Determinants of surgical department research success

Surgical departments play a vital role in advancing patient care through the research and development of new surgical techniques, evidence-based practices, and innovative treatments.1 Their contributions extend beyond clinical practice, encompassing the training of the next generation of academic surgical staff, fostering professional growth, and upholding excellence in surgical education and research.2 A successful research program within surgical departments not only enhances patient outcomes but also strengthens evidence-based decision-making and provides valuable career opportunities for all multidisciplinary staff involved in surgery.3 Despite these benefits, many surgical departments struggle to establish and maintain successful research initiatives.4, 5 Studies examining research capacity across healthcare settings have highlighted substantial variability in research capabilities, even within major teaching hospitals.6 These variations are frequently associated with differences in infrastructure, availability of protected research time, access to funding, and mentorship opportunities. These issues are compounded by common barriers such as heavy clinical demands and complex regulatory requirements.7 While general frameworks for building research capacity exist, there is limited evidence that specifically addresses the factors that contribute to the success of surgical research.8, 9 Understanding the unique challenges and opportunities within surgical research is crucial for identifying the factors that enable departments to overcome these barriers and achieve success.10 Therefore, the primary aim of this study was to identify key measures of research success within surgical departments. The secondary aims of this study were to determine the key steps needed to achieve each of the identified determinants and to identify aspects that would support (facilitators) and prevent (barriers) a surgical department from achieving them. This study employed a three-round survey methodology across 16 surgical departments (including breast surgery, cardiothoracic, colorectal, ear nose & throat, benign gynaecology, gynae-oncology, head & neck, hepatobiliary & upper gastrointestinal surgery, melanoma & surgical oncology, neurosurgery, ophthalmology, orthopaedics, plastic & reconstructive surgery, transplantation, urology and vascular surgery) at the Royal Prince Alfred Hospital, in Sydney, Australia.11 The surgical department research leads from each department were invited to participate using a secure web-based platform over three survey rounds. The first survey round collected departmental metrics including the number of active research projects, publications, and higher degree by research (HDR) students and asked participants to identify key determinants of surgical research success. The second round focused on identifying the key steps needed to achieve the determinants identified in round one. The final round explored facilitators and barriers to achieving the key steps identified in round two. Each round included an initial contact followed by two reminder emails for non-responders at 10- and 20-days after the initial survey. Participation was voluntary, with implied consent assumed from survey responses. Data was analysed using descriptive statistics. Human Ethics and Governance approvals were obtained from the Sydney Local Health District Human Research Ethics Committee (2023/ETH01887). Among the 16 surgical departments invited to participate, 11 department leads (69%) completed the surveys. Participating departments had a median of 14.0 active research projects (IQR = 9.0–41.0), of which 4.0 (IQR = 2.0–5.5) were externally funded. Departments maintained a median of 1.5 full-time equivalent research assistants (IQR = 0.75–2.0), published a median of 20 publications annually (IQR = 15.0–35.0) and reported a median of 3 (IQR = 2.0–5.5) enrolled HDR students. The study identified 11 themes of surgical research success, with three emerging as key determinants: external collaboration (Fig. 1a), academic output (Fig. 1b), and internal engagement (Fig. 1c). External collaboration (Fig. 1a) focused on the importance of partnerships beyond the department, including interdisciplinary alliances, external funding opportunities, and institutional networking. This was thought to be achieved through fostering meaningful relationships with external stakeholders, securing collaborative research grants, and leveraging institutional partnerships. Key facilitators included robust institutional support, access to established networks, and shared research goals. Barriers to this determinant included competing priorities, limited access to external funding, and a lack of collaborative infrastructure. Academic output (Fig. 1b) focused on the measurable and impactful outcomes of research, such as peer-reviewed publications, conference presentations, and the development of innovative clinical applications. Steps to enhance academic output were thought to involve setting clear research objectives, adhering to high-quality methodological standards, and ensuring effective dissemination of findings. Facilitators for achieving strong academic output included supporting skilled researchers, mentorship opportunities, and efficient dissemination platforms, whereas perceived barriers were related to publishing challenges, insufficient research expertise, and lack of collaborative opportunities. Internal engagement (Fig. 1c) focused on fostering a supportive and research-driven departmental culture. This included active departmental leadership, engagement of the entire surgical team in research activities, and recognition of individual and team contributions to research. Steps to strengthen internal engagement were thought to involve creating platforms for open communication, providing incentives for research involvement, and prioritizing research in departmental agendas. Facilitators included strong leadership support, cohesive team dynamics, and observable recognition of research achievements. Perceived barriers included competing clinical priorities, inadequate leadership focus, and insufficient resources for internal initiatives. The remaining themes identified in this study included research support staff, database management, HDR students, infrastructure, recognition of research activity, clinical translation, experienced high-volume surgical department, and leadership. These themes, while important, were ranked lower in priority compared to the three key determinants. The results of this study provide surgical departments with a comprehensive overview of how to enhance research success through targeted strategies that create positive feedback loops between external partnerships, academic productivity, and internal organizational development. The identification of key determinants offers practical value beyond theoretical frameworks. For example, strong internal engagement often drives external partnerships, which can lead to increased funding opportunities and, subsequently, enhanced academic output. This cyclical relationship suggests that even resource-limited departments can build research capacity by strategically focusing on strengthening these core elements, rather than attempting to address all potential barriers simultaneously.12 It is worth noting that the participating surgical departments (11 out of 16) in this study were generally research-active units with established track records of academic output and ongoing projects. While this could be viewed as a limitation, as perspectives from less research-active departments might differ, it actually strengthens the findings of the study, as the results come from departments that have successfully navigated the challenges of building robust surgical research departments. Their experiences provide valuable information for departments seeking to enhance their research capacity, as less active departments may not have the experience to identify the key determinants of research success. Several critical questions emerge from this work that warrant further investigation. Future research should examine how these determinants manifest across different healthcare systems and resource settings. Development of standardized assessment tools based on these findings could assist departments to benchmark their research capacity and identify specific areas for improvement. Furthermore, longitudinal studies tracking the implementation of targeted interventions based on these determinants would provide valuable insights into their practical effectiveness. As surgical departments in Australia continue to navigate challenges in balancing clinical demands with research objectives, the framework established by this study provides a foundation for growing sustainable research programs that advance surgical evidence and may ultimately improve patient outcomes. Daniel Steffens: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; writing – original draft. Michael Solomon: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; resources; supervision; writing – review and editing. Sascha Karunaratne: Data curation; formal analysis; project administration; writing – review and editing. Kate Alexander: Conceptualization; data curation; formal analysis; project administration; writing – review and editing. Charbel Sandroussi: Conceptualization; investigation; methodology; resources; supervision; writing – review and editing. Kate McBride: Conceptualization; formal analysis; funding acquisition; investigation; methodology; resources; supervision; writing – review and editing. Sophie Hogan: Conceptualization; investigation; methodology; resources; writing – review and editing. Sharon Carey: Conceptualization; investigation; methodology; resources; writing – review and editing. Jonathan Clark: Conceptualization; formal analysis; investigation; methodology; resources; writing – review and editing. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.