Reducing the Research Footprint: A Sustainable Quality Improvement Evaluation of Electronic Investigator Site Files

This project was completed as part of the 2026 Hampshire Hospitals NHS FT Green Team Competition. 

Team members

Cate Lee (R&D Governance Manager), Emma Levell (Senior Research Nurse, Surgical Division) and Hayley Cousins (Research Nurse, Medical Division). 

Setting / patient group

This project was undertaken within the Research and Development Department at Hampshire Hospitals NHS Foundation Trust (HHFT). The department supports more than 65 research studies across over 20 clinical specialties and recruited 3,264 participants during 2025-26. The project focused on research administration and governance processes rather than a specific patient group. 

Issue

Research activity at HHFT relies heavily on paper-based Investigator Site Files (ISFs), requiring large volumes of printing, filing, archiving, storage, transport and document retrieval. Research documentation must be retained for up to 25 years and be available for regulatory inspection. The existing system depends on paper records, local drives and multiple unintegrated systems, creating duplication, administrative burden, storage pressures and increasing challenges relating to document control, audit trails, inspection readiness and sustainability. 

Intervention

The team evaluated the impact of replacing paper-based Investigator Site Files with the Florence Healthcare electronic Investigator Site File (eISF) platform. Process mapping, stakeholder engagement, staff surveys and sustainability modelling were used to compare current and proposed workflows and to estimate implementation, training and operational costs associated with adoption.

The next step is to progress organisational approval, via a successful business case to the trust board, and implementation planning for Florence Healthcare

Potential outcomes

Clinical
The project does not alter patient treatment pathways, eligibility for research or clinical interventions. However, electronic document management is expected to improve document accessibility, version control and oversight, enabling research teams to spend less time on administration and more time supporting research delivery, participant recruitment and study conduct, while maintaining standards of governance, regulatory compliance, inspection readiness, participant safety oversight and data quality. 

Environmental
Modelling estimated that the current paper-based pathway generates 2,186. kgCO₂e annually compared with 130 kgCO₂e for the proposed digital pathway. This equates to a projected annual carbon saving of 2,056 kgCO₂e, representing a 94% reduction in emissions associated with research document management and archiving. 

Financial
The current paper-based pathway was estimated to cost £75,639 per year compared with £43,567 for the proposed digital pathway. This represents a projected first-year saving of £32,073. Once implementation and training costs have been absorbed, annual recurring savings are estimated at approximately £43,361 Over five years, cumulative savings are projected to reach £205,515. Savings are primarily associated with reductions in paper use, printing, filing, transport, archiving, document retrieval and related staff time. 

Social
Nineteen staff members completed a survey. Eighty-seven percent reported that reducing the environmental impact of research was highly important, 88% believed the department should place greater emphasis on sustainability, and 92% supported digital archiving. Eighty-nine percent reported insufficient storage space for paper files. Staff identified significant time spent obtaining signatures, maintaining paper records and preparing studies for archiving. The proposed electronic system is expected to reduce these administrative burdens, improve access to documentation, reduce manual handling requirements and support reallocation of staff time towards research delivery and participant-facing activities. 

Key learning point

The project demonstrated that electronic archiving has the potential to deliver substantial environmental, financial and social benefits while maintaining research governance and compliance requirements. However, the evaluation was based on modelling assumptions rather than implementation, highlighting the importance of collecting robust activity data and undertaking prospective evaluation following implementation. The team also identified that successful adoption would require investment in implementation, training, information governance assurance, cyber security review and organisational change management