Introduction

In this interview Tim Cahill sits down with CAHS' Director of Research, Alexandra Robertson, to reflect on the transformation from a research plan, to a living, breathing strategy delivering tangible outcomes.

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Tim Cahill: The first question I had for you was really just to give a bit of an overview of CAHS, what you do and specifically your footprint in research.  

Alexandra Robertson: CAHS is the Child and Adolescent Health Service, and it's made up of a few groups, the Perth Children's Hospital, Neonates, which is actually located at another hospital, King Edward Memorial Hospital, a couple of kilometres north of here, a community health presence and a mental health presence.

Those four groups make up the broader CAHS. My remit more specifically as the Director of Research Operations here is to support the clinicians across CAHS to conduct more research, better research, translate their research more effectively, engage with consumers more effectively, the whole spectrum of the research journey, providing that support to those clinicians.

Tim Cahill: And suffice it to say the role of research in CAHS is very patient focused and very outcome focused, correct?  

Alexandra Robertson: I would say that it is consumer focused and outcome focused. I think we're also, turning our attention, more towards a health services delivery type research, we have dedicated health services delivery research team and fellows.

But yes, historically, it's been very, Patient focused, outcome focused.  

Tim Cahill: Now, when we first met, we met through, I believe, a referral from a mutual colleague. But can you just describe for me the kinds of challenges you were facing at CAHS around research before we started our engagement together?  

Alexandra Robertson: CAHS had historically had a poor research culture there had been times where the hospital CEO and executive had specifically said research is not something that we do as a hospital and, we'd moved on from there. The previous director of research had developed a research strategy, but it had very much remained a glossy document on the website, and it hadn't progressed into actually operationalising that strategy, pushing that strategy and pushing that culture.

The challenges that we were facing was that it was a lot of work ahead of us and I knew that the research strategy was important, but it almost felt like tackling it was going to be too big a job with everything else that we were doing as well.

And so when a colleague said, we've engaged Research Strategies Australia and they're actually fantastic, using this sprint methodology, this was the first that I heard of you, using this sprint methodology to bite off bite sized pieces of a research strategy, almost in a full weekly sprint to really operationalise that strategy.

And I thought, gosh, the strategy that we have is actually really good. But what I'm,feeling overwhelmed or struggling with is how do we actually start? And so, I thought that by engaging you that's what we would get.  

Tim Cahill: And is that what you got?  

Alexandra Robertson: That's exactly what we got. I think what you did by coming in and working with us to say, and you actually said it to me, I wouldn't throw this strategy out.

This is a good strategy. That was the validation that I needed to hear because I also thought that it was a good strategy. But doing that engagement piece with our research community, making sure that they still felt like it was their strategy, even though it was from three years ago and that we didn't need to alter too much.

And it was good to actually interrogate what had we done and what were some of the things we could tick off, and what were some of the assumptions that had changed over those three years, and how are we going to refresh it. So that piece was really useful in making sure that everyone still felt like it was their strategy, our strategy.

But then one of the most helpful pieces that you did was then giving us those tools, things like Planner and putting the strategy into Planner and then coming to our monthly sprint meetings for a few months and giving us that framework to show us this is how you can measure how you're tracking. This is how you can see barriers. This is how you can pull in other people. That was so useful.  

We still have a glossy, 8 page strategy on the website and the board is happy. I'm happy because I can see progress in our strategy and the community is happy because they can see progress in the strategy.

And ultimately the board and executive…I presented our first quarterly update to them this month because we officially launched the strategy in the middle of the year, so this was our first quarterly update and it was so great to be able to show them progress in each of the four different pillars, in a number of objectives.

So it was really pleasing to see.  

Tim Cahill: That's really heartening to hear. You haven't told me about the quarterly update but I really like that because I think that's exactly what we aim for is tangible, visible progress and results. I'd be really keen if you can share any details about that progress that you've made.

And that has been literally a quarter since we kind of got things up and rolling and started doing this seriously in earnest. I'd be really keen to hear what you think we've achieved in that period.  

Alexandra Robertson: Because we've got this Microsoft plan and now that we're tracking our strategy - we've got the milestones in the plans, we've got our project officer tracking with the leadership group how to do that - we can visibly see and easily translate into a quarterly report, What have we achieved in that quarter? We can literally see the milestones being ticked off. We can literally see the objectives being marked as completed. It gives us that sense of achievement but also enables easily reporting.

So some of the things we reported on this quarter is we really ticked the celebrating research and celebrating the success of research. We developed a year in review, an annual report type document where we took the 12 months of research stories that our research group Communicator was developing anyway, but we took them and, turned them into a glossy brochure along with, a list of all the research and publications and things that have been done over the year.

So that was a really nice celebration document for our organisation. That plus our research symposium highlighted to the executive and board what we'd done there.  

Then that plus what was under the People pillar, under the People Pillar, we could see that we've made some really good ground on the clinician researcher pathway that we've managed to expand our telethon fellowships outside of medical, and they now include nursing and allied health.

And the other one is we've been successful in winning some funding from Perron [Foundation] for small translational research grants for that very beginning of the journey, clinicians who want to dip their toe in the research pool but haven't been able to secure funding or feel too overwhelmed, we've now secured these grants which will enable them to apply for this small grant doubled with mentoring and education to give them 12 months experience in research alongside their clinical portfolio. Then in platforms we could say that we've done some really good work on the CCI platforms with Paula.

And then we had a couple of things under priorities and partnerships, but we were really pleased to see that progress just after 3 months.

Tim Cahill: The thing I like about that is that, as you said, the strategy you had wasn't bad. In fact, it was good. But one of the things that we went back to early on was to reframe it as not a to do list and not these activities as ends in themselves, but there was a logic to why we thought these were important things to do.

And expanding those scholarships is a great example, right? So, we had pockets of excellence, and we knew that we had pockets of excellence, but we made the decision that to really prosecute our research agenda, we needed to expand the scope of where those pockets of excellence were being created, share the learnings from pockets over here to inform work that could happen over there.

So it's nice to see, you're ticking off the to do list, but what you're also doing in the process is testing and validating the logic of why you thought these things were important in the first place, and that's really great to see.  

Alexandra Robertson: Absolutely, and it helped us identify gaps. So, like you say, these were projects we were already going to do, but it was nice to see that they hung clearly on the strategy and that we were doing them to achieve these greater things. And actually, here were some gaps where we didn't have initiatives or projects or measurable outcomes to achieve these other things. So, it was really useful in both those senses.  

Tim Cahill: You've already talked about things like embedding Planner, coming up with the monthly meeting protocol and running those with you.

Are there any other things about how we worked together that really stood out for you?  

Alexandra Robertson: Those were the biggest things. I mean, they may seem like little things, but I don't know that we would have thought of them on our own. And they've just been so useful. Just those two things have really changed the way that we work and that we manage the strategy.

Tim Cahill: Can you tell me a little bit about that transition to the before and the after and what the difference is that you perceive?

Alexandra Robertson: I think before we had this sort of operational action plan of things that we were ticking off, but it really didn't hang from our strategy. So, we felt good with the initiatives that we were doing and we were getting good feedback, but it just wasn't giving us that full, overarching picture of everything we wanted to achieve. So I suppose, the work that we're doing is still similar, but we're much more clear on the depth and breadth of work and what we're trying to achieve, and, what we're trying to achieve now in the first year versus the second year versus the third year.

And also, everybody I feel like especially in our senior leadership team and across the research advisory committee, feels ownership over that process, rather than it just sitting with, [Professor Tim Jones] and I. I think, those are the main things that we've been really able to achieve with this new process.  

Tim Cahill: I think you alluded to it earlier, but those workshops that we undertook early on in the process were really good for giving people a sense of ownership. That was my view. We had lots of people in those workshops. They were really well subscribed and lots of your senior researchers were in there as well. I'd be interested in your views on the value of those as well.  

Alexandra Robertson: I think those are invaluable that, really bringing our consumers, our researchers, along to feel like it was their research strategy, that they were developing it in collaboration with us, was really important. Because now, when we raise things that we're doing, they understand why we're doing them, and, they feel the value in us doing them right from the beginning. And I think it also helps with culture and, the saying that culture eats strategy for breakfast is absolutely true, by doing that work on our strategy and involving them in it, it's also improving our research culture.

And yes, we had senior researchers at that focus group, but we also had the executive directors and the CE. So, it's improving that research culture and visibility across the board. That exec team now have a much better appreciation and understanding of what we're trying to achieve in the research strategy and what some of the barriers that we're trying to overcome is. It's them that asked for this quarterly reporting. They've never had regular reporting from research before and they now want it quarterly. So, increasing that visibility, improving that research culture, those are all secondary but really valuable outcomes from having those focus groups.

Tim Cahill: I think that point, particularly for a health service provider, of elevating the visibility and the importance of research, because you're competing with saving lives in a very tangible way and improving patient and consumer outcomes in a very tangible way, and research in that context, in my experience, is often hard to make the case for its importance and the time allocation, the workload allocations that would support that. But I think again, I've seen a shift in how that's being received inside of CAHS.  

Alexandra Robertson: I agree. Absolutely.

They're starting to talk, the CE is already talking and I've heard her say it to the board ‘We need to make sure that research is, bigger, higher, more visible in the hospital's broader strategy’. So the fact that she is already understanding that and seeing that is fantastic. And I'm also hearing them talk more about, and I can hear them saying this, because this is what I say, trials are treatment, they're starting to understand that sometimes research and clinical trials are clinical care. We're getting that embedding of research into clinical care that we wanted, that we know is needed.  

Tim Cahill: That's makes me very happy to hear all of this, Ali.  

Can I just finally maybe ask would you recommend RSA to others?  

Alexandra Robertson: 10 out of 10, I would, Tim. The, the value that you've brought our organisation far exceeds the money that we paid you to do so. So I would absolutely recommend you to other organisations.  

Tim Cahill: Oh, that's great to hear. Look, from my perspective, it's been such a pleasure working with you and Tim [Jones] and the whole team. And as well to just, again, in a very short time, be able to see material differences in how things are not just happening, but also translating into outcomes particularly again, in an environment where the ultimate outcomes are a pretty slow burn in terms of research, translating into patient and consumer outcomes, it's nice to see some really quick wins taking place inside your organisation.

Alexandra Robertson: Agree. It's fantastic.  

Tim Cahill: Ali thank you so much for taking some time to chat. I really appreciate it. Like I said, I've really enjoyed working with you guys over the last little while.  

Alexandra Robertson: Thank you, Tim. I think the thanks is with us to you. We've really enjoyed working with you and, felt such value from your support and guidance. So, thank you very much.  

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