Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review

Abstract

Objective: There is a widely held assumption that engagement by clinicians and healthcare organisations in research improves healthcare performance at various levels, but little direct empirical evidence has previously been collated. The objective of this study was to address the question: Does research engagement (by clinicians and organizations) improve healthcare performance? Methods: An hourglass-shaped review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves healthcare performance; and (3) a wider (but less systematic) review of papers identified during the two earlier stages, focusing on mechanisms. Results: Of the 33 papers included in the focused review, 28 identified improvements in health services performance. Seven out of these papers reported some improvement in health outcomes, with others reporting improved processes of care. The wider review demonstrated that mechanisms such as collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved healthcare performance. Conclusions: Current evidence suggests that there is an association between the engagement of individuals and healthcare organisations in research and improvements in healthcare performance. The mechanisms through which research engagement might improve healthcare performance overlap and rarely act in isolation, and their effectiveness often depends on the context in which they operate. Strengths and limitations of this study • This review brings together for the first time a diverse body of literature addressing whether engaging clinicians and healthcare organisations in research is the likely to improve healthcare performance • It also explores the mechanisms through which improvement is achieved to try and understand how any improvements might come about • However, it relies on the quality and coverage of the existing literature • It is an extremely complex topic, but nonetheless one worthy of further exploration, particularly given the pressure to justify research spending in healthcare systems, and to encourage its implementation.