ORIGINAL ARTICLE

Innovations and action research to develop research skills for nursing

and midwifery practice: the Innovations in Nursing and Midwifery
Practice Project study
Kenda Crozier, Jenny Moore and Katharine Kite

Aims and objectives. To develop sustainable resources and activity in one hospital to encourage, support and build research
activity and innovation among nurses and midwives.
Background. Much resource is spent internationally to enable nurses and midwives to critique and quote research papers. The
evidence suggests that little resource is focussed on enabling staff to conduct structured interventions that implement research as
a service improvement activity, or enable nurses and midwives to undertake research in their clinical areas.
Design. Two cycles of action research took place in the hospital led by a steering group of insiders and outsiders. Each cycle was
evaluated through interviews with participants and analysis of steering group meeting records.
Method. Action research methodology was used to develop partnership working between the hospital and university. A steering
group of participants in the project led the development and made decisions based on findings from the evaluation stages of each
cycle.
Results. The data demonstrate that the process is one of the slow snowball effects that gathered momentum. Key skills such as
leadership, resourcing and time management are required alongside research skills.
Conclusions. Nursing research capacity can be developed in institutions where there are individuals with an enthusiasm to drive
the agenda. Structures and processes need to be clear and transparent as well as supportive at the individual level. Change of this
nature takes time and sustained effort.
Relevance to clinical practice. This study demonstrates that a combination of strong leadership, partnership working and
development of clear infrastructure enabled nurses and midwives who provide direct patient care to develop, implement and
evaluate their own service improvement/research initiatives. Enabling nurses and midwives to use research methods in their
practice increases the amount of nurse/midwife-led evidence-based innovation.

Key words: action research, health services research, nursing education, partnership, research capacity building

Accepted for publication: 14 August 2011

create centres of excellence has focussed almost exclusively

Background
There is generally a drive to encourage research from in
clinical practice (Grainger 2010), and this is being further
focussed by UK government insistence that hospitals sign up
to the development of research opportunities for all staff. The
development of Academic Health Science centres in the UK to
on developing research in medicine and biosciences with
almost no inclusion of nursing and midwifery research
(Grainger 2010). The Royal College of Nursing (RCN) in
the UK has identified the importance of developing a nursing
research culture, stating that research and development needs
to be regarded as ‘a legitimate nursing activity’ (RCN

Authors: Kenda Crozier, PhD, MSc, BSc, RN, RM, Senior Lecturer,
Faculty of Health, University of East Anglia, Jenny Moore, EdD,
MSc, BSc, RN, RM, Lecturer, Faculty of Health, University of East
Anglia, Norwich; Katharine Kite, PhD, BSc, RN, RNT, Consultant
Nurse, James Paget University Hospital, Gorleston and Honorary
Senior Lecturer, Faculty of Health, University of East Anglia,
Norwich, UK
Correspondence: Kenda Crozier, Senior Lecturer, Faculty of Health,
University of East Anglia, Norwich, UK. Telephone: +44 01603 597094.
E-mail: k.crozier@uea.ac.uk

 2012 Blackwell Publishing Ltd

Journal of Clinical Nursing, doi: 10.1111/j.1365-2702.2011.03936.x 1
K Crozier et al.

2004:3). However, time pressures, lack of training and skills
and lack of time to read and implement research findings
have been identified as barriers to nursing research in clinical
practice (Parahoo & McCaughan 2001, Sigsworth 2009).
Therefore, if nursing research in practice is going to be a
mainstream overt activity, then cultural and organisational
change needs to take place.
Study aim
The Innovations in Nursing and Midwifery Practice Project
(INMPP) was born out of recognition that staff in one
hospital had ideas but lacked skills and infrastructure to
introduce innovations in practice. The overall aim of the
action research study was to develop sustainable resources in
the hospital to encourage, support and develop research
activity and innovation among nurses and midwives.
Within this were embedded several objectives:
1 To secure funding to enable the project to have a reason-
able chance of success
2 To support several small research projects to be generated
from in the hospital staff
3 To identify projects with the potential to be externally
funded and to support and develop these.
The project took place between 2008–2010 in one univer-
sity hospital in East of England.
Method
Action research is usually characterised as a series of spirals
or cycles where actions seek to make changes in a setting.
The cycles comprise planning, action and evaluation (Cogh-
lan & Casey 2001). The process is conducted by either
insiders to the organisation or ‘friendly’ outsiders (Elliott
1991). As a process, action research is a reflexive method
that tracks the evolution of organisational changes using
the various perspectives of those involved (Kemmis &
McTaggart 2000).
This study employed an action research method to develop
the infrastructure and processes for research capacity build-
ing in one University Hospital. It comprised a pre-step to
understand the existing support and infrastructure for nurs-
ing and midwifery research, and two action cycles in each of
which the infrastructure for research activity was developed
followed by a call for proposals for innovation projects from
nursing/midwifery staff to test the effectiveness of the
infrastructure. Each cycle ended with an evaluation of the
infrastructure and processes. From the evaluation of the first
cycle, changes were made to the processes before beginning
the planning for the next cycle.
The pre-step was effectively a scoping exercise to identify
the structures and processes in existence and gauge staff
views and opinions about research activity in the organisa-
tion. Key informants were identified who could provide
comment on the way nursing research worked in the hospital
organisation. Some of these key informants were subse-
quently invited to take part in the steering group to take an
active role in the change process.
Project organisation
The INMPP study had several layers (Fig. 1). The authors of
the paper were the project leads. The INMPP steering group
numbered eight people and comprised matrons, a specialist
nurse, education manager and R&D officer and the three
project leads. Matrons were the senior nurse/midwifery leads
for each of the speciality divisions in the hospital (Emergency,
surgical, medical, maternity etc.). The steering group was
responsible for developing and instituting an infrastructure
and processes to support nurse-led innovation projects, aimed

INMPP ac on research project leaders

2 academics, 1 clinical lead

Steering group comprising academics, consultant

nurse, matrons, R&D officer

Innova on project 1:2 Innova on project 1:3

Innova on project 1:1
test ing a postopera ve checklist development of a communica on
key worker role in the orthopaedic
tool about deteriora on in a
department
pa ent’s condi on

Innova on project 2.3

Innova on project 2:1
a ercare at the end of breast
cancer treatment
Innova on project 2.2
experiences of having a family
suppor ve antenatal care for
member in intensive care
pregnant teenagers
Figure 1 Organisation of INMPP.

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2 Journal of Clinical Nursing
Original article
at developing research capability and capacity. INMPP
funded and supported nurse- or midwifery-led innovation
projects which had a clear patient-centred focus. The process
for selecting projects for support and funding was via a call
for ideas/proposals and a structured support package includ-
ing individual and group workshops to help develop these. In
the first cycle, three innovation projects were supported, and
in the second cycle after changes were made to the processes,
another three were selected. Members of the steering group
acted as mentors to provide support to the innovation project
teams and monitored progress on timelines and expenditure,
Participants
Those who had been involved in the steering group and
innovation projects were invited to take part in evaluation
interviews. Steering group minutes were also analysed as data
with the agreement of members. The participants in this
study were involved in a variety of ways. Some simply took
advantage of the opportunity to conduct a small-scale
innovation project funded by the INMPP action research
team and made changes in their clinical area. Their views
were elicited through interviews and fed into the change
cycles. These passive participants were from the full range of
staff grades, from matrons to ward nurses. Others were
members of the steering group and actively took part in
making decisions moving the change cycles forward. Morri-
son and Lilford (2001) noted that not all will want to be
involved in diagnosing, theorising and managing the direction
of an action research study but will be content to view it and
comment on its progress. So we found with this project that
there were participants who were involved in all stages of the
cycles and those who more passive.
Twenty-six participants took part; about half of these were
interviewed towards the end of cycle 1 and again towards the
end of cycle 2. The remaining participants were interviewed
once at the end of cycle 2. Staff members across all grades
were represented from junior staff (band 5) to those at
management (band 8), including matrons and executive staff
to understand the impact on the organisation as a whole.
Rigour
The principles of rigour in action research described by
Heikkinen et al. (2007) have been applied in our study
comprising five steps: historical continuity; reflexivity,
dialectics; workability; and evocativeness. Our narrative
describes the process as it occurred throughout the cycles,
thus showing historical continuity. In terms of reflexivity, our
epistemological standpoint is based on research education
 2012 Blackwell Publishing Ltd
Journal of Clinical Nursing
The INMPP study
and the ontological belief that by providing an environment
that encourages learning and research activity, the workforce
can improve the care of patients. The perspectives of the
participants, including our own, are demonstrated through
direct quotes, and the decisions taken throughout the process
draw directly on the collected data to find direction in which
to move forward (‘dialectics’). The ways we instituted change
are shown at the end of each cycle following our evaluation.
In addressing the workability of the study, we are clear that
the involvement of insiders and outsiders added to the range
of perspectives offered to the steering group. The data present
a picture of change including frustration with pace and
process in the organisation. This adds to the evocativeness, a
principle which is similar to authenticity described by Lincoln
and Guba (1985) in their principles of rigour in qualitative
research.
Feldman (2007) criticised these criteria on grounds of
naivety, stating the need for researchers to acknowledge and
demonstrate simply the truthfulness of their work. However,
they are a useful means of enabling us to demonstrate to the
reader how quality and rigour have been addressed. The
audit trail through the work demonstrates a transparent
approach to decisions and therefore a true representation of
the way the research took place.
Ethical issues
Local NHS research ethics committee approved the action
research study. Participants were given written information
and asked to consent to be interviewed.
Action cycle 1
The steering group recognised the need to identify three
groups of talent in the organisation. These were:
Innovators – those with bright ideas about changing practice,
Mentors – to help innovators develop projects; and
Champions – would effectively sell the idea of the develop-
ment process and act as leaders.
The mentors and champions were provided with coaching
training to enable them to fulfil their role. Leadership of the
project in the hospital was very important to ensure
momentum. The third author was a very visible presence
who drove the project and encouraged the champions and
mentors to fulfil their roles. A formal competition was set up
which encouraged teams or individuals with an innovative
idea to submit a proposal for funding in the hospital. An
intranet site facilitated the process of information sharing,
providing dates and times of meetings and deadlines for the
proposals. Support was provided (by the authors) to help the
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K Crozier et al.

applicants develop research skills to convert ideas into
innovation project proposals. Criteria for selecting projects
were drawn up by the steering group. The need to be able to
select projects with a high probability of successful comple-
tion was important to develop confidence in the process. The
timelines and activities in the action cycles are shown in
Fig. 2.
It was also necessary to set up a support infrastructure to
track the projects as they were progressing including agreed
timelines, project milestones and costs. Steering group mem-
bers agreed to share the responsibilities for this and devel-
oped proforma to help with the administrative process. We
also considered it important provide opportunities to dis-
seminate information about the innovation projects as they
progressed. Therefore, presentation events took place when
the innovation projects were first selected and again when
they were at or near completion.
Evaluation of the structure and processes
Advertising for the first round call commenced in January
2009, with the distribution of 900 postcards to nurses/
midwives and an article in the Hospital newsletter. Eight
ideas were received, and individuals were given support in
research methods and proposal writing. Three project
proposals were selected by the steering group for support
with funding. These projects included the evaluation of a new
key worker role in the orthopaedic department which
challenged thinking on skill mix; a project to develop and
test a checklist to help nurses make decisions about timely
return of postoperative patients to ward areas; and the
development of a communication tool to help nurses com-
municate concern about deterioration in a patient’s condi-
tion.
Findings in cycle 1
A total of 14 interviews took place over a two-week period
following the launch of the successful projects. Interviewees
came from a range of staff grades representing nursing and
midwifery staff and management. The aim was to gauge the
views of participants on the processes in the first call and to
consider how it could be improved. There was a sense of
genuine enthusiasm for the project: ‘Because all the research
usually is medical led and to know there is some monies for
nursing type projects there was a lot of people very excited’
(P6 band 7).
Senior staff led the projects
The first round of innovation projects was led by senior staff
members, two were matrons (band 8) and the third was a
senior nurse (band 7). Some participants were disappointed

Iden fying the talent and first

PRESTEP leads to cycle 1
Jan- April 2008
Securing funding. Planning
call for ideas. Support for
infrastructure and processes
development of nurses ideas
by INMPP steering group
into proposals (INMPP leads)
April - Dec 2008
Dec 2008 -March 2009

Selec on of innova on Implementa on of innova on

projects by steering group ,
award of me and resources
Arpil 2009
Evalua on by INMPP leads
projects with support by
then dissemina on of findings
steering group partners
May - July 2009
April - Oct 2009

Suppor ve workshops for

Changes leading to Second call for proposals
developing nursing/midwifery
Iden fying the talent and the
Cycle 2 ideas into proposals INMPP
ideas
leads + finance and R&D input
July - Sept 2009 Sept 2009
Sept - Dec 2009

Implementa on of innova on
Selec on of projects, award of Evalua on of processes and
projects with support from
me and resources projects in cycle 1 and 2
steering group partners
Dec 2009 April - May 2010
Jan - July 2010
Figure 2 Action research process and
timelines.

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4 Journal of Clinical Nursing
Original article
that junior staff were not more visible. One participant who
came forward at the ideas stage but did not complete a full
proposal reported that they needed more support to give
them confidence to move forward: ‘Maybe the matrons, I’m
not sure it needs to be someone who is a role model who is a
leader type person rather than a manager type person who
would be able to inspire someone (P3, band 6). Senior nurses
identified that they were more likely to have project
management skills either through experience or through
training therefore perhaps these attributes led them to be in
the first wave.
Strong leadership from the hospital project lead (third
author) was identified as a primary means of advertising the
project to matrons especially and getting them to consider
innovation project ideas. ‘K comes to the matrons group so
she wanted to sell it there. So we discussed it, we discussed
about ideas so INMPP was advertised through that too’ (P1
band 8).
Time and workload as barriers
Time limitation was identified as a significant barrier partic-
ularly in those projects which had been unsuccessful. Those
who had struggled with a large workload and inability to
factor in time to prepare proposals suggested the need for
negotiated time for the application process. Many of the
participants suggested the projects would add to their normal
workload so chose not to proceed:
I know that people saw it straight away as another additional piece of
work that they would have to do on top of their day job. (P1 band 8)
It was seen as important that staff applying in future should
negotiate dedicated time to prepare proposals. Participant 7
summed this up:
Table 1 Learning from cycle 1
Issues identified
More information needs to reach all levels of staff
Greater involvement from other departments in
the hospital is required to support projects
Template for proposals would be useful to
help staff intending to submit
Short time frame inhibited some from
submitting in first round
Greater coherence between INMPP steering
group and the research support committee
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Journal of Clinical Nursing
The INMPP study
…you are going to need built into your work schedule some time to
do the proposal and work the proposal up; rather than trying to do it
as well as trying to do your ordinary clinical work. (P7 band 7)
In discussions with participants, it appeared that negotiating
and planning time into work schedules was easier for senior
staff, but there was recognition of the need for managers to
consider this on behalf of more junior staff.
However, one participant pinpointed the fact that many of
the projects proposed were for initiatives that met a nation-
ally driven agenda for changes in clinical care. This partic-
ipant, a member of the steering group, commented that
nurses should be able to see that an application for funding
would actually help them to fulfil the target:
The matrons who took up the opportunities are the ones that will say
‘we can’t do this without the resource. We will work out the business
case, we will do a scoping for the work required and the staff
numbers’ and they were the ones who came through with the
successful bids. (P8 band 8)
The steering group had perhaps not considered that strategic
thinking in terms of understanding resource requirements for
projects was not a skill that many junior staff would possess.
Therefore, it was not really surprising that the initial cohort of
projects were led by the most senior members of nursing staff.
Action research cycle 2
Issues that required changes to the process were identified
through evaluation in time for cycle 2 (Table 1). In
preparing the call for the next round of proposals, we
decided to use a different support process. Applicants were
offered one to one meetings, and in addition, workshops
Solutions
Poster campaign. An information point was set up in the staff dining room.
Matrons were strongly encouraged to support junior staff in
the submission of proposals
Workshop sessions were set up with input from R&D office and
finance department to help staff prepare their proposals.
Stronger links to R&D office were established so that
project teams were encouraged to also seek support and
advice from R&D manager
The format of the proposal and a project flow chart were made
available on the INMPP intranet site
A longer period of time was allowed for the development of proposals
The reporting and communication to other groups with an interest
in research and development were strengthened
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K Crozier et al.
were held to enable applicants to meet, share ideas and be
provided with information on hospital support mechanisms
including help with questionnaire development, ethics com-
mittee applications and costing of projects. The second call
was advertised via a poster campaign and information
including templates, and guidelines for proposals were
accessible via the intranet site. In addition, we had expertise
from those who had already been through the process and
could speak and provide support based on experiential
knowledge.
The second call resulted in three funded proposals. These
had a strong patient focus including aftercare at the end of
breast cancer treatment; supportive antenatal care for
pregnant teenagers; and exploring relatives’ experiences of
having a family member in intensive care. The projects were
supported by being paired with a member of the steering
group who could monitor progress in relation to timelines
and expenditure to enable projects to remain on target.
A final evaluation took place at the end of cycle 2. The aim
of the evaluation was to consider the success of INMPP in
developing research awareness and skills among the nursing
staff as well as the impact of the individual nursing and
midwifery innovation projects. We also considered the
sustainability of the infrastructure which had been developed
and refined.
Twenty interviews were conducted, transcribed and anal-
ysed. Interviewees were staff across all areas of the Hospital
and included managers, steering group members, those
involved in projects and others across the full range of staff
grades.
Impact
Participants identified themselves as being grounded in the
clinical aspects of their role and suggested that research was
not previously considered to be part of the nursing role. The
majority of respondents reported that INMPP provided
opportunities to develop their own evidence base and to use
their clinical expertise to inform innovation. It raised staff
awareness of research and enabled them to influence service
development for patients:
I think it has highlighted the fact that it’s a possibility now and I don’t
think it was on most peoples’ consciousness that that’s something
that they could do and that they would be supported to do it. (P9 FE
band 8)
One staff member had been supported to apply for a funded
research fellowship at regional level in the first round, and
another was supported to develop a proposal which was then
used to apply for a funded master of research degree.
6 Journal of Clinical Nursing
Participants suggested INMPP enabled ideas to come
straight from practitioners, which was seen as positive. There
was a sense that nurses and midwives could control the
agenda which was not the case previously:
It’s about stimulating the staff or exciting the staff in respect of its
something you need to run with and change that culture, I suppose
that we haven’t always done… (P7 FE band 7)
Other staff in the hospital became aware of the innovation
projects as they progressed, and the changes in patient care
were presented in dissemination events:
…they will lead to greater improvements in patient care and the
quality of patient care and patient safety. (P11 FE band 8)
Research capability
The project has built residual capability in those people who
have been involved, because they have acquired skills as part
of this process, which will give them confidence in their
ability to undertake future research activity, but also in
helping the people they work alongside. Traditionally,
innovation has been led by external influences, but INMPP
has enabled innovation from ground level and the success of
projects has motivated others:
I suppose in the long term raising the profile of nurses but that’s not
as important as us knowing that we are and having the evidence that
we are effective. (P8 FE)
A hospital management team member highlighted what the
hospital board see as beneficial in building these types of
skills:
How do we highlight the aspects of the project that address the
agenda that we are facing at the moment? …We have to demonstrate
clearly that we have reduced length of stay as a result of [the]
orthopaedics project; that the prevention aims in the midwifery
project fit in with the PCT strategy. So we have got to take
responsibility now for showing that it is going to save money. It is
going to improve productivity; it is going to reduce length of stay and
as a result of that we will invest in it. (P12 FE Exec level)
Gathering momentum
The innovation projects demonstrated improved patient care
and were able to produce statistics showing reduced length of
stay in hospital and more efficient management of patient
care. These impacts were disseminated, and board members
were aware of the positive aspects of the projects.
Overwhelmingly, it was identified that matrons (senior
nurses who have responsibility for a division or group of
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Original article
wards) are in the best position to champion, inspire and
motivate staff: ‘…quite a lot of push comes from the matrons,
because we have got a dynamic bunch’ (P9 FE band 7)
The matrons can see where it will have an influence. They have an
awareness of pieces of work…they will always be the people who will
prompt other people. (P10 FE band 8)
Key lessons learnt from cycle 2 are shown in Table 2.
Challenges
All those involved in collecting data in the innovation
projects experienced some resistance from staff and identified
problems getting people to comply with the requirements of
their innovation projects. The reasons provided for this were
bound up with the practicalities of change management, in
that they were ‘confronting their existing practice. You are
challenging them to think outside the box’ (P14 FE band 6).
The project has had a snowball effect. Senior staff who led
the first innovation projects have the potential to prompt
other people to develop skills so that research skills come to
be seen as relevant in clinical practice:
We can build up a bank of people who have got some research
training, some research background, some practical skills so that we
can increase capacity. (P2 FE)
Those who had been given some coaching training in the
early part of INMPP were able to help those who were
dealing with difficult staff to consider approaches and
strategies for managing these situations. Participants identi-
fied that the innovation projects have changed practice and
that the hospital as an organisation is beginning to see
benefits of research capacity building as a result. The results
of the innovation projects indicate improvements in the
quality of patient care and patient safety, and resulting tools
and practices have been adopted across the hospital.
Table 2 Lessons learnt from cycle 2
Issues identified
Importance of a strategy to sustain the activity
beyond life of project
Identification of staff with ideas needs to come from matrons
Staff identified the need to know what projects were
taking place and where
Small projects can make big changes to improve nursing
practice and patient care
Maintaining the momentum after the life of the project
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Journal of Clinical Nursing
The INMPP study
Limitations
As with all research, our study has some limitations that
should be highlighted. It was undertaken in one NHS
hospital; consequently, there may be context-specific factors
which may have influenced the willingness of the workforce
in accepting and responding to change. Another limitation of
this work is the small numbers of nurses involved, which
makes it difficult to generalise the potential benefits of this
project to a wider population.
Discussion
The aim of this action research study was to develop a
sustainable infrastructure in one hospital to support and build
research activity and innovation among nurses and midwives.
McCance et al. (2007) identify that building research capacity
and infrastructure in organisations can be problematic
because of the need to address structural and cultural
challenges in a specific context. One of the main challenges
identified in our evaluation was that staff perceived that they
did not have the capacity to incorporate innovative practice
into their existing workload. Other authors also identify lack
of time and workload as barriers to research capacity building
(Happell 2004, 2008, McNicholl et al. 2008). One of the most
significant elements that we found helped to overcome such
challenges was the importance of project planning at a
strategic level through the INMPP steering group. Similarly,
Segrott et al. (2006) suggest that successful RCB initiatives
involve developing an overall strategic approach realised
through specific objectives, as in our work. Also, the inclusion
of ‘key’ senior personnel in the INMPP steering group enabled
them to contribute to the planning and developmental stages
of the project. Consequently, they were more likely to
facilitate the processes developed because of their involve-
ment. Alleyne and Jumaa (2007) found that nurse managers
Moving forward
Careful negotiation in the steering group enabled a form of
exit strategy that allows for continued partnership working
beyond the project
Matrons who had completed a successful project invited onto
steering group to create better links with matrons group
Dissemination of work in progress as well as completed
projects encourages staff engagement
Continue to encourage staff to make changes using the
research skills developed in the hospital
The hospital board has been impressed with the project and will
fund further nursing projects
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K Crozier et al.
and leaders are more likely to be committed to actions they
have discovered for themselves. In our experience, another
significant factor was the steering group had access to financial
resources which enabled them to support the operational
aspects of each project such as protected project time for staff,
human resources and equipment. Richardson et al. (2007),
likewise, cite the key to the success of research capacity
building as planned and protected investment in resources
such as nursing research time.
Another finding from our evaluation was that research was
regarded as a medical preoccupation and nurses were not
expected to lead on research. Perhaps, this is not surprising,
as Reed and Lawrence (2008) explain most nurses are
socialised into being users, not producers of knowledge, and
highlight that less than one per cent of nurses are developing
knowledge for the other 99. They suggest that one of the
reasons for this might be because nursing has not ‘shaken
loose an operative ontology of ‘physicians orders’’ (Reed &
Lawrence 2008:424). However, Sambrook (2009) argues
that recent health policy has introduced a package of reforms
to shift the balance of power from managerial and medical
domination to frontline NHS staff to empower staff to
develop innovative services. Interestingly, in our work, we
found that after involvement in the project, participants
reported they felt more capable of initiating and undertaking
research in practice because they had been provided with
opportunities to contribute to their own knowledge base and
because they could see tangible benefits in terms of enhanced
quality of care and more efficient care management. Gaw-
linski (2008) suggests that as nurses acquire new skills
required for research capacity building, their involvement
broadens their scope of influence, as they are empowered to
bring about measurable improvements in practice.
In our study, the collaboration between hospital and
university enabled the process to be led by a combination of
insiders and outsiders. Thus, the university outsiders were
able to make use of the connections and contacts of
the insider members to carry out the research role while the
insider acted as a change agent and driver, using the ideas
generated from the evaluations to make effective infrastruc-
ture and process changes. This has proved to be a powerful
combination, and resulting changes would have been difficult
to achieve by outsiders or insiders acting alone. McCormack
et al.’s (2009) systematic review of practice development for
sustainable change recommended collaborative relationships
between Higher Education Institutions (HEIs) and clinical
institutions for innovation to be successful, as it has the
potential to reduce isolation for practice developers and also
harnesses the potential for systematic and rigorous processes
to be adopted, as in this case.
8 Journal of Clinical Nursing
The hospital culture change process is slow, and this has
been a stumbling block for previous attempts to build
capacity and capability in other studies. Happell (2008)
identifies that culture change is required before nurses feel
that undertaking research activity is part of their role.
However, in this study, there appeared to be a gradual
snowball effect of increasing interest and involvement of staff
in INMPP, which gathered momentum throughout the study
cycles. This was in part owing to building residual research
capability in staff which was harnessed as support for others.
Similarly, Happell (2004) identifies that equipping clinicians
with research knowledge and skills helps to create a ‘pool’ of
research leaders and supervisors in mental health services in
Australia. We have found that the need for champions in the
organisation who motivated and coached staff was impera-
tive to successful research activity. The use of coaching skills
to drive research activity is being recognised in the hospital,
and it is important for future recruitment to the matron role
that research activity is part of the job description.
Our experience with INMPP has highlighted the impor-
tance of the need for research capacity building structures
and processes to be transparent in institutions where there are
individuals with an enthusiasm to drive the agenda. Similarly,
McNicholl et al. (2008) identify that it is fundamental for all
organisations to develop and maintain a visible nursing and
midwifery research infrastructure across all boundaries.
The role of the ward sister or ward manager in research
activity and use of research is recognised by the Royal College
of Nursing (2009), yet in our experience, ward managers
were the grade of staff least likely to be involved in
developing research ideas. The data suggest that this is owing
to the high operational workload which allowed little time to
consider research, yet the demand for ward managers
to affect change in their clinical areas is implicit in the role.
It may also be lack of skills and knowledge which prevented
them initiating research activity. This is supported by Drey
et al. (2009) who found limited opportunities for continuing
professional development activity at ward sister grade and
suggest that more needs to be done to support this group.
Conclusion
Our three original aims have been met to some extent. We
were successful in securing funding to enable us to develop
INMPP and to support six innovation projects submitted by
staff. The identification of projects for external funding is an
ongoing aim, and we have submitted one application for
external funding. We have been successful in supporting
individuals to secure fellowships for study at PhD and
Masters Level. Our findings in this study suggest that nursing
 2012 Blackwell Publishing Ltd
Original article The INMPP study

research capacity can be developed in institutions where there highlight, if a strong foundation has been built, people have
are individuals with an enthusiasm to drive the agenda. Reed been empowered and culture has changed, it is likely to
and Lawrence (2008) identify that where practice and continue after a project has completed.
research meet, there is an ‘edge effect’ where the synergy in
bringing together knowledge production and practice can
Acknowledgements
create a dynamic interface, producing new ideas and inno-
vations. This sense of activity providing a creative energy for The project was funded initially by the Hospital, and further
innovation was certainly evident throughout the INMPP funding was provided by NHS East of England. Ethical
study and one that gained momentum. But the success of approval was granted (REC reference no. 09/H0310/9).
INMPP was in part owing to the presence of a strong, visible
leader in the hospital who provided a ‘visionary’ role in
Contributions
driving the project forward in the organisation and main-
taining the transparency as well as the successful partnership Study design: KC, JM, KK; data collection and analysis KC,
between the hospital and the University. We have found that JM and manuscript preparation: KC, JM, KK.
change in this nature takes time and sustained effort. We
believe that sustainability of INMPP will be a test of its
Conflict of interest
success, and further innovation projects have since been
funded and supported. However, as McCance et al. (2007) The authors declare that they have no conflict of interests.

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Journal of Clinical Nursing 9
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