Researchers in Residence

Professor Martin Marshall

Lead, Improvement Science London

One of the challenges facing the science of improvement is the need to design and evaluate practical ways of narrowing the gap between those who produce research evidence and those who use it. The Researcher in Residence model is an approach which is stimulating a lot of interest.

The in-residence model is not new. Wimbledon has a Poet in Residence, Heathrow airport an Artist in Residence, the British Library an Entrepreneur in Residence and it is widely reported that Will Self is about to be appointed as the BBC Radio 4 Writer in Residence. The problem that the model is trying to address has sociological roots. People with expert knowledge or skills tend to seek, or sometimes just find themselves in the company of, like-minded people. A process of socialisation ensues which differentiates them from others without that expertise. This process allows them to develop their expertise in depth but also risks rarefying that expertise and prevents others from gaining access to it. The In Residence model attempts to bring that expertise back to the masses.

Researchers in Residence have been active in the field of education for nearly two decades but its potential in the health sector has yet to be realised.  Rare examples include the work of the anthropologist Paul Bate who provided organisational insights for staff at University College Hospital in London and the work of Martin Utley and Christina Pagel, academic modellers working with Great Ormond Street Hospital to help them to deal with a problem of patient flow through operating theatres.

The Researcher in Residence places the researcher in an unaccustomed active role – not a detached observer or even a passive participant, but a stakeholder in the success or otherwise of the initiative being implemented. Such a model challenges traditional perceptions of researchers as objective and remote from the endeavour under study. The researcher becomes a core part of the delivery team, bringing expertise which is different from but complementary to that of the managers and clinicians involved. By blurring traditional boundaries between experts, relationships change and power and influence is redistributed between stakeholders.

In the health sector, specialist expertise brought by the researcher might include a deep understanding of the published evidence and national and international experience in the field, a theory based appreciation of how to achieve change in organisations and in individual people, an understanding of the generic facilitators and barriers to improving quality (such as project design and planning, organisational context, how to embed and sustain change and the unintended consequences of change), expertise in how to assess whether and how an intervention is making a difference and finally a sophisticated understanding of how to use data in ways that produce new insights. Academics do not have a monopoly on any one of these areas of expertise but they have been specially trained to utilise them.

These areas of expertise are brought to the table by the researcher and their meaning and usefulness are actively negotiated with other members of the implementation team, rather than being ‘imposed’ or ‘transferred’ to them. Whilst this potentially conflicted role is complex and not without risks, the model is based on the belief that the advantages of increasing the likelihood of success of the project outweigh these risks. This is most likely to be the case if a researcher is used who has experience and the respect of their peers and who understands the complexity of the health service.

There are many unanswered questions about the Researcher in Residence model but it seems to me to have potential. If you have any experience of using the model, or are interested in exploring it further (particularly if you are interested in funding and establishing one in your own organisation), do get in touch.