By Dr Beth Fylan and Professor Rebecca Lawton
Over the past weeks we have witnessed the raised profile of health research and the fundamental role it is has in addressing the international crisis caused by COVID-19. Health research organisations around the world have rallied to focus on identifying treatments and vaccines to aid prevention, recovery, save lives and enable societies to return to near-normal functioning. The hugely important role of behavioural science in understanding how best to persuade and support the general population to play their part has also been evident throughout. In the UK, the Government has placed its financial clout behind vaccine development and clinical trial centres are galvanised in establishing an evidence base to help clinical decision making. The RECOVERY trial established by the University of Oxford, for example, is currently testing a range of potential treatments for COVID-19 in 170 sites, including our own Bradford Teaching Hospitals NHS Foundation Trust.
Beyond this crucial, clinically focused work, applied research groups such as ours have been considering how their disciplinary expertise can contribute to benefit the healthcare system at this time. NIHR Patient Safety Translational Research Centres occupy a unique space in national healthcare research. Our role is to explore concepts, theories and methods that may have a role in increasing the safety of care but have not yet been developed or fully exploited. In short, we ‘aim to turn patient safety discoveries into practice’.1 We translate through developing new knowledge and understanding, or skills and tools which can be used or tested further.2 The commitment to funding such exploratory research is one of the reasons why the UK is at the forefront of health research internationally, recognising that innovation is key to enhancing the benefits gained from decades of work improving the safety of care.
We have come a long way in the UK since the publication of the report An Organisation with a Memory in 2000 3 in understanding the extent and nature of unintended harm to patients. Whilst the NHS has made great strides to eradicate many major of causes of harm to patients, such as wrong-site surgery and retained foreign object post-surgery (often called the ‘biggies’ of patient safety), harm is still prevalent (estimated to affect one in 20 patients).4 We have recognised the need in tandem to explore different ways of improving care.
Early translational research offers a route into these improvements and PSTRCs are a crucible for ideas yet untried and untested. Like others during this time of crisis, we find we have a role to play in the ongoing effort and the opportunity to adapt our work to address some of the challenges the NHS – and the public as a whole – faces. This means that, while some of our studies have been paused to reduce staff and patient burden, we can adapt quickly to the COVID-19 challenge by refocussing our early translational research where it can potentially bring benefits.
For example, our ongoing portfolio of work using resilient healthcare theory has given us the building blocks of a study to monitor and understand organisational response to the crisis. Similarly, our work to understand the impact of healthcare staff wellbeing and emotions in teams on care quality has enabled us to launch resources to support them given the unprecedented conditions that staff are working under. We are also adapting current studies in order to understand how patients and the public are supporting the health system by staying safe or why, in some instances, they may be staying at home, rather than seeking care if their health is deteriorating.
Having opened up new areas of enquiry based on our learning from previous work, we hope the findings from these studies will contribute to the growing knowledge of how we work together to respond to a patient safety crisis on a grand scale as well as how safety can be maintained when the norms and rules for delivering the service no longer work.
All us who have worked in health research for many years are deeply impressed, not only by the speed of the response of the academic and clinical research community to understanding this disease, but also to national bodies – such as the National Institute for Health Research (NIHR) and the Health Research Authority – which have swiftly adapted processes to agree funding for research studies, give due oversight to their protocols and approve them. We hope that collectively we can generate an organisational memory for working in a crisis that will help us think differently about safety in the future.
And, finally, we remain grateful for the extraordinary work of our frontline NHS, social care and key worker colleagues in tackling the COVID-19 crisis.
- National Institute for Health Research. £17 million invested in NIHR Patient Safety Translational Research Centres. 13 February 2017. https://www.nihr.ac.uk/news/17-million-invested-in-nihr-patient-safety-translational-research-centres/12278
- Aronson J. When I use a word . . . Defining translational research. BMJ Opinion 2017. https://blogs.bmj.com/bmj/2017/04/21/jeffrey-aronson-when-i-use-a-word-defining-translational-research/
- Department of Health. An organisation with a memory: report of an expert group on learning from adverse events in the NHS. London: The Stationery Office, 2000.
- Panagioti M, Khan K, Keers RN et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ 2019; 366 :l4185