What have academics ever done for us?

Professor Martin Marshall

Lead, Improvement Science London

I had a fascinating conversation with a group of senior health service managers and clinicians in North London recently. I had been invited to a meeting to discuss how the local health community could better integrate and coordinate services for vulnerable elderly people. As the meeting progressed, decisions were made to improve the ways in which information is transferred between health and social care, shift some services out of the hospitals into the community and introduce care coordinators – pretty straight forward decisions for those responsible on a daily basis for organising and delivering health and social care services.

Towards the end of the meeting I couldn’t help but reflect on what had influenced these decisions. Political pragmatism probably came top of the list (‘we couldn’t possibly do that, our GPs wouldn’t engage’), closely followed by personal experience (‘I saw care coordinators working really well in my previous job’) and a bit of ideology (‘what we need is more/less competition’).

Perhaps a little mischievously, I asked the group whether the decision-making process, or the decisions themselves, would have been any different if an academic had been part of the conversation. Some were unsure but most were dismissive. Well-rehearsed arguments were voiced – academics have their heads in the clouds, they don’t understand the need to make quick decisions, they are too purist, too nihilistic and they don’t speak a language that we understand. Stereotypes perhaps, but even as an academic myself, I wasn’t inclined to be too defensive.

But I did push them. ‘How about’, I said, ‘if you had a friendly academic whispering in your ear as you made the decisions, someone who really wants to be useful. What could they bring to the table?’. The conversation then opened up. One person said that they were vaguely aware that some research had been conducted into integrated care (there is a substantial international evidence base) and it would be useful if the academic could bring this evidence to the table and help interpret what it meant within the local context. Another person said that the need for change lay at the heart of the work and that whilst they had a good practical understanding of how to go about it, they were aware that there was a vast literature about the psychology of individual change and the sociology of organisational change and it would be helpful if this theory could be described in an accessible way. Someone else said that they wanted a more objective assessment of whether what they were planning was likely to have an impact, so they would like to draw on the academic’s expertise in evaluation. And a fourth person admitted that they had lots of data but they would like help to analyse or interpret it in more sophisticated ways and it would be useful to have academic advice.

And they could have gone on. It felt remarkably like a Monty Python ‘what have the Romans ever done for us’ conversation. Whilst clinicians and managers will always have responsibility for making decisions about how care is organised and delivered, and these decisions will always be influenced by factors other than the scientific evidence, academics have a role to play and this is what the science of improvement is about – helping decision makers in the service to make better use of the scientific evidence and helping academics to produce more useful research. The use of clinical research, through the evidence-based medicine movement, has become deeply embedded in the psyche of health professionals over the last two decades. We now need to develop and embed an equally convincing science to underpin health system improvement. This will be a significant cultural challenge but the stakes have never been higher.