The Covid-19 pandemic set real challenges for research leadership in the NHS. The distinct emphasis on a single disease and on the need for speed to develop research to tackle the pandemic have required super-efficient management processes in the R&D Offices of the NHS. Multidisciplinary working has proliferated in the face of the threat of Covid-19. What has also come to the fore has been the need for research leaders in the NHS and Universities to successfully work at, and beyond, the boundaries to deliver a response to the pandemic.
Biomedical research is complex. Research in healthcare settings is a collaborative operation, requiring the knowledge, input, support and goodwill of multiple partners – be they different individuals, departments or other organisations. If one component of the system is missing or misaligned, the whole system suffers. If the communication within the system isn’t clear, combined efforts are thwarted. And the cost of not getting it right? – progress for patients is stifled. Biomedical research is all about delivering answers to benefit patients short, medium, long term. The stakes are therefore very high.
I have a long-held view that the theory of boundary objects[1], which has its origins in sociology, offers a useful framework for understanding research leadership and the practice of research management. One way to get to grips with the boundary objects concept is to consider it as a lens through which we can look at complex situations and understand how the various partners involved can cooperate on a project, even when they have disparate or perhaps even conflicting views or interests on it.
So how do we understand boundary objects in the context of research leadership in the NHS and the roles that R&D Offices play? How can this resonate for a research leader or manager?
We can consider the research protocol as a boundary object. This is the essential document around which multiple research partners interact. Principal investigators and their teams will be inclined to see the protocol as the way of transferring the research idea to ‘paper’ – and a first step to action. They also tend to see the emerging protocol as the mechanism for securing grant funding. Regulators see the protocol as the key research plan to scrutinise and assess for patient safety aspects and legal compliance. NHS Pharmacy and Imaging Departments also have an interest in the protocol for reasons of safety, compliance and feasibility. Patients are interested in protocols, and patient information sheets, because they provide insight on what the research aims to do and how the researchers plan go about achieving it.
A shared understanding of different partners’ roles and information needs is essential if those different perspectives and interpretations are to be successfully brought together and mutually understood to deliver a high quality protocol, and a successful project. This is the key role that research leaders and their teams in R&D Offices in the NHS provide.
If you’re working at the boundaries, then you need to be able to span those boundaries in the interests of delivering an outcome. But the boundary spanning role is challenging. People in the research system are often ‘specialists’ – they hold very specific knowledge and expertise that is aligned to their professional roles – clinicians, pharmacists and statisticians will have trained for many years in their specific fields acquiring specific knowledge in the process. The explicit knowledge aligned to these professional roles needs to be codified and socialised so that all the partners involved can understand it and why it is required for the research. To do that demands skills of reflexivity, mediation, and negotiation, all of which we have seen vividly from research leaders and their teams during Covid-19 - and at speed.
In response to Covid-19, research leaders have rapidly brought together clinicians from across a wide range of specialties – such as infectious diseases, acute medicine, respiratory medicine, haematology and oncology, to share insights of Covid-19 from the clinical front line. Research leaders have galvanised such clinical specialists, aligning them with scientists from multiple disciplines including clinical trials, data science and engineering, with the aim of rapidly devising research protocols to address clinical need. With research managers and service support departments also involved, these dynamic forums have become the engine rooms for the NHS research response to Covid-19. At UCLH/UCL the 50+ projects that we have activated in Covid-19 are the product of that process, which will continue to contribute to the evidence base around Covid-19 for months and years ahead.
During Covid-19, I have seen a real pride amongst research management staff in being part of these wider multidisciplinary teams. Research managers have drawn a greater sense of belonging in their organisation as Principal Investigators, Chief Executives, Non-Executives and patients have acknowledged their specific contributions to the effort. Having been involved in NHS/University research for many years, that sense of belonging has not always been apparent for research managers, who can all too often feel like they play a peripheral role in the research process, simply performing one part of the research production line with little opportunity to follow-up on their interest in specific studies and topics, and losing track of the downstream impact that those studies have for patients.
When we consider how R&D leaders span boundaries in their work we need to consider the external as well as internal elements. Acquisition and sharing of knowledge and perspectives from counterparts in other Trusts, Universities and other related organisations helps shape the actions of R&D leaders. That has never been more so than during the Covid-19 challenge. These boundaries can be difficult to traverse, particularly when they can be fraught by competitive rivalries. Yet informal collaborative networks have been working overtime during Covid-19, serving as important mechanisms for sharing insights, approaches to assembling research delivery teams and delivery staff. Formal networks are also increasingly playing their part - UKRD and the R&D Forum for example, are providing much needed mobilising and consultative roles, enabling the views and insights of the research leadership and management community to be heard and shared. Government approaches to restarting non-Covid-19 clinical research in the NHS have also been shaped by this input.
What have been your boundary moments in the last 3 months? Where have you successfully worked at and beyond the boundaries? What makes some boundaries easier to span than others? What will you do to make sure you carry these practices forward for the months and years ahead as the world gets to grips with Covid-19?
Dr Nick McNally is Managing Director UCL/UCLH Research and Chief Operating Officer for the NIHR biomedical research centre at UCLH. n.mcnally@ucl.ac.uk @UCLHResearch @NickMcNally47 Nick is also a member of the Leadership Team of UKRD: R&D Leaders in the NHS (www.ukrdleaders.org @UKRDLeaders)
[1] Star, Susan; Griesemer, James (1989). "Institutional Ecology, 'Translations' and Boundary Objects: Amateurs and Professionals in Berkeley's Museum of Vertebrate Zoology, 1907-39". Social Studies of Science. 19 (3): 387–420. doi:10.1177/030631289019003001
