Change‐promoting research for health care

Citation

Bacharova, L. (2000), "Change‐promoting research for health care", Journal of Management in Medicine, Vol. 14 No. 3/4, pp. 249-250. https://doi.org/10.1108/jmm.2000.14.3_4.249.1

The title of the book immediately attracted my attention, since it promises to deal with the “change‐promoting research” for health care. It naturally evokes a question if this type of research differs (and can be distinguished) from that type of research which does not promote a change. In other words, to ask a very basic question about one of the roles of research – should the research promote a change (in general or in some specific cases), or should research fix current knowledge or behavior?

Another motivation for reading was the appealing first sentence in the Preface: “This book is about research and development in health services being a part of all managers’ repertory”. The authors identified themselves with the managerial part of the interdisciplinary team, and they promised to look at the problem of overlapping (and the need of collaboration) of management and research fields in health care from the managerial perspective. This was of special interest for me, since I am a medical doctor working years in research, both in clinical and basic‐experimental research. And now, as a newborn MBA, I was curious as to how far these two points of view will meet (my opinion is that “the management should be a part of researchers’ repertory”). In other words, how far my long‐lasting medical research background, relatively short‐lasting managerial training and experience, and newly acquired education in management will be in agreement or/and in disagreement with the authors.

The third (and not least) motivation was to know more about the situation in the UK, since I am from Central Europe, from a country undergoing a substantial, complicated and painful transformation of society. And my interest was, how far the British experience can be generalized, what lessons can be learned in general and for Central European countries in particular.

The book is written from the perspective of managers, but with deep understanding and experience from clinical and health care research, so it addresses equally both groups of readers: researchers as well as managers.

The first part presents the relationship between changing health care and research, which should not be seen as a stand‐alone, isolated activity, accessible only to researchers. This part gives milestones of the process of integration of R&D with management, a process, which started in the 1980s and became an official paradigm of the health care sector in the 1990s, aiming at evidence‐based health care. The role of research is seen on several levels: providing new knowledge, but also the vision of what to do with this new knowledge and how to implement it into practice and dissemination. Appropriate managerial knowledge and skills are discussed in this connection, with a special emphasis on the relevant decision making.

The second part of the book deals with commissioning, as an active management of R&D resources. It discusses the role of managers in defining research questions according to their priorities, in study design, in determining the outcome measures and in thinking ahead about possible routine implementation and its consequences. The theoretical considerations are demonstrated by an example from the North‐West of England, and in a selected clinical diagnosis. This part is focused mainly on the managers’ (commissioners’) role in the interdisciplinary teams, such as setting the research question, bringing researchers together, working with researchers to produce the study protocol, and project management. And especially important, managing the transition from development to implementation, managing dissemination and encouraging a positive ethos for R&D. This part is written with deep understanding of both parties: health care research and management.

I must say that I have read the third part “Doing and using research” really with pleasure, since it gives unexpected views on research of theoretical background and fixed routines, such as statistical methods, type of study, sampling, or statistical modelling. They are analysed and considered from the point of view of the purpose/aim, effectiveness, and likely consequences. For example, the seemingly highly theoretical statistical decision about the size of the sample, the power of the test and type 1 and type 2 errors of significant tests, has very practical impact when implemented in health services and translated into “management” language: cost‐effectiveness, financial and humanistic aspects.

Special attention in the context of the new paradigm is paid to the contribution and relevancy of quantitative and qualitative methods of research, to technical issues of creating research questions and producing sound research design. The ethical problems – the involvement of the pharmaceutical (and equipment) industry is also touched. Research is seen in terms of costs, benefits, broader strategic consideration and the decision made in the light of the long‐term consequences of right and wrong decisions. The final recommendation for using research is aimed at decreasing gaps between researchers and managers, with the underlying idea of many people of different backgrounds and different skills working together to ensure that health services research is really useful.

The book provides an interesting point of view on research in health care from the perspective of management, as a natural, effective and contributing part of the interdisciplinary team. It opens unexpected dimensions for the practical consideration of seemingly purely theoretical aspects of research procedures, e.g. for the proper use of statistical methods. The theoretical considerations and practical recommendations have general validity. I recommend it as an interesting reading, but not only reading and a personal discussion with the book, but also as a trigger to think in a broader context and to start acting in this direction.