Kingston Hospital: From a good hospital to a hospital that’s good at research
In 2014 Kingston was rated as a good hospital (CHKS, a leading provider of healthcare intelligence and quality improvement services, rated it a top 40 hospital and top 5 most efficient) but rated ‘worst performing research Trust out of 12 in South London CRN.’ This was due to the following factors:
- No infra-structure/ dedicated equipment/ rooms
- No training- research considered as an ‘optional extra’ rather than part of job role
- No support to set up trials, making the process appear ‘daunting’ and overwhelming
- Insufficient money/time available for research
- No support with screening or data input
- Problems with pathology/ pharmacy/ radiology
- No cross-speciality interaction
- No trust recognition or high level support
What has changed?
- Helen Matthews was appointed as Research and Development Lead for Kingston Hospital in 2014. Before this, there was no member of staff at Kingston to promote research. CRN then funded an R&D Coordinator, Jennifer Crooks; a dedicated resource to assist staff with the research process, provide support, and ‘demystify’ paperwork. Jennifer was responsible for assisting organisations in selecting the right initial studies (‘Gateway trials’) to promote research and keep up momentum. CRN staff have also provided support in setting up trials. Staff now feel more supported and are therefore more willing to get involved with research studies and ask questions. The research process has now been broken down and seems less overwhelming/ daunting. This post is now paid for directly by the hospital. Money from the CRN and charities has also improved staff engagement and allowed Kingston to build and develop a research portfolio.
- There has been an opportunity for Clinical Nurse Specialists to act as Chief Investigators which has proven successful. They are able to spend more time with patients and have a ‘sense of ownership’ for the process as a whole. This should be replicated in more Trusts. One of the Clinical Nurse Specialists have been asked to write an article for the British Association of Dermatology journal, helping to spread the word further and promote research.
- Band 3 staff are commonly used for screening and data entry, which leaves Band 5 staff free to focus on recruiting participants
- Support from Pharmacy has now increased, due to the appointment of a proactive Research Pharmacist.
- Targeted/ face-to-face GCP training has taken place within the Trust, which has been well received. Staff often find the online course overwhelming/ off putting, so this approach often works better.
- Kingston has been able to work collaboratively with Royal Marsden (e.g. on the NICE FIT trial) and also have a good relationship with Kingston University.
- More events have been organised since 2014 to promote research and involve the public e.g.
- International Clinical Trials Day 2016/17
- Research Awareness Survey: Hospital Volunteers
- Hospital Open Day- Research Stand
- Board of Governors
- Wall of Pride
Perhaps most importantly, due to these success factors there is now more face-to-face conversation about research, and more support at Board level. Targeted road shows have taken place to promote research, and Helen and Jennifer are keen for research to embedded within the Trust at every level.
Despite the numerous successes, there are still barriers to overcome, most of which are common within NHS Trusts:
- There is still a need to speed up the research set-up process
- Although the number has decreased, there are still staff within the Trust who oppose research, largely due to a lack of understanding of what research is or what the tangible benefits of research are. The aim at Kingston is to effectively embed research into everyday care.
- The GCP process is still considered daunting and may put staff off getting involved in research if they are unable to take part in face-to-face sessions.
- The Trust is still lacking some specialist equipment, which limits the number of trials that can take place within the Trust.
- Kingston still needs a greater understanding of how to support patients and volunteers who are considering getting involved in research
- Like many Trusts, Kingston is currently reliant on Bank Staff in research, and the R&D department is still lacking office space.
How can these challenges be overcome?
- GCP should be mandatory at least for Band 7 and above, Registrars, and Consultants. Training should be included as part of staff inductions to emphasise that research is a compulsory part of everyday roles which should be embedded within job plans.
- More comms involvement and resources required to really spread the positive message of research across all departments of the Trust.
- The only way to really embed research is tied in with the collaboration with CQC- research is needed as a key quality indicator.
- Outside/ CRN help needed to further assist with building commercial profile.
- More permanent research staff are needed within the Trust.