Marleen Bekker

Hybrid Management Configurations in Joint Research

Researchers are increasingly expected to deliver “socially robust knowledge” that is not only scientifically reliable but also takes into account demands from societal actors. This article focuses on an empirical example where these additional criteria are explicitly organized into research settings. We investigate how the multiple “accountabilities” are managed in such “responsive research settings.” This article provides an empirical account of such an organizational format: the Dutch Academic Collaborative Centres for Public Health. We present a cross-case analysis of four collaborative research projects conducted within this context. We build on (and extend) Miller’s notion of “hybrid management.” The article shows that the extended concept of hybrid management is useful to study the different accountabilities encountered in such settings. We analyze how the collaboration developed and which conflicts or dilemmas arose. We then focus on the different hybrid management strategies used in the collaboration. The empirical material shows how the different aspects of hybrid management feature in various configurations in the four projects. We highlight that hybrid management strategies may be used by different groups or at different moments, may reinforce or contradict each other, and may be more or less effective at different points in time.

Linking research and policy in Dutch healthcare: infrastructure, innovations and impacts

The call for ‘evidence-based health policy’ in the Netherlands has to date been accommodated by the consensual policy tradition in this country and by the institutionalised arrangements for research funding, researcher career development and research accountability systems. The aim of this paper is to describe and explain from a sociological perspective how these arrangements for two-way research–policy interactions enable the co-production of ‘useable knowledge’ for ‘doable problems’ in health policy making. We conclude that many arrangements function as boundary objects that allow for mediation between research and policy. This mediation occurs via both frontstage and backstage processes. The backstage processes are an essential precondition for the co-production of acceptable evidence, policy advice and policy in the frontstage. However, as a result of the increasing emphasis on evidence-based policy, and an accompanying instrumentalisation of research use in the policy process, some of the characteristic, and until now productive, elements of the Dutch system are threatened.

Connecting evidence and policy: Bringing researchers and policy makers together for effective evidence-based health policy in the Netherlands: A case study

The use of evidence in health promotion has become the gold standard, and obliges rethinking how to increase the (often limited) use of evidence in public health policy. Recently calls have been made to reconceptualise science policy relations as dynamic, interactive and coconstructive practices. Building on a qualitative investigation of an information tool for the Dutch government, the authors show how the nature of evidence is closely linked to its usefulness for policy, and how a specific infrastructural organisation of science-policy interactions contributes to an effective participation and interaction between both scientists and policy makers and the translation of research findings.

The construction of evidence-based local health policy through partnerships: Research infrastructure, process, and context in the Rotterdam ‘Healthy in the City’ programme

Many authors in public health identify gaps between science, policy, and professional practice and seek to solve the problems by facilitating interactions between policymakers and researchers by creating partnership structures. Little empirical research indicates how these interactions contribute to use of research by policymakers, and under which conditions. We provide empirical information by analysing one project in an innovative partnership structure in the Netherlands. We show that although a partnership structure might facilitate interactions, it does not automatically render these interactions meaningful. To balance potential conflicts, careful issue management on a formal and informal level is needed. Partnership designs aiming to facilitate interactions between researchers and policymakers should pay attention to the role of knowledge brokers, expectations of science and policy actors, and the ways in which different perspectives can be helped to converge.

Dutch Academic Collaborative Centres for Public Health: Development through Time--Issues, Dilemmas and Coping Strategies.

textabstractWhile much research utilisation literature shows an increasing emphasis on the added value of structural partnerships, which should facilitate prolonged interactions between researchers, policy makers and professionals, the question of how such collaborative structures develop over time and what consequences that has in terms of collaboration is usually neglected. This paper offers an empirical analysis of a Dutch partnership format developed over a period of four years, based on two interview rounds conducted between 2007 and 2010, supplemented with document analysis and a focus group. It focuses on changing challenges and dilemmas in different development stages and outlines which strategies are used.

Health Impact Assessment and advocacy: a challenging combination

Local authorities, national governments (UK Department of Health, 2004) and the EU (article 152 Amsterdam Treaty) have committed themselves, to put it simply, to the aim to “see to it that any decision taken by the (...) Council is in line with (...) the population’s health” (Simos 2006, this issue). Increasingly, health impact assessment is used as a tool to reach that goal. Every policy tool needs some degree of institutionalisation to become effective. This forum provides us with interesting pitfalls and problems concerning the institutionalisation of HIA (Litzistorf Spina 2006, this issue). Yet, the evidence for the (potential) success of HIA, which should convince policy-makers to institutionalise HIA as a tool, still remains obscure. Policy makers question the effectiveness of the HIA: has the policy or plan actually been changed to protect or improve health and if so, was that change the result of the HIA? Most evaluations, however, are limited to the process and product of the HIA. As for the process of HIA, there is as yet limited consensus on how HIA should be conducted. Most defi nitions emphasise two elements: predictions of health effects and advising policy (Kemm 2003). We may distinguish between broad scope HIA, which considers the perceived risks by the population as evidence; and tight scope HIA, which is based on epidemiological and risk analysis traditions and considers quantitative data mainly (Kemm 2000) (table 1). Some of the broad scope HIAs consider community empowerment and democratisation through participation as their main objective. This is in line with the Gothenburg Consensus which considers four values to underpin HIA: democracy, equity, sustainable development and ethical use of evidence (European Centre for Health Policy 1999). These values are derived from the health promotion movement, which has adopted political modes of advocacy for health, such as mobilizing public support. The “broad scope” form of HIA seeks power foremost from public support. An example of this is the Brighton and Hove HIA of smoke-free public places (Scanlon et al. 2006, this issue). The “tight scope” form seeks to derive power from scientifi c evidence, of which the HIA on the Energy from Waste plant in North Quay is an example. In a four-year evaluation project of HIAs in the Netherlands, we have found that marginally institutionalised HIA lacks the resources to make a difference and mainstream health into decision-making procedures. The obvious solution of mobilizing public support, may be effective in the short term but counterproductive in the long run: in case of potentially adverse impacts on health, HIA might become a “blocking power” to the non-health policy plan but decision-makers may experience HIA in a negative way and disapprove of future cooperation, as has happened in one of the local Dutch cases. Instead, early consultations and a constructive attitude will lead HIA to a brighter future. The non-health sectors that are asked to make “healthy decisions” need convincing argu-

De Volksgezondheid Toekomst Verkenning als infrastructuur voor evidence-based gezondheidsbeleid

SamenvattingBinnen de openbare gezondheidszorg speelt de notie van op ’evidence’ gebaseerd beleid een steeds grotere rol. In dit artikel worden de rol en de betekenis van de VTV beschreven als kennisinstrument voor (overheids)beleid. Vanuit een wetenschapssociologische benadering is onderzocht op welke wijze de VTV zich positioneert als kennisinstrument binnen het gezondheidsbeleid. In hoeverre kunnen we hier spreken van ‘evidence-based policy’ en wat voor vorm neemt dat dan aan? De VTV fungeert, zoals blijkt uit onze analyse, als consensusplatform voor wetenschappelijke kennis waarbij steeds de juiste balans tussen wetenschap en beleid gezocht moet worden. De VTV heeft daarvoor een infrastructuur in het leven geroepen die de participatie van zowel wetenschappers als beleidsmakers in het proces van totstandkoming van de VTV coördineert, zonder dat beiden in elkaars vaarwater terechtkomen. De VTV manifesteert zich frontstage als een wetenschappelijk gefundeerd kennisinstrument met een duidelijke rol binnen het beleidsproces van de overheid. Anderzijds vergt deze rol backstage veel informeel overleg en onderhandeling tussen verschillende actoren uit alle lagen van de overheid en het centrum VTV in het VTV proces. De opzet van de VTV maakt deze twee posities mogelijk. De huidige ontwikkelingen binnen het zorgstelsel vereisen een grotere rol voor lagere overheden, provincies en gemeenten in het zorgdragen voor een goed functionerende openbare gezondheidszorg. Regionale en lokale overheden hebben daarvoor instrumenten nodig die vaak nog niet zijn ontwikkeld. De manier waarop de VTV vorm geeft aan haar gezaghebbende rol binnen het evidence based gezondheidsbeleid van de centrale overheid kan als ’good practice’ dienen voor de verdere ontwikkeling van beleidsinstrumenten voor lokale en regionale overheden, bijvoorbeeld bij het opzetten van lokale VTV’s. De belangrijkste les is dat bruikbare kennis alleen tot stand kan komen in de interactie tussen beleidsmakers en experts. Daarvoor vormen backstage coördinatie van informele contacten tussen experts en beleidsmaker een noodzakelijke voorwaarde voor evidence based gezondheidsbeleid.AbstractThe Future Health Prospects as infrastructure for evidence-based health policyThe development of public health policy shows a trend towards evidence-based policy in the past years. The Dutch government has, according to this trend, developed policy tools to help effectuate (scientific) knowledge for policy making. The Future Health Prospect (VTV) takes up a central role within evidence-based health policy. In this study we have investigated the role of the VTV as knowledge instrument in the policy cycle of health policy development, by means of interviews and document analyses. Our research has shown that the VTV acts as instrument of consensus making for scientific knowledge, and requires a constant coordination of people, and work processes at different levels; between scientists, between policy makers, and between scientists and policymakers. The centre VTV has developed a social and material infrastructure that coordinates the participation of both scientists and policy makers in the process of development of the products of the VTV. The VTV manifests itself front stage as a tool for governing knowledge, with a clear role in the policy process. This, on the other hand, demands informal meetings backstage to facilitate negotiations between different parties in the process. The specific social and material infrastructure of the VTV meets these two oppositions. Moreover, the use of knowledge in policy processes benefits from informal and local contacts at all levels of both the government and the centre VTV. Changes within the health care system demand an increasing role for regional and local governments in the development of public health policy and the execution of the health law. These governments therefore need instruments such as the VTV. The way the VTV shapes its authorized position in evidence-based policy making serves as a ’good practice’ for the development of useful tools for local and regional governments.

Responsieve evaluatie van Integrale Actie (RIA): een methode voor monitoring door stakeholderdialogen over gezondheidsgerelateerde integrale actie

SamenvattingOm processen van integrale actie voor gezondheid te kunnen monitoren is een methode nodig die gevoelig is voor de percepties en ervaringen van verschillende betrokken stakeholders en het soms onvoorspelbare, grillige karakter van dit soort processen. Responsieve evaluatie is een vorm van participatief onderzoek waarbij de onderzoeker actief inspeelt op de informatiebehoeften, verwachtingen en mogelijkheden van de belanghebbenden in kwestie. Doelen zijn om een gelijkwaardig overzicht te verschaffen over de diversiteit aan beelden, verwachtingen, waarden en veronderstellingen van belanghebbenden, en om wederzijds inzicht en begrip te bevorderen. Samen met gezondheidsadviseurs van de provincie Noord-Brabant werd een responsieve evaluatie van Integrale Actie (RIA) opgezet, uitgevoerd en geëvalueerd om in kaart te brengen hoe de twaalf grootste gemeenten in Brabant invulling geven aan een gezonde fysieke leefomgeving. Na twaalf groepsinterviews met verschillende functionarissen in de twaalf gemeenten is een interactieve stakeholderworkshop georganiseerd op het thema Gezonde Stad om een dialoog te faciliteren over al lopende initiatieven en acties, bevorderende en belemmerende factoren van integrale samenwerking en bestuurlijke en politieke randvoorwaarden voor een Gezonde Stad. RIA bleek een geloofwaardige methode om authentieke stakeholderinzichten uit te wisselen, die heeft geleid tot meer steun en draagvlak onder stakeholders en diverse spin off activiteiten.AbstractResponsive evaluation of Integrated Action (RIA): a method for monitoring by stakeholder dialogues on health-related integrated action Processes of integrated action to promote and protect health require a distinct method for monitoring and evaluation that is sensitive to the perceptions and experiences of different stakeholders and the often capricious and unpredictable course of events. Responsive evaluation is a method for participatory research in which the researcher actively builds on the information needs, expectations and capacities of the stakeholders. Goals consist of providing a balanced overview of the diversity of frames, expectations, values and assumptions, and facilitating mutual understanding. In collaboration with the health policy officers of the Province North-Brabant and an independent professional dialogue facilitator we developed, conducted and evaluated a responsive evaluation of integrated action (RIA). In group interviews with a diverse representation of policy officers, we first mapped the activities of the 12 largest municipalities in the province that they associate with a ‘Healthy City’. We then organised a stakeholder workshop based on the themes that resulted from the interviews. There the stakeholders identified current activities, enabling and disabling conditions for integrated action, and the political-administrative conditions for a Healthy City. Afterwards stakeholders valued the responsive evaluation as a credible method for exchanging authentic stakeholder experiences, which has led to more support among the stakeholders and a diversity of spin off activities and consolidation of health considerations in other provincial policy documents.

Consortium Instruments for integrated action (i4i)

Veel kennis over en ervaringen met IGB en KT was tot op heden gefragmenteerd, verspreid over diverse onderzoeksgroepen in Nederland. In het door het RIVM gecoordineerde consortium i4i komt deze kennis en ervaringen bij elkaar. Negen onderzoeksgroepen werken samen aan zowel conceptuele verheldering als praktische onderzoeksinstrumenten voor IGB en KT-BOP. De samenwerkingspartners zijn: RIVM, Erasmus Universiteit Rotterdam, AMC, Vrije Universiteit Amsterdam, TNO, Wageningen Universiteit – GGD Noord- en Oost Gelderland, Universiteit van Tilburg, Erasmus MC en Universiteit Maastricht-GGD Zuid Limburg. Het consortium i4i heeft een doorlooptijd van september 2012 tot september 2014. Het eerste jaar is gewerkt aan de uitwerking van theoretische noties en bijbehorende kwalitatieve en kwantitatieve instrumenten.

De Academische Werkplaats als grensorganisatie

SamenvattingEen belangrijke uitdaging in de publieke gezondheidszorg is het coördineren van onderzoek, beleid, en praktijk. Het ZonMw programma Academische Werkplaatsen Publieke Gezondheid is erop gericht om deze coördinatie te verbeteren, om op die manier enerzijds het onderzoek binnen de gezondheidszorgsector lokaal relevant te maken, en anderzijds het beleid en de praktijk binnen de publieke gezondheidszorg meer op wetenschappelijk bewijs te stoelen. De negen Academische Werkplaatsen die inmiddels zijn opgestart, hebben verschillende (maar ook overlappende) thema’s, zoals Gezondheidsbevordering, Jeugdgezondheidszorg en Infectieziekten. Het instituut Beleid en Management Gezondheidszorg analyseert in opdracht van ZonMw de wijze waarop aan de interactie tussen wetenschap, beleid en praktijk binnen de Werkplaatsen wordt vormgegeven. De Academische Werkplaatsen worden in dit onderzoek geconceptualiseerd als grensorganisaties: organisaties die verschillende ‘sociale werelden’ coördineren en tegelijkertijd verantwoording naar iedere wereld blijven afleggen. Dit artikel beschrijft de eerste resultaten van het onderzoek. De organisatiestructuren, instrumenten, ervaren opbrengsten en genoemde randvoorwaarden van de Werkplaatsen worden vergeleken. Op basis van deze bevindingen worden de interessante spanningen en aandachtspunten in kaart gebracht die in een aantal verdiepende case studies nader worden onderzocht.AbstractThe Academic Collaborative Centre as boundary organizationA major challenge within the area of public health is the coordination of scientific research, policy, and practice. The program Academic Collaborative Centres for Public Health is aimed at improving this coordination. By doing so the program aims both at making scientific research within the public health sector more locally relevant, and to increase the use of evidence-based methods within public health policy and practice. The nine Academic Collaborative Centres that have started all have different (yet also overlapping) themes, such as health promotion, youth health care and infectious diseases. In this article we analyze the ways in which the interaction between science, policy and practice is organized within these centres. This article describes the first results of the research. It compares the goals and the organizational structure of the centres as well as the instruments used and the conditions that are perceived to be central in attaining those goals. On the basis of these findings we address tensions within and points of attention for the centres, which will be elaborated in further research.Keywords: Academic Collaborative Centres, relation of science, policy and practice, public health