Research Context and Aims
Boards in health and care organisations in England play key and sometimes statutory roles in their governance, shaping strategy, direction and culture, and being accountable for organisational performance (Mannion et al., 2010; Ramsay et al., 2010). In this context, it is important to ensure that board decisions are informed by the best available evidence from a range of sources, including from service evaluations, organisational performance data, research and guidelines. There is a substantial body of literature on board structure, function and relationships to organisational performance. There is also some research into how boards mobilise knowledge and intelligence more generally, such as, for example, various types of organisational performance data and data from service evaluations. However, there is a scarcity of evidence about how boards use research evidence to carry out their roles. We defined research evidence as evidence stemming from generalisable empirical research, rather than from service evaluations, internal reviews, experiential evidence or routinely generated data such as performance information.
Against this context, THIS Institute commissioned RAND Europe and the Health Services Management Centre (HSMC) at the University of Birmingham to conduct a scoping study on how boards use research evidence.
The focus was on NHS Trust boards and the boards of Sustainability and Transformation Partnerships (STPs) or Integrated Care Systems (ICSs). More specifically, the study aimed to explore:
- What types of research evidence boards need and use
- What sources and formats of research evidence are viewed as most relevant and helpful
- What influences the use of research evidence by health and care boards
- How the use of research evidence could be improved (if improvement is needed).
Given the importance of the COVID-19 pandemic at the time of this research, we were also asked to consider whether and how research evidence was used by boards in shaping their response to COVID-19. We focused on two areas specifically: (i) personal protective equipment (PPE) and (ii) the use of remote consultations and remote patient monitoring.
Methods
The principal data collection method for this scoping study was qualitative interviews with members of health and care boards. We interviewed 17 board members, from seven different boards in three main localities in England: West Midlands, Cambridge and South East London. The interviewees included executive and non-executive board members, with diverse backgrounds. In addition, we carried out an initial brief review of academic literature to help refine the focus of the scoping study and to assist in the interpretation of findings. We also looked at a sample of board minutes but found very limited reference to research evidence.
The 17 interviews enabled us to obtain important insights into the perceptions and experiences of diverse board members in a range of roles and circumstances. However, they are not necessarily generalisable to other boards, or to individuals whom we did not interview within the boards in our study sample. Future, larger-scale studies could help build on the insights we obtained in this scoping research.
Key Findings
The boards involved in our study all engage with research evidence in some capacity, but board members have differing views on the extent to which boards use research evidence as part of their activities. These views varied between board members on the same board and between boards. These diverse views may indicate actual differences in the use of research evidence between different boards or between different individuals on the same board, or it may reflect differing perceptions and levels of awareness about the extent to which the board overall (e.g. colleagues on a board) use research evidence. While it is not possible to reach firm conclusions on the levels of engagement with research evidence based on this scoping study, our insights do point to a need for further larger scale research on this issue, including potentially through methods that enable collective sense-making.
All of the board members we interviewed told us that their board did engage with research evidence in some way, although specific examples were sparse. The types of research evidence used, and the purposes for which they are used are also diverse. Clinical research, health services and organisational and management research are all consulted. This speaks to the heterogeneity of decisions made by a board—for example, decisions may be related to novel clinical interventions, to financial management, the organisation of patient pathways and workforce planning. However, many interviewees described research evidence being used in sporadic and opportunistic ways, rather than being systematically and routinely embedded in board functions. Although interviewees described different types of evidence that can be used, the extent to which they are used is unclear, and some concerns were raised that use of evidence by boards may not always be robust.
In addition, even when research evidence is used, this happens alongside the use of other types of information (e.g. on local population needs and priorities, organisational intelligence and performance data, and data from evaluations). The use of research evidence is also context dependent. For example, during the COVID-19 pandemic, boards were forced to make pragmatic decisions quickly and in a fast-changing environment. While research evidence could be consulted on some issues, pragmatic decisions sometimes needed to be made rapidly in the light of policy developments and guidance. The emergency nature of decisions being made during the pandemic meant that there was little evidence available in some areas where boards made decisions. Interviewees suggested specific research topics that could be useful to boards in the future, in the context of recovery from the pandemic and resilience to future pandemic shocks. Most notably they sought research that can help inform how the health and care system can balance needs for COVID-19 related care and routine care. An interest in better understanding the impact and effectiveness of remote consultations and remote patient monitoring as ways of providing care was also identified.
Boards access research evidence through different routes—both from diverse sources and in different formats. Although some interviewees reported engaging with research papers (or their authors) directly or actively seeking research-based knowledge on a particular topic through other channels (such as conversations with clinicians or consulting guidance documents), research evidence also seemed more often to be fed to the board through intermediary channels. More specifically, boards often appear to delegate the consideration of research evidence to their sub-committees or to other organisational experts such as clinical teams, who then report back to the main board. There was also significant appetite among board members to engage with the research through simpler and more accessible formats than academic journal articles. Some examples included presentations, bespoke workshops, seminars, summaries of research, discussion papers, case studies, opinion pieces, blogs, various visuals and media articles.
We identified several influences on the use of research. As overviewed in Table 1, these relate to the nature of research evidence, the types of decisions being made, the function, structure and composition of a board and to external circumstances and events.
Table 1. Influences on the Use of Research Evidence by Boards
| Category of influencing factors | Features that play a role |
|---|---|
| Nature of research evidence |
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| Type of decisions being made by boards |
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| Function, structure and composition of board |
|
| External circumstances and events |
|
Many board members expressed an appetite for improving the ways and extent to which research evidence is used at board level, and this scoping project indicates that both boards and the research community would need to play a part in facilitating this. Researchers would need to ensure that research was timely, accessible, and communicated in a way that highlights its direct relevance for boards. Boards would also need to have the skills, capabilities and supportive organisational processes in place to support the more wide-scale use of research evidence, including skills to constructively assess and, if needed, challenge research evidence alongside other types of information that inform decision making.
Although there was a general recognition that boards could improve the extent to which they engage with research evidence, there were some reservations as to whether boards are necessarily always the “right place” within organisational structures, to embed more systematic and direct engagement with research evidence. There may be other channels within organisations that allow research evidence to feed into wider board level functions. There are questions also as to whether capabilities and capacity for engagement with research evidence needs to be built across an entire board, or within specific sub-committees of the board, to complement the capabilities in other parts of the organisation (e.g. research and development, information services) or other organisational structures.
Reflections
Our findings suggest some important areas for further research to refine and extend the insights we have gained through our scoping research. For example, there is a need to strengthen the evidence base on current practices more systematically and explicitly, through a larger scale study that controls for boards with different features and for different functions on boards. This could help to better understand and perhaps reconcile the variety of views that were expressed by individuals consulted for this research about the extent to which research is used. A larger scale study could allow collective sense-making to understand the real and perceived differences between boards and within them (perhaps through a combination of interview, survey and workshop or focus group methods). Further exploration would be valuable to understand how different board features related to structure, composition, size, culture, performance and incentives play a role in the extent to which boards engage with research evidence and in their requirements for such evidence.
Last but not least, there is scope for better understanding what types of improvement interventions could support board decision making to be informed by the best possible research evidence and in user-friendly ways. This includes considering improvement interventions for the accessibility of the research, as well as for building board skill and confidence levels. For research supply, key considerations might include the nature of evidence and sources and formats that reach boards. For interventions to improve the ability of boards to engage with research effectively, such interventions might include board development programmes to improve board skills, confidence and processes. They might also affect how interactions between the board and its various sub-committees and other organisational structures support evidence- based decision making at board level.
