Intended for healthcare professionals

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Analysis Essay

Reform reform: an essay by John Oldham

BMJ 2013; 347 doi: (Published 20 November 2013) Cite this as: BMJ 2013;347:f6716

Rapid Response:

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 [1]. 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 [2].

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

27 November 2013
Martin N. Marshall
Lead, Improvement Science London
Dominique Allwood
Improvement Science London, 3rd Floor, 170 Tottenham Court Road, London, W1T 7HA