Diana Egerton-Warburton: Bringing research to life with stories.
When FACEM Professor Diana Egerton-Warburton OAM talks about encouraging more people to explore a career in research, it’s driven by her belief that it’s a professional pathway that makes creating sustainable change possible.
It’s a career that’s also “incredibly rewarding” says Diana, the head researcher on ACEM’s newly released report, Alcohol-Related Harm in Australasian Emergency Departments, that surveyed ED staff on the impacts of alcohol-related presentations.
“There’s only limited things we can do in the emergency department to influence health outcomes for the community, “ she says, “so by expanding our research to policy and advocacy, we can have a much bigger impact.”
To help explain her desire to work in emergency medicine, Diana describes herself as “a very practical person”.
“I love the fact that emergency physicians are sort of the Jills, or Jacks, of all trades. We’re not limited to one particular area – and that’s exciting”.
““Community is the funders of our healthcare and the funders of our research – both directly and indirectly – so we need to involve them.””
Her focus on working in public health was another carefully considered decision.
“Many doctors – whether they’re specialists or GPs – end up as small business owners. I think that’s very tricky and conflicting, so I liked the ideal of working in public health so I can focus on quality of care and outcomes.”
But she acknowledges that finding success in the field of research comes back to money, too. “It’s about getting the funding to do the type of research that you want to do.”
Filling in grant applications to access that much-needed money can feel like “a soul-destroying process,” she says. But “I do feel very fortunate to have the ability to apply for grants.”
After years of honing her grant writing skills, Diana understands how to effectively angle grant applications so that those involved can see the value of the money for the projects. Equally important, she says, is making sure the community sees the value for money and the outcomes too.
ACEM’s Alcohol-Related Harm in Australasian Emergency Departments was released in April 2024.
Learning from lived experiences
The sobering findings from ACEM’s Alcohol-Related Harm in Australasian Emergency Departments echo the findings from a similar ACEM study ten years earlier.
That doesn’t question the value of the research, Diana says, but reinforces the reality that genuine change only happens when research is acted on. “It highlights the urgent need for implementation of greater policy action by decision-makers and governments.”
Leaping the implementation gap divide
Inaction, she says, widens what she refers to as an “implementation gap – the chasm that happens between the research being released and it actually being implemented”.
It’s a gap she says can expose weakness in the delivery of quality care because it means that clinicians don’t always get timely access to up-to-date information.
“We have a huge amount of complex behaviour change work to do about how we bring forward the implementation of the findings the research uncovers,” she says, adding that she knows it won’t happen overnight.
“On average, when we have new information about a procedure or a drug or a treatment working or not – it takes 17 years to be inculcated into clinical research.“
This delay, she believes, is “pretty staggering.”
The reasons why implementation of research needs to happen faster are evidenced in the updated finding about the impact of alcohol in EDs across Australia and Aotearoa.
““It also tells us that alcohol harm leads to occupational violence and aggression that is unacceptable. Clinicians shouldn’t be experiencing it. Although it happens every day, it shouldn’t be seen as an everyday part of our work.””
Gathering any research data, she says, is an important early step in a lengthy and multifaceted process that should involve numerous stakeholders.
Combining research data with findings revealed by the police, policy makers and other multidisciplinary clinicians, for example, can help create compelling arguments for policy changes that could actively reduce the potential harm of alcohol in the ED.
ACEM support is critical
ACEM’s commitment to research on alcohol’s impact in the ED is heartening, Diana says.
“For the clinicians who are experiencing this type of alcohol-related violence and aggression, to see that their experience is being recognised and they’re not just having to deal with it by themselves – that the College is recognising it and advocating for it – is a powerful step forward.”
The report clearly highlights that alcohol harm in the ED is an “every day problem”, Diana says.
“It also tells us that alcohol harm leads to occupational violence and aggression that is unacceptable,” she says. “Clinicians shouldn’t be experiencing it. Although it happens every day, it shouldn’t be seen as an everyday part of our work.”
“The fact that nine out of 10 clinicians have experienced violence or threats of violence stands out. Another thing that stands out is the stories people tell about their experiences. Hearing those stories is so important – both for the person whose voice is heard and the for the people listening who can be compelled to find solutions about how we can get people to say ‘enough is enough’.”
Quality story-driven research relies on funding
Historically, she says research drawing on people’s stories hasn’t always seemed like “proper science”. But by combining these stories with hard data, Diana believes that research comes to life and can be made more meaningful.
“The most amazing experience” of hearing “this burly police officer” share data and tell her that his last 100 assault cases included 99 involving alcohol-related harm strengthened her resolve to utilise story-centric research to drive change.
“He describes the College project partnership we’d done as the biggest thing he’d done in his thirty years of community policing.”
Key findings from ACEM’s Alcohol-Related Harm in Australasian Emergency Departments.
To quote researcher Brené Brown, Diana says research stemming from real people’s experiences is “like data with souls”.
“That’s been a very helpful analogy when I talk to Ministers and policymakers to put those stories, as well as the data, forward to help influence policymakers and create the beginnings of meaningful change.”
Funding bodies “coming on board” to recognise the important part story-driven research plays in the ability to provide sustainable healthcare is, Diana says, “going to happening more and more”.
But she says accessing greater support for funding research projects is about community connections as well. “Community is the funders of our healthcare and the funders of our research – both directly and indirectly – so we need to involve them,” says Diana.
With a lot of her research focused on what she calls “unhelpful care”, she says explaining her needs to policy makers can “be tricky”.
“Because we know that about 10 per cent of healthcare is actually harmful, and 30 per cent has an element of low-value care, when you add that up it just blows your mind that 40 per cent of what doctors do is not really helping,” Diana says.
Fortunately, Diana laughs, one of her characteristics is that “I am a bit like a dog with a bone”.
She says that persistence is an important trait for anyone working in research. “You have to keep pushing and keep telling the story and accept that there will sometimes be setbacks. We need research updated and repeated because we need a continuous idea of the scale of the problem – and to create lasting change, we need all jurisdictions to agree.”
It’s the type of change-making that might take 20-30 years. “But it doesn’t mean it’s not worth trying to make it happen.”
A hope to see more women in leadership
Diana hopes to see more women moving into research leadership roles and says that, because it’s underpinned by exceptional listening skills and analytical skills, research is a great field for women to explore.
Changes are needed within key funding bodies to continue to improve funding equity, she says – but things are slowly getting better. “There’s still an over-representation of women in junior research roles, and an over-representation of men in more senior areas but we are moving in the right direction.”
Diana’s message to women who have an interest in research is clear: “There’s no time like the present to get involved.”
