Perspectives
Health services administration
Volume 203 - Issue 7

Co-creation: a new approach to optimising research impact?

Authors:  Claire L Jackson and Trisha Greenhalgh

Med J Aust 2015; 203 (7): 283-284. || doi: 10.5694/mja15.00219
Published online: 5 October 2015
In these challenging times, research funding is seen as an investment, and funders expect demonstrable returns in both monetary and societal terms
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Bold new world offers researchers opportunity and challenge

Traditionally, academics benchmarked their success with metrics of publication such as journal impact factors or their personal h-index (a citation measure). Increasingly, researchers are required to demonstrate impact beyond academia.

In these challenging times, research funding is seen as an investment, and funders expect demonstrable returns in both monetary and societal terms (including morbidity, quality of life and economic benefit). The United Kingdom’s Research Excellence Framework now allocates 20% of its score, and linked public funding to universities, on the basis of demonstrated research impact. Australia’s recent Strategic Review of Health and Medical Research contained recommendations to “embed research in the health system” and “[strengthen] partnerships between researchers, healthcare professionals, governments and the community”.

The applied traditions of knowledge translation, research utilisation and implementation science have developed rapidly in recent years to inform how we achieve, measure and monitor research impact.1 But do they truly assist researchers to embed research into practice?

For traditional science-based enquiry, such approaches make sense. But they work less well for applied research, because their focus is on taking previously completed research and “translating” it for real-world consumption. In doing so, they make the assumption that the original research is destined for a close eventual fit with society, and that the real world is both ready for, and engaged with, their research “product”. All too often this is not the case, and we are trapped, trying to massage the Ugly Stepsister’s large foot into Cinderella’s smaller shoe. The eventual uptake and impact of our lengthy and expensive research is often disappointingly small.

This mismatch is well illustrated within the applied discipline of health services research. The aims and approach of carefully conducted trials may not fit the competing demands of busy clinical practice. Despite a lexicon of new terminology and mixed-methods study designs (“complex interventions”, “normalisation”, “mediators/moderators”, “process evaluations”, “Phase IV”) to understand and operationalise implementation processes and causal influences, the reality is that the health service delivery world often fails to generalise our research product.

The reason for this is not (as is often assumed) disinterest, lack of understanding or poor leadership on the part of our service colleagues. Conventional analytic frameworks describe barriers to implementation such as readiness to change, perceived relevance and incentive frameworks. A more contemporary conceptual framework depicts new service models as “complex interventions”.2 We thus need to move from approaches based on industrial metaphors (develop a universal intervention package, overcome barriers, and then “roll it out” at scale) to ecological ones (solutions must be locally grown and owned, and fit materially, historically and culturally with the particularities of context).

An approach rapidly gaining currency in addressing this mismatch, is research “co-creation” or “co-production”.3,4 Similar paradigms emerged decades ago in both the management world and development studies. They emphasise ongoing, collaborative “value creation processes” between multiple stakeholders — to understand and agree desired outcomes, create real innovation and deliver better performance. In health service research, co-creation draws researchers and end users together far earlier and more powerfully than in traditional research translation. Academics, consumers, clinicians, and service organisations (across public, private and third sectors) work together from the outset to frame relevant research questions, create research designs that map real-world environments, and commit to implementing the research and its findings in the broader health service community (Box).

Co-creation is not a new concept, nor is it a panacea. But it aligns in particular with four recent developments in applied health services research: (a) the emerging science of pragmatic randomised controlled trials, developed and executed in real-world conditions;9 (b) the increasing sophistication of efforts to embed complex interventions in a local organisational context and the wider health care ecosystem;10 (c) the growth of multistakeholder research collaborations;11 and (d) the call to go beyond tokenism when involving patients and the public in the research process.12

Co-creation methodology is informing the work of multistakeholder collaborations to generate research with rather than on local health services in the United Kingdom,13 Canada,14 the Netherlands15 and Australia.11 These new partnerships are not without their management and governance challenges, and we still have much to learn about how to run them effectively. But to do so, and truly “embed” research meaningfully within the health system, researchers need to revisit the methodology of research impact and their own relational connection with end users.

Rather than “Here is one I have cooked earlier, now eat it”, researchers may increasingly say: “Here’s the kitchen, let’s choose the ingredients and method, make the meal, sample and refine it together, and shoot for Masterchef”.

Box – Developing culturally congruent research and services for a multi-ethnic community in London, United Kingdom

  • In the deprived and multi-ethnic East End of London, United Kingdom, the prevalence of diabetes is high, health outcomes are often poor, and attendance at conventional health education sessions is usually low. Systematic reviews and randomised controlled trials published in academic journals seemed to have limited relevance, perhaps because most described “clean” scientific samples in which important variables (comorbidity, poverty, low health literacy, limitations of local health systems) had been excluded or controlled for.
  • Led by a consultant diabetologist and academic general practitioner, a dynamic and evolving network of partners (including community-based social services, faith-based organisations and academics linked to a local university) worked collaboratively to define a research agenda, seek funding from a range of sources (research councils, charities, the National Health Service, the European Commission) and strive for the twin goals of local service improvement and high-quality research outputs.
  • Projects have included development and evaluation of an innovative peer support program for black and minority ethnic groups through oral storytelling,5,6 mapping diabetes risk with aggregated data from electronic patient records in general practice,7 and an analysis of the complex sociocultural barriers to behaviour change in South Asian immigrants.8

Authors

  • Claire L Jackson MD, MPH, FRACGP1
  • Trisha Greenhalgh MD2
  • 1. University of Queensland, Brisbane, QLD
  • 2. University of Oxford, Oxford, UK

Correspondence: c.jackson@uq.edu.au

Competing interests

No relevant disclosures.

References

Provenance: Not commissioned; externally peer reviewed.

View this article on Wiley Online Library