The Four Paradoxes That Stop Practitioners from Using Research to Change Professional Practice and How to Overcome Them
Abstract
:1. Introduction
Literature Review
2. Materials and Methods
2.1. Generating Intermediate Theory about Mechanisms and Challenges of Research-Use to Change Professional Practice
2.2. Generating Boundary Discourses through a Cross-Profession Analysis
2.3. The Overall Design and the Studies
2.4. The Analysis: Dialogically Interanimating Findings across Studies to Generate New Conceptual Insights
3. Results
3.1. The Paradox of Agency
“this extraordinary event. I mean [student’s name] would never do anything like this normally. So, we were very surprised indeed.”(Study2b)
“Teacher5: For some of my kids, for some of the students who can be absolutely vile to each other were encouraging, and I didn’t understand it at all, massively not at all, because they can hurl abuse in a normal lesson, and they choose to work with that person who they have hurled abuse within a normal lesson. Weird. And then actively encourage each other. So, talking about [Student1’s name]-Teacher 6: Oh god!Teacher 5: Yes, [Student1], in maths, was as quiet as-Teacher 1: She was in English too. She didn’t speak-Teacher5: -because her confidence was so through the floor. But [Student2’s name] was the one doing ‘You did really well [Student1’s name]. Come on, keep going’, and I’m like, ‘What’s happened? What the hell has happened to you?’Teacher6: All lesson?Teacher5: Yes.Teacher1: She [Teacher5] came into the office, and we were, ‘I can’t believe what’s going on.’”(Study1)
“There were some massive surprises because there is a child in that group who has very little confidence, at all, in their ability, has an amazing amount of time off school and doesn’t really like anybody asking her questions. They all chose what groups they wanted to be in, and the group that she went in, the other kids were encouraging her, and she had chosen to work with somebody and I just thought, ‘It’s going to be car crash.’ And, actually, it wasn’t.”(Study1)
I think if you’re going to get a cardiologist to police your echoing you wouldn’t get very far. Because I’ve found it’s been antagonistic rather than facilitatory most of the time.(Study5)
“We may have carried out group discussion in group tasks previously, but not within the set guidelines and using your toolkit to guide them and make it more purposeful and meaningful, and, to have that structure has enabled us to bring that into lessons and ensure that when we do group tasks that involve discussion and the promotion of dialogue between students, it is given more purpose so it is more effective and it has given a real structure to it.”(Study1)
I kind of grew in confidence while I was [in another hospital where] you have the advantage of having quite a few people with echo skills there so again there are people you can turn to and say ‘I don’t know but this looks to me like that’ and you can get immediate feedback.(Study5)
“So, when I personally heard about the dialogue in maths, I must admit I was thinking that would be useful, but at the same time I was thinking, well, we do it all the time anyway: we are always talking to the kids. How can this be of any kind of benefit to be using dialogue in maths? However, the difference between using the ‘dummy run’ [with no tool], where we practised without any kind of guidance, and then the second one where we had all the structure and the skills to be able to do it properly was massive, and that was a big surprise to me, because I thought, well, talking is talking: you just give them some work and they can get on with it in a group.”(Study1)
I am more motivated and more encouraged that next time a project I need to get off the ground, I’ll be able to do it, just because I’ve got better tools to use.(Study4)
“What the [PLI] allowed me to do was to go through that journey in a safe way, where the reputational risk wasn’t there for me because I could say it was a ‘Chief Residents’ [PLI] service improvement project that I was doing.”(Study4)
[It] isn’t necessarily giving people that power, it’s just showing them that they do have it.(Study4a)
3.2. The Paradox of People
“Every week there will be echo teaching, where they will take one or two people usually to a bedside and there’s usually a couple of echo trainers there and you will do an echo and get talked through it. There’s different levels of skill there so again, there are people who are just learning and finding views and there are those who are more experienced and you can have a collegiate discussion about your findings. You really need that because if you’re not training your people to do echo, you really can’t expect them to do it.”(Study5)
“I think the biggest thing is trying to get people motivated and to try to make change because I feel like there is resistance to change—as there is a tendency to stick your head in the sand and say ‘this is how we do it we’ll continue to do it this way, there’s no money to change anything anyway so this is what we are going to do’.”(Study4)
“I think it’s still quite daunting because it is difficult and I’m more aware of the barriers now, but I’m also aware of how to get around them and how to, who to talk to and I guess how to get things done. I think I am more motivated, and more encouraged that next time there’s a project I need to get off the ground I’ll be able to do it just because I’ve got better tools to use.”(Study4)
I understand more, probably, about the reasons why some things succeed and other things do not. I think I know more about things needing to align with the wider department or Trust priorities, maybe to have the support that is needed.(Study4)
“I think it’s just broadened my experiences of the NHS [National Health Service], there’s a whole other side of the NHS that we just don’t see, and having a better understanding of how to get things done, and the right people to talk to get things done.—so I think next time project like that and I want to implement it I will be a lot better prepared in terms of who to talk to and how to get things done, and the different layers of management on the NHS to try and get things done.”(Study4)
3.3. The Paradox of Norms
“So they [heart surgeons] are quite happy to have a cardiology registrar who may not have passed all the accreditation come and look at the patient, whereas they don’t believe the intensive care doctor—So they kind of said, ‘Oh well, it’s nice that you did your [FICE] scan but I want someone else to look at the patient.’”(Study5, trainee doctor)
“You wouldn’t automatically do an echo on a patient. It’s a waste of time and it’s a waste of money.—You have to do things led by clinical need.”(Study5, senior consultant)
“The Ground Rules for Dialogue came in really useful because we presented it to our class and we were both pretty impressed with them and how much they just wanted to work as a group and wanted to talk and share their ideas. That Ground Rules for Talk was really effective when it was linked in with colourful semantics, which we use quite a lot in our school.”(Study1)
“I used the talk tokens as well.—it worked well for some of them. For others, they just couldn’t comprehend why they can’t just talk. [So I introduced] response tokens. So, they had to spend their talk tokens, but then, if they wanted to respond to something that somebody else had said, I got them to think about their response: why were they arguing that, why did they disagree, why did they agree, rather than just talking, because I thought that was important to differentiate it between making a point and actually making an argument and having that discussion. That worked really well because, actually, they did argue against each other in a constructive way, surprisingly.”(Study1)
3.4. The Paradox of Risk
“I think there’s a reluctance to put yourself out there amongst doctors, to take the risk, we manage risk brilliantly in our day jobs, especially GPs, that’s what we do, but actually putting themselves outside their comfort zone and outside the zone they’ve been trained to feel uncomfortable in. And I think people worry about personal reputation—and I think that’s enough to put some people off.”(Study4)
“It is quite high pressure, and you’ve got to be quite resilient—and I think some doctors really struggle with that—they can take it really personally and feel that people are having a go at them as a person, rather than because they happen to head up a [new] process.”(Study4)
“I think we need to help change the mindset of the NHS, which I think has become very very risk averse so people don’t like to do anything in case it goes wrong.”(Study4)
“I think I would have done it eventually but it’s helped me—it’s given me the confidence to sort of, get on with it—So soon—exactly. Yes that’s what I’m saying as well. I would have done this eventually, you know. Once I’d sort of understood and worked my way in, and been careful about what I did and where I treaded for a little while.”(Study4)
“If you are a junior consultant and you hadn’t done it [a SI project before] you’d be saying ‘well I’m just finding my feet, I don’t want to get too big for my boots and try to change things, I’m just going to lay low for a while’ so the sort of things that you might take on might not happen for another five or ten years. So it [the PD programme] probably does accelerate that process a bit.”(Study4)
“If you have got the backing of your head of department to say, ‘Do it. See what happens. If it’s carnage, we’ll deal with it.’”(Study1)
“It [their improvement project] was a learning experience but it was painful.—If you’d have asked me six months into the project, I’d have probably thought well what’s the point, but actually at the end of it I realise what the point was.”(Study4)
4. Discussion and Conclusions
- Research findings to be utilised need to be visibly linked with practitioner-identified problems of practice;
- Practitioners need to be offered not only research to be implemented, but also research-based tools to support its implementation (including changing practice norms and facilitating productive peer collaboration and dialogue);
- They need to be offered research-based tools to mitigate innovation risks, such as monitoring and self-evaluation tools, based on research but translated to practice contexts.
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Dimension | Similarities | Differences |
---|---|---|
Developing new practices | Despite policy emphasis, research-use is actually fairly rare [17,18,26,27] Time, workload, political and psychological pressures are similar [2,17,18,26,52,66] Practitioners find it hard to translate research to their local practice and its needs [22,64,66] There are similar identified mechanisms of practice change involving critically reflecting on the problems of practice and trying to ‘see’ change opportunities [67,68], as opposed to accepting problems and seeking quick solutions which would also facilitate research-use | Doctors have higher levels of autonomy than teachers [26,64], which could facilitate experimenting with new practices |
Working with others | Work is described as relational [31,37] There are commonalities in the relational skills required and challenges observed: need to be able to communicate with and integrate research and new norms with the perspectives/expectations of lay people [26,57] Personal–professional knowledge is often not well articulated [62,64], making it less available for shared interrogation and development with colleagues | Working with individual patients (as opposed to classes of students) [58,64], and greater opportunities to collaborate [40] could facilitate doctors’ relationality required for research-use |
Norms of practice | There are highly established communities of practice with set practice norms [26,27,54] Professionals are influenced by the normative expectations of lay people (patients/students/families) [26,57] and strong institutional norms, which create challenges for using research to generate new practices [54,69] | The knowledge base and discourse in healthcare are more strongly oriented towards ‘evidence-based practice’ than in education [31,41,64], which could facilitate doctors’ development of new practices based on research-use |
Risk-taking | They carry out work in which they intervene in others’ lives, requiring their work to be highly ethically responsible [2,18] They work in highly risk-averse high-accountability cultures [18,27,31], which have been shown to not encourage engagement in attempting change to improve their service [70] | Doctors’ work on patients involving direct safety issues is a key factor shaping their work [58], which could make risk-taking harder; however, research shows that many risks involved in practice change are not related to patient/student safety, but to personal/reputational risks in change efforts [2,27,71]; the extant research base offers few detailed insights with regard to risk perceptions in research-use |
Objective | To Develop Deeper Conceptual Understandings of the Phenomenon | To Enhance the Practical Relevance of the Findings | ||
---|---|---|---|---|
Principle | Triangulation across studies [78] | Grounding in concrete settings while enabling comparison [79] | Ensuring opportunities to explore the phenomenon of interest [78] | Selecting study settings to enhance learning opportunities for practice [80] |
Design features | Inclusion of several studies with different settings/participants Although the exact focus of the target research and practices varied, all were in line with the understanding of research-use as outlined above by the literature and focused in some way on improving their institutional practice using the research-informed interventions as a starting point | (i) Focus on participants’ perspectives (ii) drawing on key dimensions of institutional practice from the literature (norms, communities, relationality) (iii) examining whether I could recognize a change mechanism identified in one setting in another setting (cf., [79]) | Inclusion of studies in which the participants were participating in professional development aligned with research-identified effective features (collaboration, dialogue, peer learning and critical reflection) [43,81] and opportunities for action to experiment with [63], and not only learn about, research-use, which offered a strong likelihood of research-use | Inclusion of studies portraying ‘ideal-typical’ cases: typical in the sense that all the studies took place in publicly funded education/healthcare institutions, which are non-selective and resource-limited; ‘ideal’ in the sense that the participants were keen to use research to develop their practice and had, in principle, institutional support to do so (both known to be important in supporting research-use) |
Benefits | Overcoming the challenge of much existing qualitative research on research-use (individual small-scale studies) [23,47] Understanding commonalities and differences across manifestations of the phenomenon [78] of research-use in practice | Understanding how/why actors did what they did in their wider institutional practice setting Ensuring there was analytic value in analysing these studies together (cf., [79]) | Ensuring there was a strong ‘best practice’ possibility of effective research-use in these settings, to ensure there was empirical value in analysing them | Ensuring what is identified as possible in these settings should be possible in other typical settings (since ‘typical’) Identifying ambitious but realistic future policy/practice objectives: if these practitioners struggle, others are likely to struggle too (since ‘ideal’) [45,80] |
Study | Study Aim | Study Team and Context | Study Design and Context | Methods, Data and Participants | Original Publ. * |
---|---|---|---|---|---|
Study1 | To understand how the research-based dialogic teaching intervention can support practice development and student learning and engagement and what the challenges are | RH led the research team at the University of Cambridge which conducted the study in East England | A year-long qualitative multi-school intervention study with primary and secondary teachers Practitioners were introduced to and utilised, in ways of their choosing and design, a research-based teaching intervention on dialogic teaching to develop their teaching to improve student learning and engagement | N = 15 primary and secondary teachers from 5 non-selective state-funded schools serving non-privileged communities 4 focus groups (N = 15); 4 interviews | Study1a: [82] |
Study2 | To understand how the research-based change-laboratory and deep learning intervention can support practice development and student learning and engagement and what the challenges are | A Finnish research team led the study [83], which was co-analysed with RH | A qualitative study of a year-long school-based multi-dept. change laboratory intervention in a middle school Practitioners were introduced to and utilised, in ways of their choosing and design, a research-based teaching intervention on deep learning approaches to develop their teaching to improve student learning and engagement | N = 30 teachers in one non-selective state-funded middle school serving a non-privileged community 9 teacher planning meetings and discussions facilitated by a research team member | Study2a: [84] Study2b: [85] |
Study3 | To understand how the research-based interactive teaching intervention coupled with open digital resources can support practice development and student learning and engagement and what the challenges are | A [RH’s University] research team, of which the author was a member, led the study in Southern Africa | A qualitative case study of a year-long school-based multi-department professional learning programme Practitioners were introduced to and utilised, in ways of their choosing and design, a research-based teaching intervention on interactive teaching and open digital resources to develop their teaching to improve student learning and engagement | N = 35 teachers in 3 non-selective state-funded schools serving a non-privileged community; in the follow-up stage: N = 26 repeat interviews, focus groups and observations in staff planning meetings throughout programme | Study3a: [86] Study3b: [87] Study3c:[88] Study3d:[89] |
Study4 | To understand how the research-based clinical leadership intervention can support practice development and outcomes and what the challenges are | RH led the research team at the University of Cambridge which conducted the study in East England | A mixed-methods study of a research-informed clinical leadership professional development programme with a service improvement project component offered by the regional health education authority and a university team Practitioners were introduced to research on leading service improvement and carried out a service improvement project | N = 226 doctors-in-training and GPs from multiple NHS (public) hospitals Open text responses in a survey (N = 226); interviews (N = 39) | Study4a: [90] Study4b: [91] |
Study5 | To understand how the research-based clinical training intervention can support practice development and outcomes and what the challenges are | RH led the research team at the University of Cambridge which conducted the study in East England | A qualitative case study with participants of the professional development programme utilising the research-based intervention Practitioners were introduced to an evidence-based clinical intervention (FICE) to utilise to support clinical practice (Focused Intensive Care Echocardiography or ‘Echo’) | N = 55 doctors-in-training and consultants from multiple NHS (public) hospitals In-depth interviews (N = 28); focus groups (N = 27) | Study5: [92] |
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Hofmann, R. The Four Paradoxes That Stop Practitioners from Using Research to Change Professional Practice and How to Overcome Them. Educ. Sci. 2024, 14, 996. https://doi.org/10.3390/educsci14090996
Hofmann R. The Four Paradoxes That Stop Practitioners from Using Research to Change Professional Practice and How to Overcome Them. Education Sciences. 2024; 14(9):996. https://doi.org/10.3390/educsci14090996
Chicago/Turabian StyleHofmann, Riikka. 2024. "The Four Paradoxes That Stop Practitioners from Using Research to Change Professional Practice and How to Overcome Them" Education Sciences 14, no. 9: 996. https://doi.org/10.3390/educsci14090996