In praise of the feasibility study
Just like other academics, nurses engaged in the pursuit of research excellence generally need to construct fundable research projects and write about them, in the hope of attracting further funds to develop the research. This cyclical process can be exciting, but securing funding can seem like a quest for the Holy Grail and the constant rejections are disheartening.
Putting a successful research proposal together is like doing a jig-saw puzzle. People approach jig-saws in different ways, such as finding the straight edges first, putting the frame together and then filling the frame a section at a time. However, we sometimes present a research proposal that is not finished. A few of the edge pieces are missing and some of the sky detail is not complete. This may look fine to us; we can complete those details once the research is funded; however, if the funding body cannot tell what the picture is supposed to represent, it is unlikely to fund it.
The ‘hit rate’ for successful proposals varies, but if we estimate it at 1 in 10, then the time and effort spent on nine proposals can be regarded as a wasted effort by those new to the process. Further, as unfunded research becomes less popular (or at least less supported in resource poor institutions), those with ideas that do not fit readily within funding streams, or who prefer to work on solo projects, can find it difficult to pursue their research. Funding bodies prefer to fund research that would be successful, usually because at least one of the applicants has a convincing track record, or because some pilot work has already been undertaken or published. Pilot studies seem to be losing ground in both the funding and publication stakes, but are, nonetheless, essential to successful studies. With this chain of reasoning in mind, I want to raise the status of the prepilot, the feasibility study, as a potentially helpful endeavour in writing those ephemeral and eternal proposals.
According to Wikepedia (2006):
A feasibility study is a preliminary study undertaken before the real work of a project starts to ascertain the likelihood of the project's success. It is an analysis of possible solutions to a problem and a recommendation on the best solution to use.
We tend to pay fleeting attention to this in research. According to Wilcox (2006), a feasibility study should contain the following key criteria:
- • A well-conceived start up process involving key interests in developing a bid to funders;
- • Recruiting high-calibre people from public, private and voluntary sectors to develop a shared mission;
- • Establishing sound management practices;
- • Planning for financial sustainability from the start.
Any feasibility work should, therefore, aim to answer the question: How can we create a competent research proposal? Of course many research proposals do not require a feasibility study, but it is not uncommon for projects to struggle because they did not account fully for variations in practice that then affect recruitment, or a divergence between the researchers’ ideas and those of the clinical staff who would be most affected by the study. Feasibility studies are particularly useful when it is just not clear whether a proposal can be successful or not. When the Higher Education Funding Council for England wanted to estimate the volume and impact of activities taking place within the Aimhigher scheme, a feasibility study was required ‘partly because it was not apparent whether a reliable measure of net impact could be achieved either at all or, even if possible, at anything like reasonable cost and/or by the time results were needed in 2006’ (HEFCE 2003). In the world of computing, feasibility studies follow a format known as TELOS, where the technical, economic, legal, operational and schedule feasibility of a project is tested before the project is undertaken to see if it is practical at all (Free On-Line Dictionary of Computing 2006). This is a productive framework as all the elements should be included in a well-constructed proposal. I would add two more components, however political feasibility and collaborative feasibility (giving the acronym TELCOSP). Systematic consideration of each component will establish whether some sort of feasibility study is required.
Some research studies require a level of technology (computing, electronic devices, equipment) that may need to be tested or developed. For example, is it feasible for nurses to carry with them an electronic device in areas of high technology, such as the intensive care unit? Does the online interface required for an educational proposal work with a dial-up connection? In this stage, it is important to test different packages, staffing and funding which may form the basis of the bid. Further, does the research team have the necessary expertise to use the technology?
The first requirement here is to understand what funders may offer, and gain permission for anything above and beyond that. Charity funding, for example, may not pay for an applicant's time, or will not pay institutional overheads. If the project is going to include an average day a week of the principal investigator's (PI) time, is the PI’s organization happy to support this? Although it should not be the case, experience suggests that costing a bid tends to be a matter of including absolutely everything possible, and then working backwards to see what can be shaved off to meet the funder's allowance. The ‘bottom-line’ here though is to ensure that a project is cost-effective, and that the benefits outweigh the cost.
This is an increasingly litigious world. Two recent medical research ethics committees (MREC) I had attended with PhD students have contested the legality of the proposals, not the ethics. Indeed, since 2004, UK ethics committees have a basis in law (Barrett & Coleman 2005). Although closely aligned, legal issues should be considered separately to ethics. Therefore, is there any conflict between the proposed research and legal requirements (e.g. the Data Protection Act?). Recruitment in one of the PhD proposals involved contacting staff through the lead nurse. The MREC pronounced that this was illegal and a new way round this had to be found. In another study, although social workers had full permission to access case files, the MREC (only contacted because there was a nurse on the proposal) and the legal department disallowed this on legal grounds. Nurses are very good at exploring the ethical issues of a proposal, but it is the legalities that can trip us up. Legal feasibility may mean contacting the Nursing and Midwifery Council or General Medical Council and this takes time that is not always accounted for fully. And what is legal in one country may not be in another.
Deciding on who should be involved in a project is usually easy. Key players probably start out with an idea, and then expand the research team to include the necessary expertise, for example, a statistician. But sometimes, it is not clear who should be involved, or how to find them. I have recently been writing two proposals to be undertaken in countries of low economic resource. Telephone and e-mail facilities are unreliable at best. Developing and discussing a concept of what the project may be like with several interests is crucial (Wilcox 2006), but the usual avenues of doing this were closed. Site visits therefore formed an important (and costly) part of the feasibility study. Further, it is also important at this point to recruit key players who may sponsor, support, or play a part in the project, perhaps as an advisory group.
Operational feasibility is one of those aspects of a proposal that is not always mapped out properly. Are current work practices and procedures adequate to support the proposed research? Do shift patterns on a ward preclude adequate data collection? If the research concerns people admitted acutely to hospital, is the research assistant able to work evenings, nights and weekends (when perhaps most acute admissions occur)? Operational feasibility was particularly important to us in setting up the overseas projects. This phase may include a local audit or appraisal of the challenges and opportunities in an area, finding out who is doing what, and the resources that may be available. It may mean negotiating access through unusual means and finding the best ways of capturing data in a foreign (and perhaps unwritten) language. What seems simple in a large and modern university may be impossible in a remote and rural primary care facility.
All good proposals include a timetable, but in some cases, it may be important to trial the feasibility of the planned timings. Recruitment, for example, usually takes longer than expected. However, there are other aspects to consider. Are laboratories able to deal with the necessary results in the proposed turnaround time? Public holidays vary between countries (even between regions) and these need to be accounted for in the schedule feasibility stage. It is, generally, not recommended to ask funders for an extension.
All good research should consider the political aspects carefully (Fetterman 1983). Politically, do the results have the potential to upset anyone? If the government has invested in a new service, what happens if your research demonstrates that is a waste of taxpayer's money? Morally, yes, but do not underestimate the political consequences of such a move (Taylor & Cantrell 2003). Research in countries of lower resource may not be best undertaken by foreigners, which may be tainted with imperialism (Wilmshurst 1997).
In praise of feasibility studies
The feasibility of a proposal always needs to be considered, and using the TELCOSP framework might be helpful. For some proposals, however, where there are many unknowns (e.g. research in countries of lower resource), I would advocate feasibility studies as essential prerequisites for such studies.