Academic Research Fellowship: Evaluation of Critical Care Paramedic Programme
Dr Ashok Jashapara, from the School of Management at Royal Holloway, University of London, carried out a Research Fellowship jointly funded by National Institute for Health Research – Service Delivery Organisation (NIHR SDO), South East Coast Ambulance NHS Trust and the Economic and Social Research Council (ESRC).
The research Fellowship looked at the ‘Evaluation of Critical Care Paramedics’. Dr Jashapara evaluated an innovative pilot scheme that has developed around 25 ‘critical care’ paramedics in the south East of England to tackle the 5-8 percent of patients who require very high levels of care more effectively. These patients are seriously ill or injured and may have suffered heart attacks, premature births or road traffic accidents.
In order to prevent fatalities, the first 45 minutes is critical. This new breed of ‘SAS’ paramedics are unique in two ways. They have received high levels of training over the past year and they will benefit from new technologies in their ambulances.
The ‘six million dollar’ question asked was whether these new critical care paramedics are cost effective in saving lives. The research fellowship aimed to produce an evaluation report to help future policy makers decide whether ‘critical care’ paramedics are effective and could be rolled out across the country.
During the project, Dr Jashapara worked with a team of doctors, paramedics and information analysts to assess the effectiveness of ‘critical care’ paramedics.
Read the SDO Network and Ambulance Service Network critical care briefing based on Ashok's research.
Fellowship Update, Dr Ashok Jashapara, June 2010
Ashok has now completed his fellowship but provided this update last year:
Innovation fascinates me, the way organisations do something different that goes against the grain. In this case, it was the South East Coast Ambulance NHS Trust (SECAMB) developing a new breed of advanced paramedic called ‘critical care paramedic’ (CCP). I was delighted to secure a research Fellowship funded jointly by the ESRC, SDO and SECAMB.
This gave me the unique opportunity to see innovation in motion and work jointly with an organisation who was engaged in dramatic changes with their inherent teething problems and difficulties. Academics and organisations rarely get this close.
During my Fellowship, I have acted as a researcher, a consultant, a confidant, an expert statistician, a writer and a critical friend. You become part of the organisation, attending meetings and so on and, yet totally independent of it.
I started the Fellowship bringing together the key stakeholders to define collectively critical success measures for CCPs. There were two important dimensions; one of saving lives of critically ill and injured patients and the other to transfer critically ill patients between hospitals.
Soon I found a creative tension existed between the needs and expectations of ambulance services and hospitals. Critical care paramedics were more interested in developing high trauma skills in their primary retrieval role whereas hospitals wanted advanced paramedics to relieve the need for intensive care nurses accompanying critically ill patients between hospitals.
Once the problem was defined, I began to choose the appropriate methodology for the evaluation. Randomised control trials were out due to the small sample size and the difficulty of showing causal links between CCP interventions and clinical outcomes.
How could one show positive outcomes came from new advanced paramedic skills rather than other hospital interventions? Instead, I opted for a qualitative evaluation interviewing key stakeholders in the UK and abroad. I made several telephone interviews to Australia where advanced paramedics known as MICAs provide a useful international comparison.
My journey on the fellowship has taken me speeding along motorways in an ambulance to road traffic accidents, visiting dying people in old people’s homes and getting aboard air ambulances. This beats my traditional life in academia, though I wouldn’t want to do it all the time!
I have conducted around fifty interviews with CCPs, preceptorship supervisors, course tutors, A&E consultants, emergency dispatch staff, critical network managers, MICAs and other international experts. Each interview has been transcribed and I have recently begun my qualitative data analysis using NVivo to make sense of this enormous level of data.
The analysis will help draft a consultancy report for SECAMB providing useful recommendations from the evaluation as well as providing rich material for publishing research papers on innovation processes and critical care paramedics in the UK.
If you are an academic or an organisation thinking about fellowships, take the plunge right now! It is a win:win situation for both parties, enhancing collaboration and sharing knowledge on both sides.
Dr Ashok Jashapara
Ashok Jashapara has conducted an NIHR SDO funded research project (with Ewan Ferlie and Tessa Crilly) on ‘Knowledge Mobilisation and Research Utilisation among NHS managers’. He is an internationally recognised expert in knowledge management and published widely in books and journals. He has secured research funding and successfully completed research projects for the ESRC, EU and the United Nations. He was Associate Director for the Information Studies discipline with the Higher Education Academy and External Examiner for various Masters programmes at University of Sheffield. He is also Trustee of the Joseph Rowntree Foundation, the largest independent social policy research organisation in the UK.