No, I'm not a paramedic—I'm not even a clinician. I did my undergraduate degree in business and my masters in public health—arguably unrelated fields. But I have been researching the NHS ambulance services for just over 2 years now, and my experience as an ‘outsider’ looking in is a fascinating one.
Why an ‘outsider’?
The literature around the ambulance services is rapidly increasing. However, at present, the lack of research around topics like patient safety means that a majority of the available research is based on data from primary care settings, like hospitals, where the context is remarkably different (Altman et al, 2004; Rust et al, 2008; Fisher et al, 2015). While the ambulance services grow their research profile and continue pairing with universities, implementing roles like the research paramedic, this problem is bound to be temporary (McClelland, 2013).
The Research Activity League Table published by the National Institute for Health Research (NIHR) demonstrates that from 2014/15–2016/17, the total number of large-scale studies conducted in the ambulance services expanded substantially from only 9, up to 46. Equally, the number of participants recruited increased from 270 to over 8300 (NIHR, 2018).
While this growth in research is remarkable and the transition to a research-literate care setting is fundamental to their success, the ambulance services still have a long way to go (Wood, 2012). As the services continue to deliver more and more research ‘in-house’, and increase the amount of research led by paramedics, in the meantime, some of the work is currently being carried out by external researchers, like myself (McClelland, 2013).
Problems for the neophyte
Very little published work is available that documents the problems facing the neophyte, or newcomer researchers in a field they have no prior experience in or knowledge of. One recent piece of work however found that four challenges face these ‘new’ researchers (Sanders et al, 2017):
Thankfully, I have only experienced one of the challenges identified by Sanders et al (2017), which was confronting the unknown.
My work
At Edge Hill, I was successful in applying for a PhD research project concerning the perceptions of patient safety in the NHS ambulance services, where a notable gap exists in the literature (O'Hara et al, 2014; Fisher et al, 2015; Wankhade, 2016).
‘The perceptions of patient safety’ sounds vague and took me ages to get my head around. However, it roughly surrounds the staff perceptions of the patient safety culture within the services—so the collective staff attitudes, values and opinions towards patient safety that reflect and determine the level of patient safety observed in an organisation (Nieva and Sorra, 2003).
To collect these data, I decided to conduct qualitative interviews with approximately 45 participants from three distinct English ambulance service NHS trusts, across three hierarchical tiers: operational, management and executive-level staff.
Experience so far
Without knowing what to expect before I started, and now having finished interviewing, I can honestly say that it was an overwhelming and enjoyable experience. Ambulance service staff are some of the hardest working people I have ever met—yet they were so willing to give me an hour of their time, regardless of their rank or level.
Although remedied quickly after each interview with the help of my paramedic friend, the two main disadvantages as a ‘neophyte’ ended up being from missing a lot of the acronyms and clinical jargon—of which there was plenty—as well as my lack of understanding of some of the structural complexities of the service.
In hindsight, there was also occasionally a palpable sense of being an ‘outsider’, where at first participants seemed a bit suspicious of my intentions, asking things like ‘what's your background?’, and ‘why are you doing a study if you're not a paramedic?’. These were both reasonable questions, and I would always try to communicate to them my background and how some PhD students get paired with specific projects, even if it is out of their remit. My responses would typically satisfy them, and we would then carry on with the interview.
Beyond any disadvantages, there are also some advantages of not having come from the ambulance services. Participants tend to be extremely honest and open with me, as they may be more comfortable with knowing that I have no authority or standing in the ambulance services. I also come into my data collection and analysis with little or no historical resentment or bias against any level of staff, which appears to be a common theme in the interviews.
Conclusion
I feel fortunate to be able to conduct my PhD research in the NHS ambulance services. I have met a countless number of brilliant, skilled and generous staff members who all care so much about what they do. Regardless of my previous background, I hope and believe that my research does the service justice, and that it goes on to have some beneficial impact on patient safety in the future.