Re: Reform reform: an essay by John Oldham
Death by research
John Oldham describes ‘death by research’ as one of the barriers to effective reform of health services . He is correct that established approaches to generating and utilising research too often have insufficient impact on efforts to improve care. But his assertion that the ‘culture of evidence’ is incompatible with a culture of implementation is surprising. His off-hand rejection of the contribution of science to improvement mirrors the view of many NHS leaders; ‘we know what to do, health professionals and managers just need to get on with it’.
The problem is, too often we don’t know what to do. We know that improvement is difficult, and that many promising projects are unsuccessful or fail to embed, spread or sustain early gains. But our understanding of why this might be the case, or what we need to do differently, is in its infancy and it behoves us to demonstrate a little humility about what we don’t know. Oldham is right to challenge the academic community but rather than rejecting the role of research outright, it would be more helpful if he identified how he thought research could be more useful. Like creating new incentives to reward researchers who want to be useful, new ways of communicating research findings more effectively to decision makers, or encouraging novel ways of generating new knowledge through active partnerships between researchers and practitioners .
Without good research, service improvement will go round in circles in the same way as Oldham claims NHS reform is doing.
1. Oldham J. Reform reform: An essay by John Oldham. BMJ 2013;347:f6716
2. Marshall M. Bridging the ivory towers and the swampy lowlands; increasing the impact of health services research. International Journal for Quality Improvement in Healthcare. 2013; doi: 10.1093/intqhc/mzt076
Competing interests: No competing interests