Table 2

Mechanisms through which research engagement may improve healthcare performance

	Mechanisms identified in the focused review		Insights from the wider review
By product papers
	Broad impact	Specific impact	Research-active staff may differ from their peers in non-research-active settings because of: personal characteristics, multidisciplinary collaboration, additional training and education or specialisation An increasing recognition of the ‘by-product’ type benefits from research engagement has encouraged further thinking about how best to build on and regularise these opportunities
Clinician	Change in attitudes and behaviour that research engagement can promote Involvement in the processes of research	▸ Greater awareness and understanding of the specific research findings
Organisation	▸ Use of the infrastructure created to support trials more widely, or for a longer period, to improve patient care	▸ Applying the processes and protocols developed in a specific study (not counting any impact from regimens in the intervention arm) to all patients with specific illness, irrespective of their involvement in the trial
Network papers
Clinician		Increased relevance of the research Increased knowledge and understanding of the findings gained through participation in the research Clinician participation in research networks particularly effective when the science is changing rapidly and when keeping up-to-date is critical	Mechanisms such as practice facilitators, project development meetings and network convocations allow two-way knowledge exchange throughout a research network, enabling clinicians to engage with question generation and the resulting research, and ensuring that the research is more relevant to practitioners Limitations about what can be achieved by research networks Need for a supportive context that enables clinicians and their organisations to participate in research and research networks Evidence of a growing international interest in the benefits that might come from research networks
Organsational	Centres within networks build up a record of implementing research findings Network membership increases the likelihood of physicians recommending guideline concordant treatment Organisations affiliated to a network adopt an integrated, programmatic approach to improving the quality of care, including the professional education, training and national meetings provided
Intervention papers
Organisation		▸ The importance of effective collaboration and the need for a supportive context	Healthcare organisations and systems provide the context within which research engagement operates at other levels Organisations in which the research function is fully integrated into the organisational structure can out-perform other organisations that pay less heed to research and its outputs