itSMF UK Board member Richard Horton offers some insights into the global research activity to develop a COVID vaccine, and suggests how our own communities of practice can help with new ways of working.
Heard people talk about ‘the Oxford study’? Got your tongue around Remdesivir? Are you perhaps one of the 100,000 plus people who have signed up for a COVID research study? Or are you one of the 100,000 plus people who have joined the COVID-19 Vaccine Registry?
After the gloom of daily death rates it has been heartening to see more hopeful COVID-related news. It’s also been really exciting to be a very small cog in the machinery that has led to the UK being in the forefront of the international COVID response, with the NIHR of which I’m part playing a significant role. ‘Machinery’ is both an appropriate and inappropriate word to use. Appropriate in that it is the work setting up repeating patterns over preceding years that created the platform on which our current research is based; inappropriate in that people have had to think differently and work together differently to make this happen.
Back in the ‘BC’ world (Before COVID) there was an awareness that it takes roughly 17 years to get a new drug ‘from bench to bedside.’ When you are treating potentially millions of people it’s really important to ensure that the treatment works and is safe, and that it doesn’t have side effects that leave you worse off than before treatment. Doing this properly takes time. In the last few months we have seen a spectacular shortening of some of the time frames involved. It hasn’t happened by accident. A wide range of people with relevant expertise and responsibilities have pooled their skills and experience, used their connections, worked out how to adapt existing ways of working, pushed themselves to the limit, and achieved astonishing results.
Meanwhile, there has been a very different, but related challenge vexing the world’s leaders: how to get people to behave how you want them to. There have been quite a range of approaches taken, with different countries (even different states) adopting at times radically different positions. Do you force or persuade? How do you force or persuade? And how do you treat people who are outside your jurisdiction when you come into contact with them? These are pretty fundamental political questions and I’m not going to resolve them here.
When leaders send out a message to their country imposing certain restrictions, does everyone follow them? The existence of prisons would indicate otherwise. In the UK it has been startling in recent months to see how differently individuals interpret what is intended to be a clear message for everyone, and also to see quite how upset individuals can get about how other people interpret what is allowed. This is a really difficult challenge to address. Perhaps we should not be surprised, given that we celebrate how diverse our country is. In the film ‘The Life of Brian’, Brian tries to persuade a crowd to stop following him. “You are all individuals” he implores. “We are all individuals” they reply in a monotone. That’s not what we see happening.
In mulling on this with colleagues it strikes me that there are lessons to be learned from how we have approached COVID research in the UK. A compelling goal has motivated us and a shared understanding of what sort of methods are appropriate. That has helped a lot. But the response has worked because, over time, we have learned how to work together as a network rather than through a command and control structure. My organisation works with other organisations across the NHS. We don’t have control of them and don’t have the power to tell them what to do. However they are partners sharing the same goals, and without us working together neither they nor us will achieve what we are trying to achieve. There are many organisations involved in ‘the Oxford study’, contributing to its success.
So, what sort of things have I seen making a difference?
- For a start, we were used to working remotely with people across the country as part of our normal professional life so the move to working from home was as seamless as we could have hoped.
- The way people support each other is one of the real strengths of my organisation and careful attention has been paid to the wellbeing of staff. This has been particularly important because some people have been really stretched, working under a lot of pressure to enable the sort of results we have seen, at the speed they have been achieved. When a five-day working week shifts overnight for some people to a seven-day working week, that is a challenge to be treated seriously.
- There has been a real fluidity around organisational structure. All our existing objectives were re-evaluated in the light of Coronavirus and many put on hold to enable the concentration on COVID research to take place.
- The impact on individuals of this shift varied, encouraging more communication across hierarchical silos so resources could be used effectively.
- We were already taking advantage of the power of ‘Communities of Practice’, and now they have come into their own. Working out how to behave as an organisation when so much is different has brought out the power of volunteer energy. People who want to make a difference working together to do so, seeking to make the most of each other’s skills.
As an example, here’s something I’ve noticed. I’m not one of the people who has been mega-busy with COVID related activity. But I haven’t been left idle either. In fact I’ve had more to do than I’ve had resources at my command. In the past that might have led to prioritisation conversations and a sequencing of work. Now I’m in conversation with people who have a wider view of other people’s commitments, seeking volunteers to help me with my (strategically aligned!) projects. Then I have to sell both the work I want done and how I propose managing it to those who might be able to help. I need to work with what commitments they have, and what knowledge they will need from me so they can do the work. One of the challenges of working from home all the time is the loss of the ‘water cooler’ moments. However, this more fluid approach to cross-hierarchy working seems to me to help to address some of what is so hard to replicate about life in the office.
Working like this is familiar territory for me, as for the last 10 years I’ve been deeply involved in an IT Service Management Community of Practice with itSMF UK, running groups which consist of volunteers from different organisations in different industries. Here I have had even less visibility of the commitments of others and even less control. It is the shared objectives and ways of working that bring us together and help us to structure how we work and what we do. There also needs to be enough fun, enough being graceful with each other to keep people coming back for more.
So, my sense is that we do need a common base to be working from. But I also think current events are demonstrating that we can often achieve more if we accept fluidity and work with it in a multi-layered way, embracing the networks that ensue, than if we try to adopt a rigid command and control approach. But then, the N in CRNCC (where I work) stands for Network, and the F in itSMF stands for Forum, so I would say that!
You can find out more about COVID vaccine studies at https://bepartofresearch.nihr.ac.uk/vaccine-studies/
Richard works for the NIHR Clinical Research Network Coordinating Centre (CRNCC). The CRN supports patients, the public and health and care organisations across England to participate in high-quality research, advancing knowledge and improving care; and the Coordinating Centre provides national leadership and coordination.