Table 2 Main findings from the NIHR funded evaluations of CLAHRCs

Lockett, 2014 [12]

Local context and key service and research actors played an important role in shaping the initial design of the CLAHRCs. This initial design then ‘locked-in’ CLAHRCs to specific paths of development. Five different archetype models of CLAHRCs were identified:

1. Purposeful integration of multiple stakeholder groups to enable a multidisciplinary research process

2. Loosely autonomous research streams with designated knowledge brokers

3. Modular independence of research and implementation processes, separated to run in parallel

4. Collaborating through loose networks building on existing relationships which form the basis for collaboration

5. Centralised control over both research and knowledge translation (KT) activities through on-going accountability mechanisms and monitoring of project teams

Two main forms of engagement were identified: work undertaken in signing up the CLAHRC stakeholders, and wnining over the hearts and minds of actors, which occurred through alignment activities and consensus building. Ability to do this was shaped by the nature of CLAHRC structures and also the professional status and role of actors.

Four main forms of activity to embed CLAHRC were identified: (i) education, (ii) the creation of new roles, (iii) the embedding of tools and routines in practice and, finally, (iv) the construction of a CLAHRC identity.

Across the CLAHRCs, there were differences in the manner in which CLAHRC focal actors sought to embed the CLAHRCs. The authors also found a significant degree of similarity across CLAHRCs over time, whereby CLAHRCs sought to learn lessons from other CLAHRCs.

There were systematic variations in CLAHRC actors’ ability to bridge the research–practice boundary. But the CLAHRC initiative has led to the development of more relationships that span the research—practice divide.

Scarborough, 2014 [14]

Mechanisms of KT developed by the each CLAHRC were influenced by the vision and beliefs of their senior leadership teams and shaped by the emergent management practices. This in turn shaped the kinds of social networks that they developed and influenced the way different groups worked together.

Analysis comparing CLAHRCs with each other, and with similar organisations in Canada and the USA, showed the impact of these differences in approach on each initiative’s ability to meet the challenge of getting research into practice. Where a CLAHRC framed KT as essentially involving the dissemination of high-quality evidence into practice, ‘bridging mechanisms’ of KT were utilised to overcome the boundaries between research and practice. Where a CLAHRC placed greater emphasis on the integration of research practices with practical concerns, ‘blurring’ of boundaries occurred to a much greater extent. There are different ways of doing this, and not a one-size-fits-all approach.

Analysis of CLAHRC social networks highlighted the importance of both ‘closure’ (dense social ties within particular areas) and ‘brokerage’ (bridging ties across different groups) for a networked process of innovation. CLAHRCs were characterised as ‘ambidextrous’ network forms in that they need both ‘closure’ and ‘brokerage’ to support the process of innovation.

Rycroft-Malone, 2015 [13]

Opportunities for CLAHRCs to implement research in practice were influenced by the vision and views of those who set them up, including how they had structured the CLAHRCs.

CLAHRC leaders played an important role in how the collaboration functioned. The academic-practice divide played out strongly as a context for motivation to engage, in that ‘what’s in it for me’ resulted in variable levels of engagement along a co-operation-collaboration continuum. More distributed leadership was associated with greater potential for engagement.

Different positions and interpretations came together to result in a mixed picture of implementation. A number of approaches to mobilising knowledge were identified, including service improvement, making evidence accessible, mobilising local evidence, paying attention to aspects of implementation in the conduct of research, and using home-grown evidence. The balance of activity was weighted towards research production rather than its use in practice and towards knowledge transfer-type approaches rather than co-production.

The creation of boundary spanning roles was the most visible investment in implementation, and credible individuals in these roles resulted in cross-boundary work, in facilitation and in direct impacts.

There were examples of CLAHRC activity having an impact on the way that services were delivered to patients and in providing opportunities for practitioners and researchers to come together to share ideas and do joint projects. Learning within and across CLAHRCs was patchy depending on attention to evaluation.

Soper, 2015 [15]

CLAHRCs were rooted in local relationships, built around matched funding from NHS organisations, local capacity and expertise. The local remit supported the development of collaboration, encouraged responsiveness to local research needs and shaped the separate character of each CLAHRC.

CLAHRCs demonstrated a clear drive to promote integration and used clinical and managerial knowledge brokers such as ‘locality leads’, ‘diffusion fellows’ or ‘CLAHRC Associates’ to encourage their peers to become involved in research.

There was some evidence that academics were becoming more interested in needs-driven research and that commissioners were seeing the CLAHRCs as a useful source of support. There was growing recognition that sustaining collaboration across sectors as well as within sectors requires iterative and continual engagement between clinicians, academics, NHS commissioners, managers and patients.

Despite initial challenges, the CLAHRCs succeeded in engaging different stakeholder groups although some CLAHRCs were less successful with some groups, such as mid-level NHS management, than others. Partnership working, responsiveness and the co-production of research were seen as core to promoting and sustaining engagement.

Exposure to people from other disciplines and other backgrounds helped to broaden mutual understanding of implementation’ and of other research fields and methodologies. Over time, the NHS focus on producing change in (clinical) practice was seen to be just as important as the academic focus on producing good-quality research.

Communication with commissioners was supported by the development of a CLAHRC ‘brand’, which helped to identify CLAHRC products and give them credence. The CLAHRCs were increasingly seen as useful sources of sound evidence to support (and prompt) constructive dialogue between commissioners and providers.