Getting research going in emergency departments can be hard but it is vitally important for improving healthcare. This presentation gives tips and strategies for building a research culture. Taking the first step is often the hardest part!

1. Building a research culture in the
emergency department
January 2015
@kellyam_jec

2. Conflicts of interest & permissions
 No conflicts of interest to declare
 The content of this presentation may be used freely
for educational purposes
 It was first presented at the Society foe Emergency
Medicine Singapore conference in January 2015

3. Objectives
 To understand:
 What a research culture is and why it is important
 The barriers and enablers to building a research culture in
emergency departments
 Strategies to build and maintain a research culture

4. Ideal emergency department activities
Clinical
care
Research
Education &
training
Quality and safety
improvement

5. ED activities – the real world!
Clinical care
Research
Education
& training

6. What stops ED having a research culture?
 “Research is not core business”
 “There is no time”
 “It’s too hard/ complicated/ etc”
 “Our ED is too small/ not university-affiliated/ etc”
 “Research projects are complicated and need a special
team”
 “Research does not directly impact my patients”
 “There are no research questions that are relevant &
feasible for our ED”
 “We get no credit for it”
 “It’s a doctor thing”
 “Research does not change the way I do things”

7. What is research culture?
 Research: generation of new knowledge
 Culture: shared values, attitudes, patterns of
behaviour and structures that give an activity
significance

8. Disabling words
 ‘Research’ is a disabling word for many ED team
members
 An alternative perspective is that research is all
about evidence
 Generation and/or application of evidence to do things
better

9. Why is a research culture important for an ED?
 Facilitation of quality improvement by:
 Assisting transfer of evidence into practice
 Investigating clinical questions arising from local practice
 By research
 By search of literature and collation of evidence
 Enhancing ED standing within an organisation or
system
 Harnessing the creative/ innovative power of ED
team
 Enhancing ED morale and teamworkThere can’t be a great ED without a research culture

10. What does a good research culture ‘look like’?
 Values, attitudes and beliefs
 Strive to do things better
 Encourages questions and ideas for innovation AND has
a structure to process them
 Focusses on important questions
 Collaborative and supportive
 Celebrates and communicates its success
 Structures
 Will vary depending on the environment
 Examples
 a research interest group
 a ‘named’ research centre

11. Letting you into a secret..(Shh)
 Joseph Epstein Centre for
Emergency Medicine Research
(JECEMR)
 1 part-time research leader 0.2EFT
 1 x 0.8 EFT research nurse/ co-ordinator
 1 x 0.2 EFT admin officer
 Internationally recognised
 High publication output
 >12 papers per year over last 5 years
 Attracts higher degree students
 Attracts international fellows
 Attracts grants

12. How do we do it?
 Supported by:
 Small amount base funding by health service
 Several emergency physicians who assist with projects
ad hoc in non-clinical and own time
 A group of keen nurses who come up with questions and
assist with data collection
 Several registrars in training who do a project (and get
published) – usually in own time
 Ad hoc students from universities
 Collaborations within and outside our health service

13. Why do they do it?
 Variety of motivations
 Individual
 Career enhancement
 Research interest but limited skills/ time
 See the benefits in patient care change
 Feel valued and included
 Collaborators
 EDs rich caseload
 Different perspective to inpatient cohorts

14. Barriers to research culture in ED
 Competing priorities, especially clinical service
delivery
 Time
 Skills
 Funding
 Structural barriers
 Fear of change
 Lack of recognition/ credit

15. Enablers for research culture in ED
 Lots of important clinical questions generated from
clinical caseload
 Lots of patients!
 Large, well educated team (medical, nursing, allied
health, etc)
 Well placed for cross-discipline & system level
research
 Used to teamwork and collaboration
 Relatively under-researched area

16. Strategies
Culture
Leadership
Structures

17. Structures to support a research culture
 Will vary with environment
 Aims:
 Promote importance of research to EM practice
 Encourage use of research/evidence to guide practice
 Process questions and ideas from ED team
 Build research skills (general and research management)
 Communicate about research – internal and external; ‘up’
& ‘across’
 Facilitate collaborations –internal and external

18. Structures to support a research culture
 ED leadership team support
 Literally, ‘on the agenda’
 Variety of structures
 Research interest group/ research
team
 Named research group
 Clarity about how to feed in ideas
and how they are handled

19. Activities of research group
 Awareness raising
 Regular research rounds
 Rotating poster displays in ED
 Research exchange events with other departments/ other ED
 Display of publications in ED
 Celebration of success – grant, publication, practice change
 Recognition of contribution
 Education and capacity building
 Structures to support mentoring
 Build relationships with other disciplines/ EDs for
collaboration
 Host annual research forum (showcase)

20. Building and maintaining the culture
 Changing culture is difficult and takes time!
 The key is COMMUNICATION
 Why it is important
 What’s going on currently
 That all ideas are valuable and welcome
 That research is a team game and that everyone is part of
the team
 That everyone’s contribution is appreciated
 That research is core business because of its link to
quality
 Of successes
 Of value to patients and the organisation

21. An international parable
 Heaven and Hell
 In hell, all the people are seated around a long
dining table piled with delicious food. Each of them
has three-foot-long chopsticks. They are all starving
because they are only trying to feed themselves.
 In heaven, same set up, long table, lots of food,
three-foot-long chopsticks, but everyone is eating
well because they are feeding each other.

22. Messages for research culture
 Research culture’s top priority is good relationships
across the research team
 Respect other members, elevate them, advocate for
them, celebrate their success
 With good relationships, results will follow

23. Leadership and research culture
 Building a research culture requires transformational
leadership
 Influence
 Inspire
 Motivate
 Stimulate
 Disseminate
 Encourage diversity of thought
 Recognise and reward
 Coach and mentor

24. The importance of influencers
 What is an influencer?
 Harnessing influencers
 Inform and consult
 Listen and acknowledge
 Explain
 Touch base frequently
 Respect as an important part of your team

25. Leveraging off other research teams
 Often more established research teams in your
organisation
 Learn from them
 Collaborate with them
 Establish mentoring relationship with their senior
members
 Use them to advocate for ED research team

26. ‘Research is a doctor thing’
 Nursing practice is a major contributor to ED care
 Emergency nursing very under-researched
 Safer handover
 Medication safety
 Triage
 Nurse-led models of care
 Educational needs
 Interdisciplinary teamwork in critical cases
 End of life care in ED
 Same applies to allied health/ other clinical groups

27. Importance of collaboration
 Vibrant research culture is truly collaborative
 All ideas for projects are welcomed and valued
 When projects are being planned, there is meaningful
consultation with any clinicians impacted
 During projects there is regular two-way feedback about
progress (and problems)
 It’s not just about the lead researcher – all contributors
are appropriately acknowledged
 News about presentations and publications in shared with
and valued by all members of the ED
 Growing & mentoring is promoted

28. Research culture is ...

29. Question #1
 A research culture requires some resources e.g.
non-clinical time, funding, etc. How do you convince
the organisation to give you support?

30. Question #2
 When you collaborate with other groups within your
hospital or external groups there is the possibility of
being ‘used’ by the other party. How can this be
avoided?

31. Question #3
 How do you get EM residents started in research in
a busy clinical environment?

32. Question #3
 Research review
 Journal club
 Research round
 Research project
 Sell benefit to their career & to patients
 Work in pairs with a nominated supervisor
 Keep the project small and manageable but relevant
 Provide active coaching and mentoring
 Retrospective data collection is probably more
manageable for a first project
 Meta-analyses are also a good option

33. Question #3
 Examples of recent projects my residents have
done.
 Validation of the Ottawa SAH rules (Emerg Med Austral)
 Failed validation of predictors of surgery in renal colic
 Do paramedics over-oxygenate patients with COPD?
 Predictors of positive blood cultures in patients with
pneumonia (HKJEM)
 The Relative Efficacy of Adenosine versus Verapamil for
Treatment of Stable Paroxysmal SVT in Adults: A Meta-
analysis.(Eur J Emerg Med)

34. Question #4
 Is there a need for a formal research attachment (no
clinical load) in an EM residency program?

35. Thankyou
@kellyam_jec