Designing and supporting embedded research

Text throughout this chapter has been reproduced with permission from Ward et al.178 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The text below includes minor additions and formatting changes to the original text.

Introduction

Despite becoming an increasingly popular strategy, designing and managing the embedded co-production of knowledge is far from straightforward. As we saw in Chapters 3 and 4, initiatives can come in a wide variety of shapes and sizes and are usually both complex and emergent in nature.158 Moreover, the nature of knowledge co-production itself is complex and multifaceted, as explored in Chapter 2. Dilemmas and challenges include the types of co-production sought, the extent to which researchers should be embedded in the organisational setting, how to manage boundaries and the (sometimes conflicting) interests of different parties, and how best to respond to the knowledge needs of organisations grappling with complex and changing hinterlands.65,155,156

Consequentially, as we saw in the previous chapters, those involved in initiatives can struggle to consider and fully articulate the range of issues that are germane or the design options that are open to them. This, in turn, can lead to tensions within initiatives due to, for example, the differing (and often unexamined) expectations of those involved, the difficulty of evaluating and demonstrating the value of initiatives (especially to those investing time and/or money), the need to respond to changing internal staffing and external influences, and the difficulty of reconciling diverse and potentially discordant aspects of an initiative.65,162

In this and the following chapter, we begin to integrate the findings from the research-based workstreams 1–3 into a design framework, supporting metaphors, and tools and resources to aid the design, analysis and management of embedded research initiatives. The framework is based on the extensive research reported in Chapters 2–5, work that enabled us to tease apart and map the various features of embedded co-production initiatives. It also draws on the extensive engagement and influencing activities of workstream 4, to focus on the practical manifestations of the programme of research. We present the design framework in the form of a ‘landscape map’ with accompanying materials, including a series of reflective questions. Other outputs and outcomes from the range of engagement activities deployed in workstream 4 (and outlined in Chapter 1) are also covered here and in the following chapter, to give a fully rounded picture of the contributions we have made to supporting the embedded co-production of knowledge. We conclude this chapter by drawing on our experiences of being involved in embedded research initiatives to discuss the potential utility and value of the materials for initiating and sustaining embedded research initiatives.

Approaches and methods

In this section, we describe the approaches and methods used to create the portfolio of tools, resources and supporting materials that emerged from this project. First, we explain how we developed the design framework for embedded research initiatives, drawing heavily on the research reported in Chapters 3–5. Then we revisit the engaging and influencing activities (workstream 4, outlined in Chapter 1) to show how these activities led to a wide range of supporting materials that promote and support the development of embedded research initiatives.

Developing the design framework

As documented in Chapters 2–5, the supporting research comprised a wide review of literatures on knowledge co-production and on embedded research (workstream 1), a scoping exercise of embedded research initiatives in health settings across the UK (workstream 2), and a co-production workshop with embedded researchers and their managers (part of workstream 4). This was followed by more detailed exploration of four ongoing initiatives, including about 50 in-depth interviews and an additional workshop with follow-up discussions to validate our thinking and create and refine the supporting materials (workstream 3).

The features of embedded co-production

As described in Chapter 3, our research identified 10 themes representing the common concerns of an embedded research initiative, and these were grouped under three categories relating to the underlying intent, structure and processes involved in an initiative. From each of these main themes, we then identified a number of additional subthemes that teased out the various aspects of each feature (see Table 5); their underlying rationales and evidence can be traced in Chapter 3.

Given the ongoing uncertainty about the link between what embedded research initiatives do and their outcomes, the features described should not be viewed prescriptively. Instead, they are descriptions of the conceptual and operational components that characterise embedded initiatives – areas that require focused attention and detailed articulation. Importantly, each feature illustrates the complexity and nuance of embedded research that sometimes fails to be acknowledged, disaggregated or given due regard. This led us to think of the features as a common language for describing, discussing, planning and managing initiatives, a set of tools and resources for more thorough and reflective analysis – and with greater specificity – than is usually the case.

Co-producing a basic design framework

Having identified the 10 features (and associated subthemes) from our literature review and empirical work, we held a day-long co-design workshop with embedded researchers and their managers (n = 18). The purpose of the workshop was twofold. First, we aimed to test, validate and (if necessary) amend the features. Second, we aimed to understand how best to communicate the features and work them into a practical framework for those designing or becoming involved in an embedded research initiative.

The workshop made use of a range of creative activities and was facilitated by an experienced team of researchers in design and health care (see Acknowledgements). The workshop began with participants adding comments and questions to postcards that depicted each of the 10 features with a simple icon (e.g. a location icon for proximity, a house for belonging). These thoughts were then discussed in small groups before being summarised and fed back to the rest of the group. Small groups also discussed and fed back whether or not some features were more of a priority than others. Insights that emerged during this part of the workshop included the emergent and often underarticulated nature of intended outcomes; the central (yet usually hidden) nature of power dynamics; the sense of ‘homelessness’ often felt by embedded researchers; the need to consider when and where to involve others in an initiative; the idea of proximity as a journey as much as a set of locations; and the need to manage expectations about researcher skills, expertise, roles and activities.

The next section of the workshop focused on visualising the features. Participants worked individually and then in small groups to produce physical models as three-dimensional metaphors of the features, before turning these into two-dimensional pictures. The aim was to give participants the time and space to explore and make sense of the features in different ways, and to develop insights about how they could best be communicated and shared with others involved in embedded research initiatives. Recurring metaphors drew on the natural world (e.g. trees, ferns, ponds, waves, soil), with many participants focusing on ideas of growth, tending and nurturing.

Other activities during the workshop included a discussion about formulating a network to support those in embedded researcher roles (informed by insights about the potential loneliness and ‘homelessness’ of embedded researchers) and a discussion about how to share the insights from our research and workshop (participants’ strong preference was for materials to be shared via a website and in open-access publications).

Visualising the framework and devising supporting materials

Although the workshop validated the features our research had identified, provided some powerful metaphors to describe those features and coalesced a group of people involved in embedded research, we still needed to develop the features into a practical framework to support the design, analysis and management of embedded research initiatives.

This additional work comprised three main activities: first, working with a professional illustrator to develop a single visual representation of the features; second, developing a series of reflective questions to help unpack the features and subthemes; and, third, providing a rich and evidence-rooted explanation of the themes and subthemes that would allow interested parties to track back to the published and grey literature.

To develop the visual representation of the major themes, we shared photographs and materials from the co-design workshop with a professional illustrator (see Acknowledgements) before holding a number of telephone and e-mail discussions. These focused on how adequately to represent the features in a coherent single image that captured both our research findings and the insights from participants at the co-design workshop. Between interactions with the illustrator, we discussed draft illustrations and metaphors with members of the wider team and sought further feedback from some of the workshop participants.

To support this visual re-working of the framework, we also developed a series of reflective questions for each theme, and we constructed more detailed and technical accounts of the themes and subthemes, drawing on our wide range of study materials. These additional materials drew on extensive discussions with members of our wider team and workshop participants, and, collectively, they provided material that was easy for potential stakeholders in embedded research initiatives to understand. All of these materials are freely available at the Embedded Research website.67

Developing other supporting materials

Throughout the project, considerable attention was paid to engaging and influencing activities (workstream 4; see Chapter 1 for an outline of its approach, audience and actions). Activities ran in parallel with workstreams 1–3, drawing on and contributing to those research activities.

A project website was constructed at an early stage,67 and a series of webinars was run to create interest and drive web traffic. As research-based materials (such as the design framework) became available, these were converted to web resources and released for wider community commentary. The collaborative workshops programmed into the lifetime of the project created opportunities for the co-production of resources, which, in turn, were used to enhance the resources section of the website. The planned workshop that could not run because of COVID-19 restrictions was replaced with podcast interviews with other members of the team to provide a readily accessible record of the thinking behind the design framework. Articles in widely read practitioner journals (Health Service Journal, Local Government Chronicle) created additional interest, spread the core messages from the research, drove further website traffic and created additional useful discussions that fed back into the creation of supporting materials. Blogs and an active Twitter account (@_embedded) offered further channels to stimulate interest, and allowed followers to engage with the supporting materials under development.

Outputs: tools and resources for embedded research

The varied activities outlined in the preceding section produced a wide range of resources for those interested in developing embedded co-production to draw on. The translation of our research output (the core features of embedded research initiatives) into these resources was seen as essential if this work was to have wider influence and we were to work in ways that were sympathetic to an engaged, inclusive and co-productive orientation to knowledge. In this section, we explore the outputs created by these processes in collaboration with, and usually co-productively with, wider partners.

Because our workshop participants, and our own research and practical experience, had alerted us to the often emergent and dynamic nature of embedded research initiatives, the potentially complex relationships between the features, and the limited evidence to date on the outcomes of initiatives, we did not seek to create a prescriptive or instructional manual for embedded research initiatives. Instead, the materials were designed to provide a structured way of engaging with the complexities, nuance and choices involved in designing and developing an embedded research initiative.

So, although considerable work went into developing, sharing and validating these outputs, we do not regard them as definitive: their nature will remain provisional, their uses conditional and contextually contingent, and the contribution they make to the design and management of schemes necessarily partial. It remains our hope, however, that they will provide useful guidance.

Three groups of outputs are presented in this chapter and in Chapter 7: first, the design framework, its visual representation and its supporting metaphors; second, the set of interrogatory questions intended to build dialogical engagement with the framework; and, third (in Chapter 7), a suite of materials for those considering employing an embedded researcher or blended research and service team. Thus, those interested in learning more about embedded research can have an easy introduction and then ‘drill down’ into the nuance, substance and evidence for each theme (see the Embedded Research website67).

These three groups allow engagement in a multilayered way. The first uses the metaphor of the garden to introduce concepts of complexity, multifacetedness and interconnectivity. Then individual aspects of the garden (the themes and subthemes) can be explored both as metaphors and dialogically through questions such as those set out in Table 15. Finally, these web resources contain click-throughs to other resources such as more detailed expositions of the themes linked to the literature, published papers, case studies, job-related resources, an animation and the opportunity to join a network of like-minded practitioners in embedded research.

The design framework: an illustrated metaphor

The visual landscape seen in Figure 12 represents the features of an embedded research initiative. Drawing on the insights of the participants at workshop 1, we selected a garden as an overarching metaphor to represent the growing, emergent nature of embedded research initiatives and the active work that individuals and organisations need to put into planning and maintaining such initiatives.

FIGURE 12 A visual landscape of the features of an embedded research initiative. (Figure not reproduced here; see the original article.)

Each theme is represented as a separate area in the garden, with relevant visual metaphors as follows:

• Intended outcomes are represented by the range of desirable produce emerging from the garden as a whole.
• Power dynamics are seen as a river flowing through the whole space, with the scope both to power initiatives (the water wheel) and also (implicitly) to overwhelm (e.g. by flooding).
• Scale is hinted at by the idea of a wood containing trees of different size, species and maturity.
• Involvement uses ideas of the hive (honeybees) to suggest that collective engagement is needed to produce more than individuals can alone.
• Proximity hints at ideas of distinct choices (the signpost), purposeful navigation (the map) and boundaries to be negotiated (the fence).
• Belonging is represented by both a summer house (a structural space for belonging) and a picnic (reflecting informal social spaces for belonging).
• Functional activities suggests the range of activities needed for success, their interconnectedness, ideas of investment for the future, and the toil sometimes involved in the tasks.
• Researcher skill and expertise are represented by gardening equipment and tools.
• Relational roles playfully suggests that actors from very different backgrounds and abilities may need to find ways to get along.
• Learning mechanisms points towards growth (the baby birds), maturity and stillness (the wise heron) and calm reflection (seen here literally but intended metaphorically).

Questions for engaging with the framework

The integrated nature of the overarching metaphor in Figure 12 illustrates the complex interconnectivity of all its aspects, yet disaggregating the overall picture into its constituent parts also has value in teasing out distinct design components and ensuring focused discussion. Table 15 shows each of these aspects in turn and lists a series of questions designed to prompt contemplation and discussion of each feature. These questions can be used alongside the visual landscape to prompt further enquiry, articulation and discussion of key design and/or management issues at the outset and again as initiatives unfold.

Clearly, the questions laid out in Table 15 do not present the last word on how to explore the themes. As new or extant collaborations grapple with the concerns laid out, new ways of digging deeper will emerge appropriate to the specific initiative under scrutiny. To aid this, the framework on the Embedded Research website67 contains click-throughs to other resources, to which we now turn.

Other supporting materials from workstream 4

The design framework described above lies at the centre of a suite of practice-focused materials that aim to assist in the exploration of embedded forms of knowledge co-production. Other resources developed across the team included:

• An animation to provide a visually attractive and engaging view of the possibilities.
• Real-world case studies to showcase possible manifestations of embedded strategies.
• A network of interested actors through which views and resources can be exchanged.
• A ‘recruitment resources pack’ containing sample job adverts, job description and person specification, which can be adapted and adopted for different circumstances. The pack also includes guidance and training resources, to help the collaborating institutions consider what will make for a successful and sustainable initiative.

Given the practical nature and the target audience for the recruitment resources pack (specifically, managers, clinicians and potential embedded researchers), the recruitment resources are presented separately from the other supporting materials in Chapter 7.

Animated introduction to embeddedness

As the limitations of knowledge transfer approaches became evident, there was a need to be able to explain the nature and (potential) advantages of more co-productive approaches, such as those embraced by the term ‘embedded research’. The animation we created is designed to stimulate discussions on how embedded research is viewed alongside more traditional research methods. It asks viewers to consider how we better align academic and non-academic perspectives, to ensure that academic outputs are useful to the service and that the service outlines real-world problems for the academic community to help solve. It is intended as a resource to enable teams to consider whether or not there are models other than traditional research that may provide a more useful approach for them.

In addition, we hope that it will help to build the credibility of embedded researchers who are already in post, and support them to be accepted into the research world. Our intention is for the animation to be provocative in order to drive discussion and enable people to think more broadly about research approaches. We believe that it will interest all three of our target audience groups: NHS and local government leaders, the academic community, and front-line staff and service users.

Real-world exemplars

Real-world exemplars of embedded research initiatives are presented on the website in multimedia format, including webinars and documentation. These introduce some of the diverse manifestations of embedded co-production, allowing those interested in pursuing this approach to better understand the challenges and benefits. These examples also highlight the great variability of approaches, suggesting that there is no simple template, thus reinforcing the use of the design framework as a guide for discussions and design decisions, rather than a prescription.

Networked activities

The research proposal envisaged the creation of a network or community for embedded researchers, and the subsequent work confirmed its relevance: one of the themes identified through the literature review, and validated further through the case studies, spoke to how lonely the embedded researcher role could be. Moreover, the tension between belonging to an academic world while being embedded in a service organisation was highlighted.

This could imply an easy opportunity to create a peer network to offer support to people who may feel isolated in their roles. Our experience in this project, however, demonstrated something rather different.

When we discussed the desirability of greater peer support at the first workshop, the participants expressed considerable enthusiasm for establishing a self-managed and lightly facilitated network to allow researchers to support and learn from each other. A network was established, but, despite the initial enthusiasm, activity in the group was limited. The project team experimented with various communication tools (e-mail lists, a Google Group, WhatsApp groups), but, despite prompting within these resources, subsequent communications traffic remained generally light.

From these experiences, and analyses of the interactions through our website, actors in this domain appear to coalesce around specific activities, rather than as peers wanting to connect more broadly. This may be reflective of the diverse models of embedded research initiatives, and the very different specific subject matter people are working on; that is, the potential for common ground could be rather more limited than might first be thought. It also suggests that engagement and connecting activities across this domain may need to be more actively managed and resourced.

In contrast, we successfully connected with existing bodies, such as the AHSN network and the ARC network, to involve them in planning the resources we were developing, commenting on emerging artefacts and improving their knowledge of embedded research models. Colleagues from these networks participated in our various workshops and publicised our work widely in their own geographic and virtual networks. Project team members also attended AHSN and ARC implementation events to speak about the potential of embedded research to deliver improved outcomes and impact.

Reflecting on the tools and resources developed

As researchers and leaders of embedded research initiatives, we had seen that interest in developing this approach was increasing in both the UK and overseas. In UK health and related services alone, we identified almost 50 such schemes (see Chapter 3), and enquiries of interest in the approach from people in health service settings showed no sign of slowing.

Many of those contacting us cited their frustration with the often limited utility and impact of academic research, their desire for better situated and ‘useful’ knowledge to help them address service delivery issues, and their desire for closer interactions with researchers. But, although they recognised the promise of embedded research in addressing some of these issues, they were often unclear about the possible components of an embedded initiative, or how to go about designing a programme to meet their particular needs. This was compounded by the largely ad hoc and somewhat opaque nature of many of the initiatives that had been developed by others. We were told that this made it difficult to see exactly how existing schemes had been designed and developed, for what purposes, and with what obstacles and success.

Recognising these challenges, we extended our research in workstreams 1–3 (on the common core components of embedded co-production and the microdynamics of implementation) to create a multilayered practical framework to guide those designing, managing or analysing embedded research initiatives. That work has been described in this chapter, augmented by an account of the range of practical tools and resources that we have co-developed. The framework, scheme-related resources and associated web-based tools are now available on open access.67

Next, we will discuss the potential for such tools to address common concerns over embedded research initiatives.

Published experience, as well as our own extensive interactions with embedded research teams, highlighted the need for open dialogue and discussion, both at scheme inception and as part of ongoing scheme development and management.162,166 This included the need for a common understanding, agreed goals and a bespoke design that fitted the local context and met the needs and ambitions of those involved. The framework we developed provides a structured way of encouraging such shared understandings, and a means of drawing on the experience of others (through the detailed linkages in deeper layers of the framework).

Used as part of an ongoing dialogue, the framework has the potential to deepen shared understandings, highlight divergent assumptions and reveal potential (and often hidden) tensions in the design options being taken.

None of the core components identified in the framework is simple or straightforward, and many will be context dependent, or even contested by the divergent actors involved in embedded research schemes. A willingness to invest the time necessary to properly explore and negotiate ideas and expectations across the components may be advantageous, as could be a willingness to return and review these issues as schemes bed in. There is also a need for those involved to know and understand what they are getting into, and to be alert to the potential risks (and not just benefits) at different levels. This might include, for example, articulating the career risks for researchers associated with not following a traditional academic route: embedded research is often not well aligned to the norms or incentives of academia, and is demanding of time and skills. It might also cover the extensive commitment needed from key players on the service side to help navigate local politics and competing priorities within operational settings. Use of the framework and exploratory questions might usefully extend and deepen discussions in these and other areas.

In similar fashion, the practice-related artefacts co-created as part of this project offer starting points for local discussion and adaptation. Although drawing on items that are (or have been) in use, we can expect considerable extension and diversification of these materials over time. It is expected that the Embedded Research website67 will be hosted and maintained, at least in the medium term, by the Research Unit for Research Utilisation at the University of St Andrews (co-investigators VW and HD are co-directors of this unit).179 The Embedded Research website67 will act as a repository for the tools, resources and materials developed as part of this project, with the potential to expand the materials held as the field matures.

As the ideas explored in this project spread and evolve, there will be a need for further evaluation of such schemes: for the purposes of learning and adaptation, for development of specific schemes over time (initiatives are often emergent and not rigorously defined at the outset), for comparison between initiatives of differing designs, and as a means to build a business case for further initiatives and investment.

There is also a conspicuous need for more rigorous and evaluative research on the process and outcomes of such schemes, so that more prescriptive advice can be given to those wishing to invest scarce resources. The framework and theoretical underpinnings reported here and previously have the potential to provide a common language and structured means of engagement with all these concerns, and the practical tools and resources developed have the potential to expedite scheme development.

This chapter has provided an account of the processes and outcomes that integrated insights from the research presented in Chapters 2–5 with some of components of the engaging and influencing work of workstream 4. In Chapter 7, we present the recruitment resource pack, which we hope will be practically useful to the embedded researchers, managers and clinicians who wish to design and deliver an embedded research scheme in their locality.