VINNOVA project 2013-04746

2016-01-28

Report from Dalarna University on the project “Research-practice partnership for innovation and knowledge implementation in health care and social services” 2013-2015.

Aims of the project The main aim of this project was to support a research-practice partnership, for the development of knowledge implementation and care of older people in health care and social services. A second aim was to involve students in projects of relevance for health care and social services, and thereby achieve higher quality in the scientific education in the nursing and social work programmes at Dalarna University (referred to as the University). These aims would be accomplished by bridging the gap between academia and practice, supporting the mutual exchange of knowledge between research and practice and by establishing strong partnerships and new arenas for interaction and collaboration with regional stakeholders.

The expected outcomes of the project The expected outcomes of the project were that: i) research-based knowledge should be translated for and used in health care and social services to a greater extent than is common; ii) the research agenda of the centres would be of more relevance for practice through the dialogue between academia and local stakeholders; and iii) specific criteria could be developed for measuring collaboration between universities and stakeholders in society.

Activities in the project

Bridge the gap between academia and practice It is well known that there is a gap between what academia produces as evidence for practice and the actual implementation of this evidence into practice to the benefit of users of healthcare and social services. It is of importance that this gap is bridged and to address this the University wanted to support the development of a research-practice partnership with stakeholders across Region Dalarna, including Landstinget Dalarna (Dalarna county council) and 15 municipalities. This type of partnership can evolve through forging relationships at a strategic level and building on these in order to engage practitioners at all levels. Below we list activities undertaken as part of ‘bridging the gap’. Strategy discussion fora Senior level meetings have previously been established and sustained between Dalarna University and regional stakeholders within the health and welfare sector including Landstinget Dalarna and the municipalities through Socialtjänstens Utvecklingcentrum Dalarna (Social service development centre Dalarna, SUD), where the stakeholders’ chief executives and key University actors are all represented. In addition, Landstinget Dalarna and the University have senior level meetings for collaboration around education and research. At these meetings the ways in which collaboration can be enabled have been mapped and discussed.

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To further develop research collaboration, a Steering Group was established for the new research centres at the University, Knowledge Implementation and Patient Safety (KIPS) and the Research Centre for Ageing & Later Life (ReCALL), as well as advisory groups for both centres. These groups provide fora at which representatives from Landstinget Dalarna, Region Dalarna, Dalarna municipalities, private care providers, industry, various universities and Dalarna University have been able to come together to review current activities and to plan the future activities of the centres. One of the expected outcomes of the project was the development of criteria for how we can measure collaboration between the University and stakeholders in society. The stage of forging collaborative relationships has been very successful and in September 2015 all partner organisations came together in a workshop (Collaboration in Research) to continue the development process by examining current collaboration, how collaboration can be improved and what future collaboration could look like. Three main questions were asked: What do we want from collaboration?; What will collaboration look like?; and How can we follow up and evaluate research collaboration? The discussion around these questions was documented and possible criteria for measuring collaboration were identified. The outcome of this workshop will be the foundation for further meetings to finalise criteria and to discuss any future evaluations. Operational level fora Monthly research seminars have been held at the University where researchers and partners from Landstinget Dalarna, Dalarna’s municipalities and the University come together to discuss research, including journal articles in development and up-and-coming projects. Co-produced research Four intervention studies on knowledge implementation have been run in close collaboration with Landstinget Dalarna and the municipalities with shared financing of the studies and using practice settings in the region as study sites. 1) Primary Leaders Implementing Stroke evidence (PLIS), a pilot study with collaborators at Karolinska Institutet on supporting health care managers at frontline and departmental level to implement recommendations from the national Stroke guidelines. 2) A pilot study on supporting managers in care of older people to implement guidelines for oral care (M-Oral). 3) A pilot study with national and international collaborators on Onset PrevenTion of Incontinence in Orthopaedic Nursing and rehabilitation (OPTION). 4) Care coordinator in the primary care organization for management of depression - A cluster randomized trial in collaboration with researchers at Sahlgrenska Akademin in Göteborg on the effect of implementing care coordinators for patients with depression in primary care. Researchers at the University have also conducted commissioned research, ordered from a regional collaborative committee, by producing a systematic literature review on patient involvement in health care. Two research studies on ageing and later life have been run in collaboration with health care staff in Landstinget Dalarna and municipalities, as well as patients and older people. These studies also involved collaboration with researchers at Uppsala, Umeå and Luleå Universities. 1) eBalance. A pilot study, carried out in one municipality focused on interactive and reflective learning among older people, practitioner-users (i.e. physio and occupational therapists) and researchers for the development and improved implementation of serious computer games for fall-prevention balance exercise. 2) The Uppsala Dalarna Dementia (UDD) study, with a focus on dual tasking and performance of executive functions. Data is collected from patients undergoing memory 2

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assessment at specialist clinics in hospitals in Falun, Borlänge and Akademiska sjukhuset in Uppsala. Following a consultation with regional stakeholders around the need for more research on eHealth and technology, the initiative was taken to start a working group with representation from Dalarna University, the University of Lund, industry (Abilia), Landstinget Dalarna and Region Dalarna. Following a series of meetings, a research application was produced and future meetings will develop this initiative further. More recently, regional concerns over the needs of older people with frail health led to the development of a second working group including researchers from the Centres and representatives of Landstinget Dalarna. This latter group, in collaboration with the Ageing Research Centre at Stockholm University, has now secured a project grant from Forte that will enable a comparison between Dalarna and Stockholm with regard to the profile of older attendees at accident and emergency departments, and the reasons for their attendance. Co-funded research posts One ingredient in the strategic and sustained collaboration between the University and Landstinget Dalarna is the establishment of joint positions for senior lecturers. Two positions in hospital care have been launched and one more in primary care is underway. These positions build on shared financing and involve clinical work, research and teaching. Co-funding of PhDstudents has been established with Landstinget Dalarna and Falun municipality with two ongoing posts each. Topics for undergraduate students’ thesis work within both nursing and social work programmes have been negotiated between the University and the regional partners. Student involvement Through the joint positions described above subjects for students thesis work have been collected from regional partners and some projects are under way while others have been completed and presented to an audience of regional stakeholders and practitioners at the Forsknings- och Utvecklingsmarknad (R&D market) arranged annually by the University. Student involvement in the research projects has so far been manifested to a limited extent. This is explained by the challenges in timing, as students’ thesis course work is not often compatible with ongoing research projects. This is an important area for further development.

Mutual exchange of knowledge between research and practice through strong partnerships and new arenas for interaction and collaboration between stakeholders. To build a strong foundation for the use of evidence in practice it is necessary that researchers and people involved in the practical work of caring for the community come together and exchange knowledge and experience. Such collaboration will ensure that research projects deal with problems that are experienced in practice and answer to questions asked by staff in the health and welfare sector. Below is an account of the most important activities carried out to encourage this mutual exchange in the period 2013 to 2015. Five competence development days were arranged. Two on the subject of Implementation of Evidence into Practice for staff from Landstinget Dalarna, Region Dalarna and the University and one for social services’ staff, that received substantial interest. Three other competence development days were arranged to exchange research knowledge and practitioner experience via expert lectures, small group discussions and practical workshops. One day focused on dementia 3

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care and two days on ‘en god måltid för äldre’ (‘a good meal for older people’). Participants at these competence development days represented many different regional stakeholders including the municipalities in Dalarna, Landstinget Dalarna and privately run care homes. Regular research seminars and workshops targeting key people in the region have been arranged. To specifically consider knowledge implementation, one workshop was arranged to discuss the results of research projects on facilitation, leadership and support for implementation of evidence into practice. Researchers from the University met with other researchers, managers and staff from healthcare and social services to discuss the results and continued research within these areas. One seminar discussed the working conditions of nurses and the relationship between staff competencies and outcomes of health care. This seminar was a joint effort between Landstinget Dalarna and the University, focusing on a major and current problem. Speakers from Karolinska Institutet in Stockholm were invited and the event received great interest from managers at different levels of health care. Another workshop was held to discuss a theoretical framework for implementing evidence into practice. Researchers and staff from the University and Landstinget Dalarna came together to discuss the new version of the framework and how this could be used to improve implementation of evidence, based on experiences from practice. Additionally a number of seminars have been organized on specific research projects with targeted groups. An international research network conference was hosted by the University in 2014 with the theme of Knowledge Utilisation. This event brought together about 90 researchers and students in the field of knowledge utilisation/translation and representatives from regional stakeholders. The conference was much appreciated and has resulted in new studies being planned. During 2014 and 2015 researchers from both KIPS and ReCALL have presented the results of their studies at the annual R&D markets held at the University. These markets give an opportunity to showcase what has been accomplished in various collaborative projects to a wide audience (other researchers, university staff and students, and regional stakeholders in the health and welfare sector) and to exchange knowledge and information.

Challenges and how they have been handled This project was carried out at a time when all regional stakeholders were under high pressure due to financial constraints and staff shortages. Our main challenge became managing project expectations in an environment where managers were busy keeping services going and with little time to spend in meetings about collaboration. Despite this strenuous situation for managers and other staff, the interest to improve and develop services was, and is still, present. The research team has worked with managers and facilitators as well as other interested staff groups to build on and rekindle their interest for service improvement/development. We accomplished this by keeping meetings focused and by showing the importance of using evidence in practice, and also by providing seminars, workshops and meetings that were of interest to practitioners and other staff groups.

The most important outcomes of the project During the last two years the research agenda of the centres has developed to be of more relevance for practice. In addition to the important contribution of the VINNOVA-funding, 4

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several research projects have been co-funded by the University and the regional stakeholders. Facilitating the translation of research-based knowledge and supporting its use in health and social care is a complex process comprising several stages and the University has managed to lay the foundation for close collaboration to ensure that this process can be fulfilled. Through the new collaborative relationships developed during the project, the university has worked with regional and local stakeholders on the co-production of research, and negotiated cofunding for PhD students to carry out research projects that are relevant to both academia and practice. Here, research staff within the Centres were asked to prepare project proposals for consideration by Falun municipality. Out of the proposals put forward, two projects were chosen by representatives of the municipality. These PhD projects are ongoing, and managed by their respective steering groups involving academic staff and municipality representatives. Dalarna University has also built partnerships with research groups based at other universities in the country (Lund, Göteborg, Uppsala, Örebro, Linköping, Karolinska Institutet, Umeå, and Luleå) who are active in the same fields of research as the University’s own centres (KIPS and ReCALL). Discussions have been held with these groups concerning PhD education, resulting in several cases of shared responsibility for PhD studentships and education. There has also been close collaboration with the above Universities through the participation of their staff in the advisory groups of KIPS and ReCALL. The workshops, seminars and competence development days described previously have provided new fora for the exchange of knowledge, experiences and information between researchers and stakeholders in the region. Research-based knowledge has been discussed in relation to the practice-based experiences of staff from regional stakeholders working with quality improvement and patient safety. The succes of the two research centres KIPS and ReCALL have encouraged the recent establishment of a third research centre at the University: Reproductive, Infant and Child Health (RICH). This is a joint venture between researchers at the University, researchers from Landstinget Dalarna, social care representatives, and other partners to increase collaboration and research with in this area. This initiative has been welcomed by regional partners as a positive step towards increasing and improving collaboration. The goal of developing criteria for measuring collaboration between the University and its stakeholders was an ambitious outcome to set, knowing that such a complex process requires a lot of time to properly go through all stages needed. However, in the time available we have succeeded in identifying criteria that can be further developed and put into practice. The discussion at the 2015 workshop was very fruitful and future meetings will be arranged to ensure this developmental process can continue.

Impact of the project on the strategic collaboration of the University The biggest impact for the strategic collaboration of the University is the breakthrough in relations with regional stakeholders. Today we have collaboration as a very natural component of research at the university. We have managed to forge collaborative relationships at the level of higher management, middle management and directly with staff who attends seminars and workshops and who themselves lecture at jointly arranged seminars and workshops. This has shown us that the interest for service improvement through implementation of evidence into 5

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practice is of interest at most managerial levels with all our stakeholders, despite the pressures of the financial climate and a lack of staff. A positive development is that the collaboration has led to a mutual exchange of expertise and experience; it is not only the University that invites stakeholders but the University is now invited to meetings arranged by stakeholders so as it can act as a source of information, provide its knowledge, and for joint working. For example, in an upcoming major implementation enterprise on person-centered care in Landstinget Dalarna, researchers from the university have been invited to provide their expertise and take part in the planning of the project. The University has also been asked to be part of a new advisory board for nursing care at Landstinget Dalarna. Conclusions The following key points conclude the most important achievements of the project:    

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The research agenda of the University has developed to be of more relevance for practice. New fora have been developed for the exchange of knowledge, experiences and information between researchers and stakeholders in the region. Research projects have been run in collaboration and shared financing between the University and the regional partners. Students in nursing and social work are now seen as potential co-workers in regional projects, with thesis work often linked to ongoing projects or addressing prioritised regional research issues and findings are presented at annual R&D markets. The University has built partnerships with research groups based at other universities in the country A new research centre has been established to improve collaboration around research in Reproductive, Infant and Child Health

Financial accounting Summary of Costs (in SEK) Salaries Services Materials (books, copying, data materials etc.) Travel (mileage, hotels, courses/conferences, allowances etc.) Indirect costs/Overheads (40 %) Other (e.g. facilities) TOTAL

1 259 000 23 500 11 400 181 200 486 600 38 300 2 000 000

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