Relational role

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

Background and supporting material

Whilst all embedded research initiatives aim to bring research and practice into a closer relationship with one other, we found that there were a number of things that characterised the type of role that researchers might play. These were the level of interdependence between the researcher and the health organisation, their relational stance and the type of input they provide.

Researchers in the initiatives we identified had varying levels of interdependence with the organisation in which they were embedded. This was expressed in the extent to which they viewed themselves (or were viewed by others) as insiders or outsiders in the health setting, the degree of flexibility and control they had over their work and the extent to which they were able to access spaces within the health organisation. Their level of interdependence was often reflected in contractual and informal arrangements for belonging and was closely tied to power dynamics. Whilst we identified varying levels of interdependence across the initiatives, the challenge of managing the boundary between insider/outsider was a common theme.

Researchers adopted a variety of relational stances towards the health setting and those working within it. The literature frequently highlights the role of an embedded researcher as a ‘critical friend’ who needs to maintain a critical stance towards the health setting (Marshall et al 2014, Vindrola-Padros et al 2016). This is usually related to the preservation of academic professional identity which depends on researchers’ ability to maintain a critical distance (Vindrola-Padros et al 2018). Researchers working in some initiatives, however, adopted roles as advocates and supporters, seeking to produce knowledge and operate in ways that would support rather than challenge the organisation. These choices were strongly related to the underlying intent of the initiative.

“…a critical friend needs to be first of all a friend.  And it’s easy to assume the role of a critical friend where actually your voice is seen as the voice of an outsider.  And in reality, it doesn’t have weight, because you’re seen as someone from the outside looking in and guiding, and instructing, and criticising, and telling.  Whereas if you’re fundamentally part of the team, and you’re seen to be part of them when they’re in the trenches, you’re there with them…”  – Embedded research manager interview

The types of input provided by embedded researchers also varied across initiatives. Some researchers provided the health organisation with a fresh pair of eyes and a new way of seeing things, bringing insights to help catalyse change (Cheetham et al 2018). Others provided an additional pair of hands, producing knowledge and evidence to drive the organisations’ processes and activities. Still others focused on providing specialist or expert advice (methodological or topic specific) in a more hands-off fashion. In line with our observations about functional activities, many initiatives also expected more than one type of input from researchers.

References

Cheetham, M., Wiseman, A., Khazaeli, B., Gibson, E., Gray, P., Van der Graaf, P. and Rushmer, R. (2018) ‘Embedded research: a promising way to create evidence informed impact in public health’, Journal of Public Health, 40(Supplement 1): i64–i70.

Marshall, M., Pagel, C., French, C., Utley, M., Allwood, D., Fulop, N., Pope, C., Banks, V. and Goldmann, A. (2014) ‘Moving improvement research closer to practice: the Researcher-in-Residence model’, BMJ Quality & Safety, 10.1136/bmjqs-2013-002779.

Vindrola-Padros, C., Pape, T., Utley, M. and Fulop, N. J. (2016) ‘The role of embedded research in quality improvement: a narrative review’, BMJ Quality & Safety, 10.1136/bmjqs-2015-004877.

Vindrola-Padros, C., Eyre, L., Baxter, H., Cramer, H., George, B., Wye, L., Fulop, N. J., Utley, M., Phillips, N., Brindle, P. and Marshall, M. (2018) ‘Addressing the challenges of knowledge co-production in quality improvement: learning from the implementation of the researcher-in-residence model’, BMJ Quality & Safety, 10.1136/bmjqs-2017-007127.

Development and adaptation process

This theme has undergone relatively little adaptation or change. During the workshop participants were generally content with and understood the theme and sub-theme. The main insight arising from the workshop was the unfolding or emergent nature of a researcher’s relational role and the importance of developing and maintaining critical distance.

On reflection, we judged that the notion of critical distance is a specific design choice (i.e. critical distance is not necessarily a pre-requisite for an embedded research initiative) but did incorporate the idea of considering how the researcher(s) will be supported to nurture and maintain the relevant stance. We incorporated the idea of emergence into the description at several levels via questions such as whether the level of interdependence will vary across settings or context.