘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

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

Research culture is ...

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?

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?

Question #3

How do you get EM residents started in research in

a busy clinical environment?

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

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)

Question #4

Is there a need for a formal research attachment (no

clinical load) in an EM residency program?

Thankyou

@kellyam_jec