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• How to Write Recommendations in Research | Examples & Tips

How to Write Recommendations in Research | Examples & Tips

Published on September 15, 2022 by Tegan George . Revised on July 18, 2023.

Recommendations in research are a crucial component of your discussion section and the conclusion of your thesis , dissertation , or research paper .

As you conduct your research and analyze the data you collected , perhaps there are ideas or results that don’t quite fit the scope of your research topic. Or, maybe your results suggest that there are further implications of your results or the causal relationships between previously-studied variables than covered in extant research.

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Table of contents

What should recommendations look like, building your research recommendation, how should your recommendations be written, recommendation in research example, other interesting articles, frequently asked questions about recommendations.

Recommendations for future research should be:

• Concrete and specific
• Supported with a clear rationale
• Directly connected to your research

Overall, strive to highlight ways other researchers can reproduce or replicate your results to draw further conclusions, and suggest different directions that future research can take, if applicable.

Relatedly, when making these recommendations, avoid:

• Undermining your own work, but rather offer suggestions on how future studies can build upon it
• Suggesting recommendations actually needed to complete your argument, but rather ensure that your research stands alone on its own merits
• Using recommendations as a place for self-criticism, but rather as a natural extension point for your work

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There are many different ways to frame recommendations, but the easiest is perhaps to follow the formula of research question   conclusion  recommendation. Here’s an example.

Conclusion An important condition for controlling many social skills is mastering language. If children have a better command of language, they can express themselves better and are better able to understand their peers. Opportunities to practice social skills are thus dependent on the development of language skills.

As a rule of thumb, try to limit yourself to only the most relevant future recommendations: ones that stem directly from your work. While you can have multiple recommendations for each research conclusion, it is also acceptable to have one recommendation that is connected to more than one conclusion.

These recommendations should be targeted at your audience, specifically toward peers or colleagues in your field that work on similar subjects to your paper or dissertation topic . They can flow directly from any limitations you found while conducting your work, offering concrete and actionable possibilities for how future research can build on anything that your own work was unable to address at the time of your writing.

See below for a full research recommendation example that you can use as a template to write your own.

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While it may be tempting to present new arguments or evidence in your thesis or disseration conclusion , especially if you have a particularly striking argument you’d like to finish your analysis with, you shouldn’t. Theses and dissertations follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the discussion section and results section .) The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

The conclusion of your thesis or dissertation should include the following:

• A restatement of your research question
• A summary of your key arguments and/or results
• A short discussion of the implications of your research

For a stronger dissertation conclusion , avoid including:

• Important evidence or analysis that wasn’t mentioned in the discussion section and results section
• Generic concluding phrases (e.g. “In conclusion …”)
• Weak statements that undermine your argument (e.g., “There are good points on both sides of this issue.”)

Your conclusion should leave the reader with a strong, decisive impression of your work.

In a thesis or dissertation, the discussion is an in-depth exploration of the results, going into detail about the meaning of your findings and citing relevant sources to put them in context.

The conclusion is more shorter and more general: it concisely answers your main research question and makes recommendations based on your overall findings.

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George, T. (2023, July 18). How to Write Recommendations in Research | Examples & Tips. Scribbr. Retrieved April 9, 2024, from https://www.scribbr.com/dissertation/recommendations-in-research/

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Home » Research Recommendations – Examples and Writing Guide

Research Recommendations – Examples and Writing Guide

Table of Contents

Research Recommendations

Definition:

Research recommendations refer to suggestions or advice given to someone who is looking to conduct research on a specific topic or area. These recommendations may include suggestions for research methods, data collection techniques, sources of information, and other factors that can help to ensure that the research is conducted in a rigorous and effective manner. Research recommendations may be provided by experts in the field, such as professors, researchers, or consultants, and are intended to help guide the researcher towards the most appropriate and effective approach to their research project.

Parts of Research Recommendations

Research recommendations can vary depending on the specific project or area of research, but typically they will include some or all of the following parts:

• Research question or objective : This is the overarching goal or purpose of the research project.
• Research methods : This includes the specific techniques and strategies that will be used to collect and analyze data. The methods will depend on the research question and the type of data being collected.
• Data collection: This refers to the process of gathering information or data that will be used to answer the research question. This can involve a range of different methods, including surveys, interviews, observations, or experiments.
• Data analysis : This involves the process of examining and interpreting the data that has been collected. This can involve statistical analysis, qualitative analysis, or a combination of both.
• Results and conclusions: This section summarizes the findings of the research and presents any conclusions or recommendations based on those findings.
• Limitations and future research: This section discusses any limitations of the study and suggests areas for future research that could build on the findings of the current project.

How to Write Research Recommendations

Writing research recommendations involves providing specific suggestions or advice to a researcher on how to conduct their study. Here are some steps to consider when writing research recommendations:

• Understand the research question: Before writing research recommendations, it is important to have a clear understanding of the research question and the objectives of the study. This will help to ensure that the recommendations are relevant and appropriate.
• Consider the research methods: Consider the most appropriate research methods that could be used to collect and analyze data that will address the research question. Identify the strengths and weaknesses of the different methods and how they might apply to the specific research question.
• Provide specific recommendations: Provide specific and actionable recommendations that the researcher can implement in their study. This can include recommendations related to sample size, data collection techniques, research instruments, data analysis methods, or other relevant factors.
• Justify recommendations : Justify why each recommendation is being made and how it will help to address the research question or objective. It is important to provide a clear rationale for each recommendation to help the researcher understand why it is important.
• Consider limitations and ethical considerations : Consider any limitations or potential ethical considerations that may arise in conducting the research. Provide recommendations for addressing these issues or mitigating their impact.
• Summarize recommendations: Provide a summary of the recommendations at the end of the report or document, highlighting the most important points and emphasizing how the recommendations will contribute to the overall success of the research project.

Example of Research Recommendations

Example of Research Recommendations sample for students:

• Further investigate the effects of X on Y by conducting a larger-scale randomized controlled trial with a diverse population.
• Explore the relationship between A and B by conducting qualitative interviews with individuals who have experience with both.
• Investigate the long-term effects of intervention C by conducting a follow-up study with participants one year after completion.
• Examine the effectiveness of intervention D in a real-world setting by conducting a field study in a naturalistic environment.
• Compare and contrast the results of this study with those of previous research on the same topic to identify any discrepancies or inconsistencies in the findings.
• Expand upon the limitations of this study by addressing potential confounding variables and conducting further analyses to control for them.
• Investigate the relationship between E and F by conducting a meta-analysis of existing literature on the topic.
• Explore the potential moderating effects of variable G on the relationship between H and I by conducting subgroup analyses.
• Identify potential areas for future research based on the gaps in current literature and the findings of this study.
• Conduct a replication study to validate the results of this study and further establish the generalizability of the findings.

Applications of Research Recommendations

Research recommendations are important as they provide guidance on how to improve or solve a problem. The applications of research recommendations are numerous and can be used in various fields. Some of the applications of research recommendations include:

• Policy-making: Research recommendations can be used to develop policies that address specific issues. For example, recommendations from research on climate change can be used to develop policies that reduce carbon emissions and promote sustainability.
• Program development: Research recommendations can guide the development of programs that address specific issues. For example, recommendations from research on education can be used to develop programs that improve student achievement.
• Product development : Research recommendations can guide the development of products that meet specific needs. For example, recommendations from research on consumer behavior can be used to develop products that appeal to consumers.
• Marketing strategies: Research recommendations can be used to develop effective marketing strategies. For example, recommendations from research on target audiences can be used to develop marketing strategies that effectively reach specific demographic groups.
• Medical practice : Research recommendations can guide medical practitioners in providing the best possible care to patients. For example, recommendations from research on treatments for specific conditions can be used to improve patient outcomes.
• Scientific research: Research recommendations can guide future research in a specific field. For example, recommendations from research on a specific disease can be used to guide future research on treatments and cures for that disease.

Purpose of Research Recommendations

The purpose of research recommendations is to provide guidance on how to improve or solve a problem based on the findings of research. Research recommendations are typically made at the end of a research study and are based on the conclusions drawn from the research data. The purpose of research recommendations is to provide actionable advice to individuals or organizations that can help them make informed decisions, develop effective strategies, or implement changes that address the issues identified in the research.

The main purpose of research recommendations is to facilitate the transfer of knowledge from researchers to practitioners, policymakers, or other stakeholders who can benefit from the research findings. Recommendations can help bridge the gap between research and practice by providing specific actions that can be taken based on the research results. By providing clear and actionable recommendations, researchers can help ensure that their findings are put into practice, leading to improvements in various fields, such as healthcare, education, business, and public policy.

Characteristics of Research Recommendations

Research recommendations are a key component of research studies and are intended to provide practical guidance on how to apply research findings to real-world problems. The following are some of the key characteristics of research recommendations:

• Actionable : Research recommendations should be specific and actionable, providing clear guidance on what actions should be taken to address the problem identified in the research.
• Evidence-based: Research recommendations should be based on the findings of the research study, supported by the data collected and analyzed.
• Contextual: Research recommendations should be tailored to the specific context in which they will be implemented, taking into account the unique circumstances and constraints of the situation.
• Feasible : Research recommendations should be realistic and feasible, taking into account the available resources, time constraints, and other factors that may impact their implementation.
• Prioritized: Research recommendations should be prioritized based on their potential impact and feasibility, with the most important recommendations given the highest priority.
• Communicated effectively: Research recommendations should be communicated clearly and effectively, using language that is understandable to the target audience.
• Evaluated : Research recommendations should be evaluated to determine their effectiveness in addressing the problem identified in the research, and to identify opportunities for improvement.

Advantages of Research Recommendations

Research recommendations have several advantages, including:

• Providing practical guidance: Research recommendations provide practical guidance on how to apply research findings to real-world problems, helping to bridge the gap between research and practice.
• Improving decision-making: Research recommendations help decision-makers make informed decisions based on the findings of research, leading to better outcomes and improved performance.
• Enhancing accountability : Research recommendations can help enhance accountability by providing clear guidance on what actions should be taken, and by providing a basis for evaluating progress and outcomes.
• Informing policy development : Research recommendations can inform the development of policies that are evidence-based and tailored to the specific needs of a given situation.
• Enhancing knowledge transfer: Research recommendations help facilitate the transfer of knowledge from researchers to practitioners, policymakers, or other stakeholders who can benefit from the research findings.
• Encouraging further research : Research recommendations can help identify gaps in knowledge and areas for further research, encouraging continued exploration and discovery.
• Promoting innovation: Research recommendations can help identify innovative solutions to complex problems, leading to new ideas and approaches.

Limitations of Research Recommendations

While research recommendations have several advantages, there are also some limitations to consider. These limitations include:

• Context-specific: Research recommendations may be context-specific and may not be applicable in all situations. Recommendations developed in one context may not be suitable for another context, requiring adaptation or modification.
• I mplementation challenges: Implementation of research recommendations may face challenges, such as lack of resources, resistance to change, or lack of buy-in from stakeholders.
• Limited scope: Research recommendations may be limited in scope, focusing only on a specific issue or aspect of a problem, while other important factors may be overlooked.
• Uncertainty : Research recommendations may be uncertain, particularly when the research findings are inconclusive or when the recommendations are based on limited data.
• Bias : Research recommendations may be influenced by researcher bias or conflicts of interest, leading to recommendations that are not in the best interests of stakeholders.
• Timing : Research recommendations may be time-sensitive, requiring timely action to be effective. Delayed action may result in missed opportunities or reduced effectiveness.
• Lack of evaluation: Research recommendations may not be evaluated to determine their effectiveness or impact, making it difficult to assess whether they are successful or not.

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Research Recommendations – Guiding policy-makers for evidence-based decision making

Research recommendations play a crucial role in guiding scholars and researchers toward fruitful avenues of exploration. In an era marked by rapid technological advancements and an ever-expanding knowledge base, refining the process of generating research recommendations becomes imperative.

But, what is a research recommendation?

Research recommendations are suggestions or advice provided to researchers to guide their study on a specific topic . They are typically given by experts in the field. Research recommendations are more action-oriented and provide specific guidance for decision-makers, unlike implications that are broader and focus on the broader significance and consequences of the research findings. However, both are crucial components of a research study.

Difference Between Research Recommendations and Implication

Although research recommendations and implications are distinct components of a research study, they are closely related. The differences between them are as follows:

Types of Research Recommendations

Recommendations in research can take various forms, which are as follows:

These recommendations aim to assist researchers in navigating the vast landscape of academic knowledge.

Let us dive deeper to know about its key components and the steps to write an impactful research recommendation.

Key Components of Research Recommendations

The key components of research recommendations include defining the research question or objective, specifying research methods, outlining data collection and analysis processes, presenting results and conclusions, addressing limitations, and suggesting areas for future research. Here are some characteristics of research recommendations:

Research recommendations offer various advantages and play a crucial role in ensuring that research findings contribute to positive outcomes in various fields. However, they also have few limitations which highlights the significance of a well-crafted research recommendation in offering the promised advantages.

The importance of research recommendations ranges in various fields, influencing policy-making, program development, product development, marketing strategies, medical practice, and scientific research. Their purpose is to transfer knowledge from researchers to practitioners, policymakers, or stakeholders, facilitating informed decision-making and improving outcomes in different domains.

How to Write Research Recommendations?

Research recommendations can be generated through various means, including algorithmic approaches, expert opinions, or collaborative filtering techniques. Here is a step-wise guide to build your understanding on the development of research recommendations.

1. Understand the Research Question:

Understand the research question and objectives before writing recommendations. Also, ensure that your recommendations are relevant and directly address the goals of the study.

2. Review Existing Literature:

Familiarize yourself with relevant existing literature to help you identify gaps , and offer informed recommendations that contribute to the existing body of research.

3. Consider Research Methods:

Evaluate the appropriateness of different research methods in addressing the research question. Also, consider the nature of the data, the study design, and the specific objectives.

4. Identify Data Collection Techniques:

Gather dataset from diverse authentic sources. Include information such as keywords, abstracts, authors, publication dates, and citation metrics to provide a rich foundation for analysis.

5. Propose Data Analysis Methods:

Suggest appropriate data analysis methods based on the type of data collected. Consider whether statistical analysis, qualitative analysis, or a mixed-methods approach is most suitable.

6. Consider Limitations and Ethical Considerations:

Acknowledge any limitations and potential ethical considerations of the study. Furthermore, address these limitations or mitigate ethical concerns to ensure responsible research.

7. Justify Recommendations:

Explain how your recommendation contributes to addressing the research question or objective. Provide a strong rationale to help researchers understand the importance of following your suggestions.

8. Summarize Recommendations:

Provide a concise summary at the end of the report to emphasize how following these recommendations will contribute to the overall success of the research project.

By following these steps, you can create research recommendations that are actionable and contribute meaningfully to the success of the research project.

Download now to unlock some tips to improve your journey of writing research recommendations.

Example of a Research Recommendation

Here is an example of a research recommendation based on a hypothetical research to improve your understanding.

Research Recommendation: Enhancing Student Learning through Integrated Learning Platforms

Background:

The research study investigated the impact of an integrated learning platform on student learning outcomes in high school mathematics classes. The findings revealed a statistically significant improvement in student performance and engagement when compared to traditional teaching methods.

Recommendation:

In light of the research findings, it is recommended that educational institutions consider adopting and integrating the identified learning platform into their mathematics curriculum. The following specific recommendations are provided:

• Implementation of the Integrated Learning Platform:

Schools are encouraged to adopt the integrated learning platform in mathematics classrooms, ensuring proper training for teachers on its effective utilization.

• Professional Development for Educators:

Develop and implement professional programs to train educators in the effective use of the integrated learning platform to address any challenges teachers may face during the transition.

• Monitoring and Evaluation:

Establish a monitoring and evaluation system to track the impact of the integrated learning platform on student performance over time.

• Resource Allocation:

Allocate sufficient resources, both financial and technical, to support the widespread implementation of the integrated learning platform.

By implementing these recommendations, educational institutions can harness the potential of the integrated learning platform and enhance student learning experiences and academic achievements in mathematics.

This example covers the components of a research recommendation, providing specific actions based on the research findings, identifying the target audience, and outlining practical steps for implementation.

Using AI in Research Recommendation Writing

Enhancing research recommendations is an ongoing endeavor that requires the integration of cutting-edge technologies, collaborative efforts, and ethical considerations. By embracing data-driven approaches and leveraging advanced technologies, the research community can create more effective and personalized recommendation systems. However, it is accompanied by several limitations. Therefore, it is essential to approach the use of AI in research with a critical mindset, and complement its capabilities with human expertise and judgment.

Here are some limitations of integrating AI in writing research recommendation and some ways on how to counter them.

1. Data Bias

AI systems rely heavily on data for training. If the training data is biased or incomplete, the AI model may produce biased results or recommendations.

How to tackle: Audit regularly the model’s performance to identify any discrepancies and adjust the training data and algorithms accordingly.

2. Lack of Understanding of Context:

AI models may struggle to understand the nuanced context of a particular research problem. They may misinterpret information, leading to inaccurate recommendations.

How to tackle: Use AI to characterize research articles and topics. Employ them to extract features like keywords, authorship patterns and content-based details.

3. Ethical Considerations:

AI models might stereotype certain concepts or generate recommendations that could have negative consequences for certain individuals or groups.

How to tackle: Incorporate user feedback mechanisms to reduce redundancies. Establish an ethics review process for AI models in research recommendation writing.

4. Lack of Creativity and Intuition:

AI may struggle with tasks that require a deep understanding of the underlying principles or the ability to think outside the box.

How to tackle: Hybrid approaches can be employed by integrating AI in data analysis and identifying patterns for accelerating the data interpretation process.

5. Interpretability:

Many AI models, especially complex deep learning models, lack transparency on how the model arrived at a particular recommendation.

How to tackle: Implement models like decision trees or linear models. Provide clear explanation of the model architecture, training process, and decision-making criteria.

6. Dynamic Nature of Research:

Research fields are dynamic, and new information is constantly emerging. AI models may struggle to keep up with the rapidly changing landscape and may not be able to adapt to new developments.

How to tackle: Establish a feedback loop for continuous improvement. Regularly update the recommendation system based on user feedback and emerging research trends.

The integration of AI in research recommendation writing holds great promise for advancing knowledge and streamlining the research process. However, navigating these concerns is pivotal in ensuring the responsible deployment of these technologies. Researchers need to understand the use of responsible use of AI in research and must be aware of the ethical considerations.

Exploring research recommendations plays a critical role in shaping the trajectory of scientific inquiry. It serves as a compass, guiding researchers toward more robust methodologies, collaborative endeavors, and innovative approaches. Embracing these suggestions not only enhances the quality of individual studies but also contributes to the collective advancement of human understanding.

Frequently Asked Questions

The purpose of recommendations in research is to provide practical and actionable suggestions based on the study's findings, guiding future actions, policies, or interventions in a specific field or context. Recommendations bridges the gap between research outcomes and their real-world application.

To make a research recommendation, analyze your findings, identify key insights, and propose specific, evidence-based actions. Include the relevance of the recommendations to the study's objectives and provide practical steps for implementation.

Begin a recommendation by succinctly summarizing the key findings of the research. Clearly state the purpose of the recommendation and its intended impact. Use a direct and actionable language to convey the suggested course of action.

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Research Recommendations Process and Methods Guide [Internet]

• PMID: 27466642
• Bookshelf ID: NBK310373

The foundation of NICE guidance is the synthesis of evidence primarily through the process of systematic reviewing and, if appropriate, modelling and cost effectiveness decision analysis. The results of these analyses are then discussed by independent committees. These committees include NHS staff, healthcare professionals, social care practitioners, commissioners and providers of care, patients, service users and carers, industry and academics. Stakeholders have the opportunity to comment on draft recommendations before they are finalised. Not only does this process explicitly describe the evidence base, it also identifies where there are gaps, uncertainties or conflicts in the existing evidence.

Many of these uncertainties, although interesting to resolve, are unlikely to affect people’s care or NICE’s ability to produce guidance. However, if these uncertainties may have an effect on NICE’s recommendations it is important for NICE to liaise with the research community to ensure they are addressed. NICE does this by making recommendations for research, which are communicated to researchers and funders. At the time guidance is issued, NICE’s staff and committees have a thorough understanding of the current evidence and valuable insights into uncertainties that need to be resolved. It is important that these are capitalised on.

To undertake its national role effectively, NICE needs to ensure that:

the process of developing the research recommendations is robust, transparent and involves stakeholders

we identify research priorities

we make all research recommendations clearly identifiable in the guidance

the research recommendations provide the information necessary to support research commissioning

the research recommendations are available to researchers and funders by promoting them (for example through the research recommendations database)

the research recommendations are relevant to current practice

we communicate well with the research community.

This process and methods guide has been developed to help guidance-producing centres make research recommendations. It describes a step-by-step approach to identifying uncertainties, formulating research recommendations and research questions, prioritising them and communicating them to the NICE Science Policy and Research (SP&R) team, researchers and funders. It has been developed based on the SP&R team’s interactions with research funders and researchers, as well as with guidance developers.

Keywords: research gaps; uncertainties; research recommendations; NICE Process and Methods Guides.

Copyright © 2015 National Institute for Health and Clinical Excellence, unless otherwise stated. All rights reserved.

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• How to Write Recommendations in Research | Examples & Tips

How to Write Recommendations in Research | Examples & Tips

Published on 15 September 2022 by Tegan George .

Recommendations in research are a crucial component of your discussion section and the conclusion of your thesis , dissertation , or research paper .

As you conduct your research and analyse the data you collected , perhaps there are ideas or results that don’t quite fit the scope of your research topic . Or, maybe your results suggest that there are further implications of your results or the causal relationships between previously-studied variables than covered in extant research.

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Table of contents

What should recommendations look like, building your research recommendation, how should your recommendations be written, recommendation in research example, frequently asked questions about recommendations.

Recommendations for future research should be:

• Concrete and specific
• Supported with a clear rationale
• Directly connected to your research

Overall, strive to highlight ways other researchers can reproduce or replicate your results to draw further conclusions, and suggest different directions that future research can take, if applicable.

Relatedly, when making these recommendations, avoid:

• Undermining your own work, but rather offer suggestions on how future studies can build upon it
• Suggesting recommendations actually needed to complete your argument, but rather ensure that your research stands alone on its own merits
• Using recommendations as a place for self-criticism, but rather as a natural extension point for your work

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There are many different ways to frame recommendations, but the easiest is perhaps to follow the formula of research question   conclusion  recommendation. Here’s an example.

Conclusion An important condition for controlling many social skills is mastering language. If children have a better command of language, they can express themselves better and are better able to understand their peers. Opportunities to practice social skills are thus dependent on the development of language skills.

As a rule of thumb, try to limit yourself to only the most relevant future recommendations: ones that stem directly from your work. While you can have multiple recommendations for each research conclusion, it is also acceptable to have one recommendation that is connected to more than one conclusion.

These recommendations should be targeted at your audience, specifically toward peers or colleagues in your field that work on similar topics to yours. They can flow directly from any limitations you found while conducting your work, offering concrete and actionable possibilities for how future research can build on anything that your own work was unable to address at the time of your writing.

See below for a full research recommendation example that you can use as a template to write your own.

The current study can be interpreted as a first step in the research on COPD speech characteristics. However, the results of this study should be treated with caution due to the small sample size and the lack of details regarding the participants’ characteristics.

Future research could further examine the differences in speech characteristics between exacerbated COPD patients, stable COPD patients, and healthy controls. It could also contribute to a deeper understanding of the acoustic measurements suitable for e-health measurements.

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While it may be tempting to present new arguments or evidence in your thesis or disseration conclusion , especially if you have a particularly striking argument you’d like to finish your analysis with, you shouldn’t. Theses and dissertations follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the discussion section and results section .) The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

The conclusion of your thesis or dissertation should include the following:

• A restatement of your research question
• A summary of your key arguments and/or results
• A short discussion of the implications of your research

For a stronger dissertation conclusion , avoid including:

• Generic concluding phrases (e.g. “In conclusion…”)
• Weak statements that undermine your argument (e.g. “There are good points on both sides of this issue.”)

Your conclusion should leave the reader with a strong, decisive impression of your work.

In a thesis or dissertation, the discussion is an in-depth exploration of the results, going into detail about the meaning of your findings and citing relevant sources to put them in context.

The conclusion is more shorter and more general: it concisely answers your main research question and makes recommendations based on your overall findings.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

George, T. (2022, September 15). How to Write Recommendations in Research | Examples & Tips. Scribbr. Retrieved 9 April 2024, from https://www.scribbr.co.uk/thesis-dissertation/research-recommendations/

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O’Hara R, Johnson M, Hirst E, et al. A qualitative study of decision-making and safety in ambulance service transitions. Southampton (UK): NIHR Journals Library; 2014 Dec. (Health Services and Delivery Research, No. 2.56.)

A qualitative study of decision-making and safety in ambulance service transitions.

Chapter 8 conclusions and recommendations.

The aim of this study was to explore the range and nature of influences on safety in decision-making by ambulance service staff (paramedics). A qualitative approach was adopted using a range of complementary methods. The study has provided insights on the types of decisions that staff engage in on a day-to-day basis. It has also identified a range of system risk factors influencing decisions about patient care. Although this was a relatively small-scale exploratory study, confidence in the generalisability of the headline findings is enhanced by the high level of consistency in the findings, obtained using multiple methods, and the notable consensus among participants.

The seven predominant system influences identified should not be considered discrete but as overlapping and complementary issues. They also embody a range of subthemes that represent topics for future research and/or intervention.

The apparently high level of consistency across the participating trusts suggests that the issues identified may be generic and relevant to other ambulance service trusts.

In view of the remit of this study, aspects relating to system weaknesses and potential threats to patient safety dominate in the account of findings. However, it should be noted that respondent accounts also provided examples of systems that were said to be working well, for example specific care management pathways, local roles and ways of working and technological initiatives such as IBIS and the ePRF.

• Implications for health care

The NHS system within which the ambulance service operates is characterised in our study as fragmented and inconsistent. For ambulance service staff the extent of variation across the geographical areas in which they work is problematic in terms of knowing what services are available and being able to access them. The lack of standardisation in practice guidelines, pathways and protocols across services and between areas makes it particularly challenging for staff to keep up to date with requirements in different parts of their own trust locations and when crossing trust boundaries. Although a degree of consistency across the network is likely to improve the situation, it is also desirable to have sufficient flexibility to accommodate the needs of specific local populations. There was some concern over the potential for further fragmentation with the increased number of CCGs.

Ambulance services are increasingly under pressure to focus on reducing conveyance rates to A&E; this arguably intensifies the need to ensure that crews are appropriately skilled to be able to make effective decisions over the need to convey or not to convey if associated risks to patients are to be minimised. Our findings highlight the challenges of developing staff and ensuring that their skills are utilised where they are most needed within the context of organisational resource constraints and operational demands. Decisions over non-conveyance to A&E are moderated by the availability of alternative care pathways and providers. There were widespread claims of local variability in this respect. Staff training and development, and access to alternatives to A&E, were identified as priorities for attention by workshop attendees.

One of the difficulties for ambulance services is that they operate as a 24/7 service within a wider urgent and emergency care network that, beyond A&E, operates a more restricted working day. The study findings identify this as problematic for two reasons. First, it fuels demand for ambulance service care as a route to timely treatment, when alternatives may involve delay. Second, it contributes to inappropriate conveyance to A&E because more appropriate options are unavailable or limited during out-of-hours periods. Ultimately, this restricts the scope for ensuring that patients are getting the right level of care at the right time and place. Study participants identified some patient populations as particularly poorly served in terms of alternatives to A&E (e.g. those with mental health issues, those at the end of life, older patients and those with chronic conditions).

The effectiveness of the paramedic role in facilitating access to appropriate care pathways hinges on relationships with other care providers (e.g. primary care, acute care, mental health care, community health care). An important element relates to the cultural profile of paramedics in the NHS, specifically, the extent to which other health professionals and care providers consider the clinical judgements/decisions made by paramedics as credible and actionable. Staff identified this as a barrier to access where the ambulance service is still viewed primarily as a transport service. Consideration could be given to ways of improving effective teamworking and communication across service and professional boundaries.

Although paramedics acknowledged the difficulties of telephone triage, they also identified how the limitations of this system impact on them. Over-triage at the initial call-handling stage places considerable demands on both staff and vehicle resources. A related concern is the limited information conveyed to crews following triage. Initial triage was suggested as an area that warrants attention to improve resource allocation.

The findings highlight the challenges faced by front-line ambulance service staff. It was apparent that the extent and nature of the demand for ambulance conveyance represents a notable source of strain and tension for individuals and at an organisational level. For example, there were widespread claims that meeting operational demands for ambulance services limits the time available for training and professional development, with this potentially representing a risk for patients and for staff. Staff perceptions of risk relating to patient safety extend to issues of secondary risk management, that is, personal and institutional liabilities, in particular risks associated with loss of professional registration. The belief that they are more likely to be blamed than supported by their organisation in the event of an incident was cited by staff as a source of additional anxiety when making more complex decisions. This perceived vulnerability can provoke excessively risk-averse decisions. These issues merit further attention to examine the workforce implication of service delivery changes, including how to ensure that staff are appropriately equipped and supported to deal effectively with the demands of their role.

Paramedics identified a degree of progress in relation to the profile of patient safety within their organisations but the apparent desire within trusts to prioritise safety improvement was felt to be constrained by service demands and available resources. Attempts to prioritise patient safety appear to focus on ensuring that formal systems are in place (e.g. reporting and communication). Concerns were expressed over how well these systems function to support improvement, for example how incident reports are responded to and whether lessons learned are communicated to ambulance staff within and between trusts. Consideration could be given to identifying ways of supporting ambulance service trusts to develop the safety culture within their organisation.

Service users attributed the increased demand for ambulance services to difficulties in identifying and accessing alternatives. They were receptive to non-conveyance options but felt that lack of awareness of staff roles and skills may cause concern when patients expect conveyance to A&E.

• Recommendations for research

The workshop attendees identified a range of areas for attention in relation to intervention and research, which are provided in Chapter 6 (see Suggestions for potential interventions and research ). The following recommendations for research are based on the study findings:

• Limited and variable access to services in the wider health and social care system is a significant barrier to reducing inappropriate conveyance to A&E. More research is needed to identify effective ways of improving the delivery of care across service boundaries, particularly for patients with limited options at present (e.g. those with mental health issues, those at the end of life and older patients). Research should address structural and attitudinal barriers and how these might be overcome.
• Ambulance services are increasingly focused on reducing conveyance to A&E and they need to ensure that there is an appropriately skilled workforce to minimise the potential risk. The evidence points to at least two issues: (1) training and skills and (2) the cultural profile of paramedics in the NHS, that is, whether others view their decisions as credible. Research could explore the impact of enhanced skills on patient care and on staff, for example the impact of increased training in urgent rather than emergency care. This would also need to address potential cultural barriers to the effective use of new skills.
• Research to explore the impact of different aspects of safety culture on ambulance service staff and the delivery of patient care (e.g. incident reporting, communication, teamworking, and training) could include comparisons across different staff groups and the identification of areas for improvement, as well as interventions that could potentially be tested.
• The increased breadth of decision-making by ambulance service crews with advanced skills includes more diagnostics; therefore, there is a need to look at the diagnostic process and potential causes of error in this environment.
• There is a need to explore whether there are efficient and safe ways of improving telephone triage decisions to reduce over-triage, particularly in relation to calls requiring an 8-minute response. This could include examining training and staffing levels, a higher level of clinician involvement or other forms of decision support.
• There is a need to explore public awareness of, attitudes towards, beliefs about and expectations of the ambulance service and the wider urgent and emergency care network and the scope for behaviour change interventions, for example communication of information about access to and use of services; empowering the public through equipping them with the skills to directly access the services that best meet their needs; and informing the public about the self-management of chronic conditions.
• A number of performance measures were identified engendering perverse motivations leading to suboptimal resource utilisation. An ongoing NIHR Programme Grant for Applied Research (RP-PG-0609–10195; ‘Pre-hospital Outcomes for Evidence-Based Evaluation’) aims to develop new ways of measuring ambulance service performance. It is important that evaluations of new performance metrics or other innovations (e.g. Make Ready ambulances, potential telehealth technologies or decision-support tools) address their potential impact on patient safety.

Included under terms of UK Non-commercial Government License .

• Cite this Page O’Hara R, Johnson M, Hirst E, et al. A qualitative study of decision-making and safety in ambulance service transitions. Southampton (UK): NIHR Journals Library; 2014 Dec. (Health Services and Delivery Research, No. 2.56.) Chapter 8, Conclusions and recommendations.
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