Tag Archives: Impact

Small Change/Big Change

This post presents a response to my last post, which talked about routines, and I think probably gave them a little bit of a hard time. Yes, they can be a little dehumanising, and we can be far too dependent on them, and external agencies can use our patterned behaviour against us…but, they are also very powerful little strategies which can be put to good use. If we use them reflectively, perhaps we can avoid many of the pitfalls I talked about previously.

One of the things I have come to learn about critique in general is that it feels a bit disingenuous to simply stand at the sidelines pointing out all the implications and consequences of everyone else’s action. At some point you have to get your own hands dirty, whether that be making recommendations to practitioners, contributing to policy debates, or even just having an honest conversation with someone you’ve done some research with.

I don’t know if i’ll ever find it easy – nailing my colours to the mast, while simultaneously being able to see the potential problems with each new solution. Nevertheless, it is necessary if you wish to make a contribution to a debate, if you wish to engage with practitioners and policy makers in their languages, and if you wish to have some kind of impact. Bringing about change in practice is one of the biggest challenges we face in our work. So often, the change you really want to be able to make is transformational, not this piecemeal, do things slightly differently, change one or two procedures, but the big, system changing, relation changing, heavy change. I don’t know whether lots of small changes add up to a big change in institutional terms. I think in some cases they can do. After all one of the greatest sources of power is alliance, so collecting enough small things together might prompt change in much bigger things.

I used to have a job with the National Institute of Health and Clinical Excellence (NICE). They produce guidelines which are non-statutory but make up the official benchmarking for clinical practice in the NHS. I was employed by one of the NICE guideline development groups as a service user representative. This was never a role I managed to find any great comfort with. Some of the reasons for this was to do with my own hang ups about what or who I was supposed to be representing, and what exactly it was that made me representative of a particular group. But all sorts of other things were just to do with the a priori constraints that existed and limited the possibilities that could be achieved through such a guideline. For example, when making assessments about which treatments to recommend for particular conditions, we were constrained by the existing health technology assessments, which used a health economics measure of efficacy called a QUALY. Basically, this is a numeric tool combining the cost of a treatment with its reported improvements of quality of life. We had the calculation and its method explained to us – it was problematic to say the least. QUALYs are seen as significant to the fourth decimal point, and yet the calculation that goes into them is hopelessly vague and subjective. But regardless of how many of the group offered their own anecdotal best practice, if it did not fit the QUALY hierarchy then it could not be recommended.

And yet, there were things about the NICE process where there was a certain amount of compromise available between the group of individuals producing the guideline, and the institutional codes which constrained us. We managed to persuade the college that was funding the guideline to commission some primary research the analysis of which was included in the guideline. This is the first time that this has ever been the case with a guideline, which ordinarily is more like a systematic review of existing research. I think it strengthened the guideline greatly, made it appear more human, and will have given cause to stop and reflect for any practitioner reading it. I suppose that this was a fairly small, but nevertheless significant change that we prompted, and I suppose if it became the norm within a guideline process then that could be considered a bigger change. Yet, there were many accepted methods and languages that we found no give in at all.

I’m approaching the stage in my current project where we will be required to write a report back to the funders, including our recommendations. Research recommendations are often the least interesting bit of a report. They can be so dry, stripped of life, taken out of context, superficial, preachy and obvious sounding. You can imagine people reading them and going ‘duh! I already know that!’, and yet they are difficult to flesh out, give context too, make thicker, because they are intended to be snappy, direct, practice focussed, headlines.

Another project I am involved in found a creative solution to this issue. We wrote the report in as ‘lively’ style as we felt able, nevertheless we had a huge amount of really rich research material that would and could never make it into this rather dry 40,000 word document. So, the PI decided to use the remaining dissemination budget to commission a writer to write a script based on our fieldnotes. This had never been a stated intention of the project, when we were researching it we never had any sense that our work was going to be dramatised – and thus we never ‘went looking for’ dramatic moments. It has been a fascinating process to be involved in though.

Roughly two years later the script has been written, workshopped, well received by stakeholders, and we are now working towards a full production of the play in June 2013. One of the most exciting things to have happened is that the healthcare trust with whom we conducted the original research have remained engaged in this unexpected follow-up – to the extent that they and two other trusts in the area have already reserved 1000 seats across 12 performances of the play for their staff to attend. This feels like double impact – both a novel and creative means to disseminate research findings, and a largely new theatre audience, drawn from some of the most poorly paid frontline staff in the NHS. That three healthcare trusts – with all the recent policy flux and budget slashing – are prepared to release something like 150 staff at a time to come and see a piece of theatre…that certainly defies expectation, perhaps represents a certain amount of transformation in itself, and if we are able to present something to challenge as well as entertain then the ripples could spread much further.

I’ll certainly be blogging more on this process, so watch this space.

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Academic stereotypes

There is a recent piece in Times Higher Education talking about the loss of the ‘dusty’ archival experience of being an academic researcher via the digital revolution, which has instead put most of us in front of a computer for most of our days. It’s an interesting point – and there are far reaching implications for the changes that the digital revolution has brought to research. The number and diversity of resources I was able to access for my PhD, with just a few clicks of a mouse might have taken months to unearth in years gone by. It’s something I have paused to consider myself more than once. However, this is not the main reason I’m posting about it. One of the interesting things was the minor twitter storm caused by the THE use of the tired cliche of ‘dusty’ in their first paragraph. Several archivists wrote in defending their shiny, well kept, mines of knowledge, and the THE duly apologised. It got me thinking about academic stereotypes, what effect they might have on professional, social, and public relations, and what we can attempt to do to combat these negative assumptions.

So, we all know that crazy haired professors sit in ivory towers speaking jargon heavy and inaccessible theories which are not based in the real world. These several stereotypes conjure up images of academics not only as idiosyncratic and eccentric, but also as self indulgent, irrelevant, and incapable of stepping outside their own languages to speak to ‘ordinary’ people.

Regardless of the perceived reality of these stereotypes, there are various effects played out in academic work as a result of their existence. These are not all bad things, as they can push academics towards making the relevance and accessibility of their work an explicit focus. Nevertheless, the mere existence of these stereotypes means that often people have a wall of assumptions raised up against academics which means they might not engage in the way that our work may require. Much of our work is about getting beneath commonly held assumptions and presenting alternative viewpoints, and in order for this to have any impact we need receptive audiences.

There are various things we can do to try and present ourselves and our work in a way that might prompt audience engagement. Publishing in a range of forums besides academic journals is an obvious example – professional and trade journals, policy forums, newspapers, online chat rooms and blogs. The fact that you can create any number of online versions of yourself and your work is quite empowering and has the potential to reach a broader and more diverse audience.

However, there is also a bit of a policy mismatch here. I’m talking here about impact, well, I’m talking about one version of impact, the version that most people might understand by the term ‘impact’ and that is, your research getting to the people who it concerns and who can (hopefully) take action on the basis of it. This has become increasingly important in fighting off charges of irrelevancy levelled at academics. It is an important part of any funding bid, and also makes up part of the research evaluation framework (REF) and it’s ‘impact case studies’.

The REF is the most important evaluative mechanism for university research, it feeds directly into both international league tables and funding quotas. However, in spite of the existence of the impact case studies, there is a sense in which only lip service is really paid to this version of impact by the REF in comparison to the alternative definition of impact which they have developed, and which makes up the main basis for the overall institutional score, and that is, the number of articles each individual academic has published in internationally renowned peer reviewed academic journals (journals with high ‘impact’ factors), where they will never be read by anyone outside academia. Real impact (i.e. engagement and knowledge exchange) thus becomes something to be done once the narrow and performative journal impact has been satisfied. This leads to a de-valuing of these kinds of activities and means that they end up not being done well, or done at all, by many.

This leaves a contradiction in place between the the rhetoric of funding bodies, university communications, and continuing development literature, which always underlines the importance of definition 1 of impact – the good kind – while only supporting, incentivising, and performance managing in relation to the narrow version 2. It also reinforces tensions between rhetoric and reality in relation to stereotypes, and how likely they are to be broken down in an institutional context which does not provide real resource based support for doing so.

Postscript

Ok. I’ve come to feel a little foolish in the past week or so, since writing this post, as I have started to discover the world of activity that is going on with blogging and its impact on impact – see the ever increasing list of blogs on the right of the page. However, I stand by the point, as I think the majority of this work is contributing to the already sizeable gift economy in academia. When blogging becomes more than a interesting footnote on a cv, when it becomes recognised by funding bodies and evaluation frameworks, then change will have occurred. I guess the only way forward is for as many people as possible to keep doing it.

Bloggers of the world unite!