Communicating research evidence to health and care governance boards

A study of health and care board members in England found that boards engage with research evidence in various capacities when making decisions, but many expressed an appetite for improving the ways and extent to which research evidence is used at the board level.

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What is the issue?

Boards in health and care organisations in England play a key role in the governance, strategy, direction and culture of an organisation. It is therefore important to ensure that board decisions are informed by the best available evidence from a range of sources, including service evaluations, organisational performance data, research and evidence-based guidelines.

However, there is a scarcity of evidence about how boards use research evidence, defined as evidence stemming from generalisable empirical research, to carry out their roles.

How did we help?

THIS Institute commissioned RAND Europe and the Health Services Management Centre (HSMC) at the University of Birmingham to conduct a scoping study on how health and care 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). The principal data collection method was qualitative interviews with diverse members of health and care boards to obtain insights into the perceptions and experiences of board members in a range of roles and circumstances. The findings are predominantly based on evidence from 17 interviews.

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.

What did we find?

The board members involved in our study engage with research evidence in various capacities, but there are differing views on the extent to which boards use research evidence as part of their activities (i.e. the extent to which using research evidence is embedded in their regular practices).
Many interviewees described research evidence being used in sporadic and opportunistic ways, rather than being systematically and routinely embedded in board functions.
The types of research evidence used are diverse, and include clinical research evidence, evidence from healthcare services research and organisational and management research.
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).
The use of research evidence is context dependent. For example, during the COVID-19 pandemic, boards needed to make pragmatic decisions quickly, which meant that little research evidence was either available or directly consulted by boards. However, boards relied on evidence-based guidelines around COVID-19 to make decisions, among other factors.
Boards access research evidence through different routes. While some interviewees reported engaging with research papers directly, research evidence seemed more often to be fed to the board through intermediary channels such as sub-committees or to other organisational experts such as clinical teams.
There was significant appetite among board members to engage with research through simpler and more accessible formats than academic journal articles. Some examples included presentations, bespoke workshops, seminars, summaries of research and discussion papers.
We identified several influences on the use of research. These relate to the nature of research evidence, the types of decisions being made, external circumstances that impact decision making and the function, structure and composition of boards.

What needs to be considered?

Many board members expressed an appetite for improving the ways and extent to which research evidence is used at board level. Both boards and the research community would need to play a part in this process. For example,

Researchers need to ensure that research is timely, accessible and communicated in a way that highlights its direct relevance for boards.
Boards 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.
There is scope for better understanding of the types of improvement interventions that could support board decision making to be informed by the best possible research evidence and in user-friendly ways.
There is a need for further research to strengthen the evidence base on current practices across a diverse range of boards, including boards with different sizes, compositions, cultures, performance and functions.
There is a need for further research on the types of decisions where board-level engagement with research evidence is needed, or areas where other stakeholders (e.g. clinicians) may be better placed to engage with research evidence.