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Table 3 An account, based on field notes from participant observations, of mediating knowledge production in an applied health research project

From: Improving the production of applied health research findings: insights from a qualitative study of operational research

I was not involved in the grant proposal for the research project and came to know about it later on through the principal investigator, who I had collaborated with before. There appeared to be opportunities for OR to add value, so I joined the research team a few months into the project using separate funding from a personal fellowship. Members of the team were already assigned to particular strands of research (e.g. a clinical research psychologist was conducting staff and family interviews in the qualitative strand). As a free resource without a specified role in the grant proposal, I was flexible to use OR however might serve the project’s aims, primarily in relation to developing recommendations for service improvements on the basis of the evidence the study planned to collect:

In my view, there was no explicit method for doing this part of the project (drawing together strands and developing recommendations) and so we’re flexible to (and need to!) design that now. [Participant observation field notes, February 2014]

I worked collaboratively with the rest of the project team, across all research strands, with my approach informed by their ideas and sensitive to the need to keep people on board. For example, in one project meeting, I discussed my early thoughts on how to bring together findings from the different strands systematically and illustrated to the team how this might be done using a grid-like framework. This received a mixed response, from very positive to very negative, prompting a detailed discussion and, eventually, agreement about how to augment my idea:

It certainly stimulated debate! And debate that has led us to a better place in terms of understanding and documenting our process in a manner in which we are all happy with […] it seems important that the idea that this is useful for the project has been reached by the research team as a whole. This way it is a constructive thing that everyone wants to be done and sees the value in - and how their work fits into it. [Participant observation field notes, March 2014]

Method selection was not solely a technical decision and also involved considering the context and requirements of the project alongside my expertise. For example, a large and unanticipated part of my contribution was developing an analysis dataset from two national audits because I had relevant skills and prior experience that others in the team did not have (“the skillset needed to, kind of, bring the data set to order I think is something that only you were able to do in the project” [consultant intensivist, project study team]). This seemed of benefit to the project but was time consuming and frustrated me when it delayed my progress in other areas:

I had a growing sense of frustration mixed with panic during this meeting as I realised how much there still is to do - and that a lot of this falls down to my responsibility. They [the project team as a whole] have hugely underestimated how much work this dataset preparation and linking involves. This is going to take quite a bit more of my time and I want to be cracking on with the other OR side of things. [Participant observation field notes, October 2013]

I was already proficient in data analysis of this kind but less experienced in another technique I wanted to use, soft systems methodology (SSM), so my confidence to push, and ability to conduct, different aspects of the OR approach varied considerably:

Much of the OR part of the project is unknown territory for me, in that I am not that familiar with the techniques of SSM - so I feel some reticence to push forward with that, which means I am susceptible to focusing on this data analysis which is much more in my comfort zone. [Participant observation field notes, November 2013]

It took time to gain expertise in the areas I was less familiar with. Indeed, I found translating the evidence into recommendations for improvement very time consuming because of the scale and breadth of tasks it required and lack of significant dedicated resource for this purpose:

Even from the point of post-workshop, pulling together the final recommendations for endorsement took a lot of work! And a lot of my time […] whilst the team thinks its really important to have something coming out of the study in terms of practical implementation, they dont have any time for it... [Participant observation field notes, November 2014]