Intended outcomes

This page provides further information on the design framework ‘Intended outcomes’ theme, including the background and supporting material, and the development process.

Background and supporting material

The literature revealed a range of working theories and concepts underpinning embedded research initiatives, all of which shared a clear focus on the intended outcome of embedded research. The literature, scoping materials and interviews enabled us to identify that these intended outcomes were related to knowledge, capacity and reputation.

In line with definitions of embedded research in the literature, the primary intent for many of the initiatives we identified was producing knowledge that would be beneficial within the healthcare organisation. Beyond this, we were able to identify two types of knowledge outcomes pursued by initiatives – local insights (generated through local service evaluation, service improvement or practice development activities) and more generalisable knowledge (generated through larger-scale formalised research activities). Some initiatives aimed to produce both forms of knowledge across a portfolio of different projects.

Capacity development was also a prominent intended outcome of embedded research initiatives, both in the literature and our scoped examples. Whilst the literature shed relatively little light on the precise meaning of capacity development, our scoping materials revealed that changes to capacity were desired at an individual and organisational level and included the capacity to produce knowledge, to deliver services and to generate income. Interestingly, the focus of such capacity building activity was almost exclusively on the health service setting and there was little consideration of how academics and their organisations could increase their capacity to produce (relevant) knowledge.

Whilst the first two intended outcomes were most prominent in the literature and our scoped examples, some initiatives focused on the reputational outcomes of embedded research. Bate (2000), for instance, notes that investment in his embedded research role represented a hospital’s attempt to retain its ‘edge’ as a nationally-recognised provider of high quality care. Across our data reputational benefits were understood to stem both from being seen as part of an initiative (signifying a commitment to the production and use of high-quality evidence and knowledge), and from the knowledge generated by the initiative (that could be used to further increase or maintain reputation and funding).

References

Bate, P. (2000) ‘Synthesizing research and practice: Using the action research approach in health care settings’, Social Policy & Administration, 34(4): 478-93.

Development and adaptation process

We originally developed 4 sub-themes within this theme – insights from local practice; formal academic knowledge; capability and capacity to produce knowledge; prestige and credibility. We used these to categorise different initiatives identified via the scoping work. For instance, it was possible to identify initiatives which were primarily intended to increase capability and capacity and those which were primarily intended to increase prestige and credibility. Whilst these categories were not mutually exclusive (i.e. we noted several initiatives which were designed to produce multiple outcomes), we nonetheless developed and then used the sub-themes in a relatively instrumental fashion.

During the workshop we came to realise that viewing and using the sub-themes in this way was not always helpful. Attendees sometimes saw more value in using the sub-themes to generate discussion and to review and revise the design of an initiative. There were several discussions, for instance, about the need for flexibility, iteration and emergent outcomes within an embedded research initiative. The overwhelming sense was that participants wanted to be able to design an embedded research initiative to meet their own context and so a tool to support decision making (rather than one to suggest which decisions to make) seemed more beneficial.

Two of our initial sub-themes (insights from local practice, formal academic knowledge) related to different types of knowledge which initiatives were intended to ‘produce’. During the workshop people spoke of the ‘scale’ of knowledge (local vs. global) and the ‘scale’ of the problem which was being dealt with (complex, unbounded issue vs. simple, well-defined and bounded issue). They also spoke of whether the knowledge being produced (and problem being addressed) was proximal or distal, and core or periphery to the organisation’s main business. This discussion alerted us to the idea that the knowledge-related outcomes which an initiative might be designed to produce were likely to be more complex than we were able to determine from the research literature, documents and interviews. To reflect some of these complexities, we removed our two sub-themes relating to the types of knowledge being generated, and introduced a sub-theme intended to support discussions and decisions relating to these issues (i.e. types and scale of knowledge).

We retained capability and capacity as an intended outcome, as this came through very clearly from our scoping work. But we relaxed the type of capability and capacity which initiatives could build (removing reference to the production of knowledge). Again, this was to facilitate a discussion not only about whether an initiative was designed to increase capability and capacity, but also and what kind of capability and capacity this might be.

Similarly, we also reworded ‘prestige and credibility’ to ‘reputational benefits’ in order to help partners discuss the range of reputational benefits which they might want to build into the initiative. This was also done in the spirit of ensuring that our sub-themes could be used to facilitate discussion and thought rather than prompting a yes/no answer.