I first wrote about capacity building activities in primary health care back in 2003; as a strategy to facilitate clinicians to use, participate in and lead research. We highlighted the cultural divide between the almost independent industries of research production and health care service delivery. We emphasised that the people delivering health care services are not often involved in asking or answering questions that are relevant to their practice. Researchers and clinicians work to different time frames, expectations, and rewards.
More recently, the diverse professions of allied health have investigated using research capacity building initiatives to boost the research skills and contributions of busy clinicians. There has been a focus on providing opportunities for clinicians to learn about research methodologies and skills; building networks between hospitals and universities and developing collaborations around research projects. Sadly, the most commonly reported outcomes are academic outputs such as publications, successful grant application and postgraduate qualifications. However, there is a growing recognition that research capacity building experiences are beneficial for clinician’s job satisfaction, and there is a desire to track how these initiatives are facilitating the use of research in clinical care.
So if we revisit the overall goal of using research in practice, we need to be reminded of the necessary but insufficient role of research in guiding clinical practice.While the principles of evidence-base medicine are useful in helping clinicians to learn how to search for and identify useful research, and appraise it for application; clinicians need additional resources to adapt the research evidence for their local context and implement it with a view to sustainable improvement for patients.
The role of health care organisations’ structures and processes are crucial. It has been suggested that organisations that support and encourage innovation, data collection and analysis, and critical appraisal and thinking skills, will be more likely to use and apply research evidence. It seems that there needs to be purposeful influence of health care managers and administrators about the benefits of, strategies for and skills required to use research to improve clinical practice. A whole range of social and knowledge interactions are required to influence processes and structures that will facilitate the use of research evidence in clinical practice.
Therefore, I can confirm, in a different set of arguments, my recommendation from 2003 that we need to think about expanding research capacity building initiatives to include organisational development work to encourage structural and process changes in healthcare organisations that support the need (and benefit to patients) of using research to improve clinical practice.