Clinical research in the time of COVID-19: Lessons from Dudley

What are the key challenges to doing research at Dudley Group?

Getting younger consultants engaged in research is a big challenge, when they may not have had much (or any) experience as trainees. We also need to engage the large cohort of nurses and allied health professionals who may have experience of or an inclination for research.

Agreeing dedicated time in consultant job plans for research can be a challenge, as direct care will take priority. Funding of research programmed activities is not part of the Clinical Research Network (CRN) remit and is determined at a departmental level. The culture of a department and the imagination of its leaders will determine if research is recognised.

Another challenge is funding. The funding for research and development (R&D) in Dudley has an approximate even split between the CRN and funds from commercial studies. The latter is reliant on a small cohort of established consultants and thus at risk of sudden change. In some ways we are lucky in that the trust supports the department with a dedicated space – there isn’t a budgetary contribution but there is help with financial management.

How has COVID-19 helped to raise the profile of research activity within Dudley?

Research at the Dudley Group NHS Foundation Trust, and indeed worldwide, has never before been at the forefront of the minds of healthcare professionals. We need to harness some of that enthusiasm for research that the pandemic has brought. The public exposure to data has also provided the opportunity for increased awareness and importance of the research agenda.1

Prior to the pandemic, one of our strategic objectives was to increase the profile of R&D and this has been done with regular research bulletins, an R&D showcase day and frequent highlighting of research successes, eg when we were top recruiters for a study.

A well-oiled administrative function led by an effective research manager, with the engagement of experienced research-active clinicians, has allowed for effective delivery and facilitation of the COVID-19 studies.

There have been three key components to improving our research output during COVID-19:

1. A vibrant R&D culture and effective framework

Research is a team effort: The research nursing teams have a generic and specialist portfolio, eg the oncology team also facilitate anaesthetic studies. Cross-specialty working is thus embedded. 

People need to hear about it! An effective communication system between research management and research teams is in place with a culture of ’openness and availability’, and regular structured meetings and updates on research activity within the team.

Culture change is difficult but worth it: An example of how team culture has been enhanced recently is with the relocation of the pharmacy research team base to the research department. This has enabled rapid communication and the ‘feeling of belonging’ rather than otherness.

The existing structure and working of the department has thus allowed for a smooth transition and rapid change to COVID-19 studies. COVID-19 studies were chosen to avoid competing studies and so that simple messages were conveyed to all clinicians working in COVID areas that enabled their involvement.

 2. Hospital trust support

A number of elements contributed to the level of recruitment to COVID-19 studies, these included;

• the majority of the R&D staff were not redeployed with the exception of those with intensive care skills
• executive support for research voiced by the medical director, chief nurse and CEO
• studies were advertised on the trust intranet for clinician access in an inclusive fashion so that even research-naïve clinicians could play a part
• daily access to a list of newly admitted COVID-19 patients
• the overall trust response to admitting and treating COVID-19-positive patients was well organised which created a degree of stability in a crisis situation.

3. Individuals making a difference delivering the research

Two research nurses worked relentlessly on the COVID-19 wards, recruiting patients to the clinical studies. In addition, a research-experienced haematology consultant was willing to go with the research nurses to a very busy intensive treatment unit (ITU) to explore approaches to recruitment in the recovery trial.

How could the RCP enhance research in Dudley?

As we put together a proposal to the board of directors to bolster funding for research with a trust contribution, we know that research-active organisations have improved outcomes (Ozdemir et al, Downing et al) and improved performance (Hanney et al).2,3,4 However, it is difficult to monetise this in a business case to justify a considerable spend over a number of years. It would be helpful if organisations such as the RCP could support a standardised way of doing so. Likewise, a job planning model that standardises how research can be integrated into job plans would support those who are planning at a local level. Finally, training for research is really important and there is a role for the RCP to support this.

The RCP has recently published the results of a membership survey showing physicians in rural hospitals, as well as women and BAME physicians, struggle to participate in clinical research. Research for all? An analysis of clinical participation in research outlines these findings and how we want to work with NHS trusts to tackle this unequal access.