Socioeconomic Value of the Midwife

2

Research and Development Action Plan 2011

The Royal College of Midwives

Acknowledgements

At the outset we wish to recognise and sincerely thank our midwifery researchers and educators who freely gave of their time and expertise to contribute to this inspirational and visionary action plan. In April 2009, a research ‘think tank’ seminar was held involving active researchers, RCM Council representatives and staff members. The aim was to discuss the development of a RCM Research and Development Strategy: Researchers and RCM Council Participants • Professor Soo Downe • Debbie Gould • Professor Billie Hunter • Amanda Hutcherson • Professor Mags Maguire • Professor Mary Renfrew • Kim Russell • Professor Jane Sandall • Professor Marlene Sinclair • Dr Dale Spence RCM Staff Members • Professor Cathy Warwick • Frances Day-Stirk • Sue Macdonald • Jacque Gerrard • Sue Jacob • Dr Kenda Crozier (RCM Research Fellow) Facilitated by Professor Mary Renfrew and Professor Jane Sandall, members were invited to explore the current and future context of midwifery and maternity care research. International perspectives were used to consider future pathways for the RCM in supporting, utilising, developing and nurturing research. The seminar culminated in highlighting the key issues and action associated with effective Research and Development. These were first drafted into a strategic plan by Dr Kenda Crozier (RCM Research Fellow 2008-2010). Drawing on the initial strategic document, this action plan was formulated by Dr Janine Stockdale (RCM Research Fellow 2010 – current) as a map and guide for achieving the strategy.

This document should be cited as: Royal College of Midwives (2011) The Royal College of Midwives Research and Development Action Plan Royal College of Midwives: London Published by the Royal College of Midwives Trust September 2011 © RCM Trust

Welcome by the RCM General Secretary

Today, evidence based practice is recognised not only as our professional responsibility, but as the

driver behind effective and efficient care of women and their babies. It is with these thoughts in mind

that I welcome you to the Executive Summary of The Royal College of Midwives, Research and

Development Strategy. This strategy was first conceived in 2009, when key midwifery researchers

and practitioners met to discuss how research, and the evidence that it generates, could guide and

serve midwives in providing women and their families with optimal midwifery care.

Today, as we launch this executive report of the RCM R&D Strategy, we hope that whether you are

a researcher, a midwife, a student, or a woman using maternity services, you embrace the

challenge contained in this document and use it as a catalyst for playing your part in generating high

quality research evidence that will guide and drive the quality of care that women and their babies

receive.

It is therefore a great pleasure to be recommending to you this new and exciting strategy for the

further development of midwifery excellence across the United Kingdom and beyond.

Professor Cathy Warwick CBE General Secretary Royal College of Midwives

Index

Background and Context 1

The Purpose of the RCM’s R&D Strategy 2

Development & Implementation of the RCM Action Plan 4

Action Goals:

Goal 1 – Input into Key Policy Developments 6 Goal 2 – Mapping Midwifery & Maternity Care Researchers 7 Goal 3 – Bringing rich research knowledge in and out of RCM 8 Goal 4 – Capitalising RCM’s influence on key finding initiatives 9 Goal 5 – Midwifery research: capacity and profile building 10 Goal 6 – Ensuring midwifery research and evidence underpins RCM activities 11

Four Country Participation, Research Standing Group and R&D Priorities 12

Factors Impacting the Research and Development Implementation Process 14

Conclusion 14

Background and Context

The Royal College of Midwives recognises that research and development form a critical part of the

relationship between education, practice, policy and commissioning associated with evidence based

midwifery.

Figure One: The Relationship between Research and the Components of Evidence-Based Midwifery

The RCM has a long history of strategic and operational involvement in supporting and developing research

capacity within maternity care, both at national and international levels. Building on the internal research

work of the RCM, this strategy is specifically designed to foster research relevant to midwifery, maternity

care, mothers, babies and families. By partnering with expert research members, practitioners and the wider

national and international midwifery and research communities, the RCM aims, through the introduction of

this strategy to support the capacity and capability of midwives to conduct and implement research. As an

outward facing plan, the strategy represents a series of goals that aim to further the RCM’s contribution to the

midwifery and maternity service research agenda.

Central to the successful achievement of this strategy for midwifery, is the dual functions of the RCM as both

a professional organisation and trade union and the intricate matrix working of the RCM that capitalises upon

the knowledge, skills, and networks within and outside the RCM and enables it to lead the implementation of

this R&D strategy.

1.

The Purpose of the RCM’s R&D Strategy

The purpose of the development and implementation of the RCM R&D strategy, as outlined in Figure one,

identifies and concentrates on achieving three critical and integrated goals within midwifery and maternity

care research and practice:

Figure One: The purpose of the RCM R&D Strategy

In step with the overall purpose of the RCM, which is to:

Promote midwifery, quality maternity services and professional standards

Support our members, individually and collectively

Influence on behalf of our members and the women and families they care for

The emphasis of the strategy is therefore to increase the capacity of midwives and maternity care researchers

to conduct high quality research that is relevant to practitioners and the women and babies they care for.

Reflecting on this greater purpose, the fundamental purposes of the RCM R&D strategy can be further defined

as outlined in Figure Two, to:

2.

Figure Two: The Purpose of the RCM Research and Development Strategy

Built on the foundational and corporate values of the RCM, the guiding principles are that of integrity,

transparency, equity and accessibility. This strategy aims to be dynamic, purposeful and visionary whilst

working within the circles of influence to drive midwifery research and the developmental agenda.

The take-home message of the RCM R&D strategy is therefore that:

3.

Development and Implementation of the RCM R&D Action Plan

Achieving the overall goals of capacity building, research conduct and effective implementation requires a

clear and dynamic action plan. At the outset, it is important to point out that this action plan is built on the

dynamic foundation of RCM’s current and on-going affiliation, representation and strategic involvement in

national and international research groups and forums. As a channel for working towards the overall

implementation of the strategy, the RCM will therefore continue to engage with key stakeholders and

partners such as:

• The National Institute of Health and Clinical Excellence (NICE), Women and Children’s Collaborating

Centre and The Scottish Intercollegiate Guidelines Network (SIGN)

• The Health Technology Assessment (HTA)

• The Academy of Nursing, Midwifery and Health Visiting Research (ANMHVR)

• The International Confederation of Midwives (ICM)

The RCM’s dissemination activity will also remain fundamental to the overall implementation of this strategic

plan; including the RCM annual conferences, on-going research events, guidelines, position papers, reports

and dissemination through our peer reviewed publications: Midwives (www.rcm.org.uk/midwives/) and

Evidence Based Midwifery (www.rcm.org.uk/ebm/).

The Action Plan - as already outlined, the RCM strategy was developed by an expert think tank (see

acknowledgements) who aimed to integrate their vision for midwifery and maternity care research with the

corporate values, vision and purpose of the Royal College of Midwives. Six strategic goals (as outlined

below) were developed through this process. It is these 6 strategic goals that are central to this action plan:

Table One: Outline of the Six Strategic Goals Designed to Direct and Guide the Development and

Implementation of the RCM Research and Development Strategy

4.

While the strategic goals are established to direct and guide the implementation process of the strategy,

specific details as to how they are achieved within this action plan, are purposely intended to be non-

prescriptive; that is, the goals and the means of attaining them are designed to facilitate the autonomy of

midwifery researchers, practitioners and users groups whose desire it is to create, deliver and enjoy

evidence-based midwifery.

While the following information outlines the key parts of the overall strategy, readers are encouraged to

consider:

• How the goals (although presented separately) are complimentary to each other

• How achievement might be realised in relation to particular research activity and/or practice contexts

5.

Goal 1 - Input into key policy developments The input of midwifery researchers and practitioners to key policy developments is essential to the future

development and delivery of midwifery services and care.

Currently the RCM influences evidence-based practice through the publication of our Evidence Based

Midwifery research journal and the ‘Research Round Up’ pages of our RCM Midwives magazine (brief

accessible research summaries). In addition, the RCM plays a critical role in the publication of policy

documents and position papers. RCM also responds to major consultations, national policies such as

Midwifery 2020, the Prime Minister’s Commission on the future of Nursing and Midwifery and Quality of

Midwifery Care projects.

While it is common practice for the RCM to seek the views of its members in relation to this work, we realise

that further enhancement and expansion of our contribution as midwives to key policy developments, is

dependent upon further expertise and networking between our researchers and practitioners. The aim of this

goal is therefore to create a strategic and effective approach to inputting into the key policy documents.

Through further strategic influencing we hope to ensure that policy is and continues to be evidence-based; so

informing and protecting evidence-based practice.

To attain to this particular goal, 3 sub-goals are proposed; each aiming to empower midwives so that they

can influence the direction of policy and development within maternity services:

Figure 3: Sub-goals associated with achieving Goal 1

6.

Goal 2 – Map midwifery and maternity care researchers as a means of establishing

communication networks A critical component in achieving goal 1 is that there is a strong culture of networking and sharing expertise

amongst our researchers, practitioners and users.

Currently the RCM encourages networking and sharing between all members through the provision of the e-

communities, conferences, think tanks, events and study days. However there is a need to further develop

and potentiate our shared knowledge. Concentrating on midwives and maternity care researchers initially,

the aim of this goal is to highlight the centres of midwifery and maternity care research and researchers.

Through implementation of this goal it is hoped that the important information required for participation in

expert reference groups is readily and easily accessible. Consequentially enhancement of the networking

possibilities and opportunities is also envisaged.

It is crucial to provide a rich flow of multifaceted research knowledge into and out of the RCM, which meets

the needs of and engages senior researchers, fledgling researchers, clinically based midwives and student

midwives. While future new technologies will enhance this communication process, these are likely to have

resource implications in terms of managing the information flow. It is therefore envisaged that engagement

will primarily be with RCM member researchers and midwives; however engagement with non-midwives and

non-RCM members is envisaged in the future.

Figure 4: Sub-goals associated with achieving Goal 2

7.

Goal 3 – To bring rich research knowledge into and out of the RCM Establishing communication pathways in and out of the RCM is essential. However it also important to

ensure that all existing and new networks are capitalised upon. This goal, although similar to goal 2, re-

directs the emphasis away from research active members, towards the dissemination pathways that exist

within the structure of the RCM networks.

Currently the RCM facilitates multiple networks and information sharing through the Heads of Midwifery,

Consultant Midwives and Educational Advisory Groups and additional groups such as Scotland Lead

Midwives and Research Group. To further utilise these networks and build new user group networks within

maternity services, three sub-goals are proposed:

Figure 5: Sub-goals associated with the implementation of Goal 3

8.

Goal 4 – Capitalising on RCM’s influence into key funding bodies & funding streams

Although goal 1 relates to influencing key policy documents; policies and guidelines continue to evolve and

adapt in response to new and on-going evidence generation. It is therefore critical that the RCM continues to

influence the key funding bodies and funding streams available. Goal 4 concentrates on achieving a strategic

and consistent influence on the funding streams and research bodies.

Currently the RCM aims to align maternity service and midwifery research with the current agenda of

research funding bodies and policy makers, for example, by engaging with stakeholders such as The Health

Technology Assessment (HTA) and The Well-Being for Women (WOW) Fund.

Nevertheless, as a professional organisation, the RCM must continue to influence and strategically engage

with all key stakeholders. To achieve this particular goal, four sub-goals are proposed:

Figure 6: Sub-goals associated with implementation of Goal 4

9.

Goal 5 Midwifery research: capacity building and profile rising Building capacity and the profile of midwifery and maternity research within and beyond the UK is essential to

the on-going development of maternity care services. This however requires that current and future

researchers are not only visible, but have the opportunity for capacity and capability building.

Currently the RCM offers opportunities for researchers and midwives to participate in research capacity and

capability building activities, through initiatives and events including:

• RCM Annual Midwifery Awards - focuses on research transfer to practice and innovation

• RCM Annual Conference – providing a peer-reviewed scientific programme

• Ruth Davies Award - funding for small project work1, to enable fledgling midwife researchers

• The RCM PhD Award –related to Keeping Childbirth Normal and Dynamic (Campaign for Normal Birth)

• The Doctoral Midwifery Society (DRMS) / RCM Partnership – aims to support emerging and new

researchers, providing an important forum for doctoral and post doctoral midwives

• The WOW/RCM Fellowship – this fellowship scheme is a joint initiative with the Royal College of

Obstetricians and Gynaecologists Well Women Program and focuses on pre-doctoral research

Further visibility, capacity and capability building is however required. To achieve this goal, the following 4

sub-goals are proposed:

Figure 7: Sub-goals associated with implementation of Goal 5

1 RCM Ruth Davies Bursary which provides small grant funding to midwives without an acknowledged track record of research

10.

Goal 6- Ensure midwifery research and evidence underpins RCM activities Although related to all previous suggested goals, it seems important to explicitly state that the RCM makes it

a goal to continue to ensure that evidence underpins all its activities, including the development of policies,

practice statements, position papers and consultation documents. This therefore includes ensuring that

research and evidence is made easily accessible to our midwives and educators; bringing research and the

evidence it produces into everyday care for women, their babies and families.

11.

Four Country Participation, Research Standing Group and R&D Priorities

The success of this Research and Development strategy is reliant on the engagement and commitment of all

relevant stakeholders across the four countries of the UK. As each country considers their part in achieving

the goals outlined, implementation and success will be achieved in collaboration with the RCM and each

other. To ensure full and effective participation, a collaborative structure will be established that involves

three important levels: that is, the establishment of regional research forums and research standing groups

and also engagement in priority setting activities:

Regional Research Forums – to ensure that key stakeholders have the opportunity to be involved in the

implementation process, a number of research and development forums will be created across the four

countries. Each country will involve those midwives and maternity care researchers who are research active

(from early career researchers to senior researchers) and who wish to participate and influence the

implementation process. Each country (or regional group as is the case in England) will consider the goals

suggested in the strategy and feedback to RCM Research Standing Group (details below) on how the key

goals maybe obtained. For example, in relation to mapping researchers, a country may consider developing

a database of their researchers, areas of expertise and contact details. This database may then be made

available via the RCM website. Up-to-date contact details for the nearest research forums across the four

countries of the UK will be made available on the RCM website at http://www.rcm.org.uk. The following map

indicates the research forums within the four countries.

Edinburgh Belfast

Leeds

London

Manchester

Southampton

Birmingham

Swansea

12.

Research Standing Group – drawing on the expertise within the countries and research forums, the aim of

the Research Standing Group is to act as a collective and authoritative voice on research and development

within midwifery. Established and maintained by the RCM, the purpose of this group is to represent the

voices of researchers and practitioners, facilitating the strategic and developmental goals as summarised:

1. Establish communication pathways between the RCM and the research community

2. Disseminate research findings via midwifery practice, education and management 2. Establish communication and collaboration with other professional groups to forward research in

midwifery practice, education and management and maternity services 3. Midwifery input into key research policy and funding bodies in the UK 4. Development of the research capacity and capability within midwifery; including establishing

communication pathways between midwifery practitioners, researchers and service users 5. Contribute to the direction of midwifery researcher career pathways 6. Collaborative working with other professional groups to forward research in midwifery practice,

education and management and maternity services

The Terms of References of the Research Standing Group can be downloaded at http://www.rcm.org.uk/college/TOR/midwifery-research/.

Priority Setting Activities – the aim of the RCM action plan is to be visionary and forward-thinking. Priority

setting is a recognised catalyst for identifying and directing future research and development activity. The

practice of priority setting is supported throughout the goals incorporated into this action plan. An example is

goal two which relates to the establishment of an effective communication system in and out of the RCM

which will support the necessary networking and identification of experts essential for effective priority

setting. Nevertheless, to further support priority setting activities within midwifery and maternity care

research and development, the RCM will work to systematically influence its members to participate and

connect them as specific experts to the relevant priority setting partnerships. This will be achieved through

continued engagement of members through on-line surveys, focus groups, debates and the RCM on-line

communities. When appropriate, such as when the opinions and experiences of the RCM members is

central to the identification of research priorities, the RCM may also participate in priority setting activities.

For example the RCM may host a Priority Setting Steering Group in relation to a specific aspect of maternity

care service. Considering the remit of the Research Standing Group (RSG) outlined above (to act as a

collective and authoritative voice on research and development within midwifery and maternity care) the RSG

stakeholders will include the following expert groups:

• Practising Midwives

• Midwifery and Multidisciplinary Researchers

• Women and Their Family Members as Service Users

• Other Voluntary Organisations and Stakeholders Interested in Maternity Care

13.

Factors Impacting the Research and Development Implementation Process

While it is important to outline the strategic goals and sub-goals associated with the overall implementation

and attainment of this strategy, it must be recognised that the research and development landscape has

rapidly changed, is rapidly changing and will continue to rapidly change. Currently two main factors are likely

to influence this strategy implementation:

1. Research Assessment Exercise (RAE) and Research Excellence Framework (REF)

The last Research Assessment Exercise (RAE)2 took place in 2008. However future assessment of research

activity within the UK will be undertaken by implementation of the Research Excellence Framework (REF).

The stated aim of the REF is to ‘identify excellent research of all kinds and the impact arising from excellent

research, within the UK HE sector’3. While the aim of this strategy is to engage with the research community

and exert influence in maintaining a focus on maternity issues, successful implementation will require that the

RCM and midwifery research community remain responsive to the implementation of the Research

Excellence Framework.

2. Research funding

The nature of the RCM as an organisation precludes large investment in research projects; therefore

implementation of research undertaken as part of the on-going research, development and evidence

generation within maternity care will continue to be funded primarily through external sources.

Conclusion The RCM’s role and vision of research provides an ideal opportunity for the RCM to inform, influence and

participate in research on a national and international level. This strategic plan outlines the goals and sub-

goals required to achieve the expansion of the RCM’s research and development portfolio. Whilst some

objectives may be aspirational, it is important that all stakeholders explore the possibilities that they present.

In conclusion, it is important to point out that the goals and sub-goals outlined in this strategy, will be

monitored and reviewed, with the intention of ensuring progress and achievement. When necessary

amendments to the direction of the strategy for midwifery research will be recommended and made.

2 The RAE was conducted jointly by the Higher Education Funding Council for England (HEFCE), the Scottish Funding Council (SFC), and the Higher Education Funding Council for Wales (HEFCW) and the Department for Employment and Learning, Northern Ireland (DEL). 3 HEFCE 2009 Research Excellence Framework: second consultation on the assessment and funding of research. www.hefce.ac.uk

14.

The Royal College of Midwives Trust15 Mansfield Street, London, W1G 9NHT: 020 7312 3535 E: info@rcm.org.ukwww.rcm.org.uk