Rik Wehrens

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.

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.

The Potential of the Imitation Game Method in Exploring Healthcare Professionals' Understanding of the Lived Experiences and Practical Challenges of Chronically Ill Patients

This paper explores the potential and relevance of an innovative sociological research method known as the Imitation Game for research in health care. Whilst this method and its potential have until recently only been explored within sociology, there are many interesting and promising facets that may render this approach fruitful within the health care field, most notably to questions about the experiential knowledge or ‘expertise’ of chronically ill patients (and the extent to which different health care professionals are able to understand this experiential knowledge). The Imitation Game can be especially useful because it provides a way to map this experiential knowledge more systematically, without falling in the dual trap of either over-relying on in-depth, but highly specific phenomenological ‘insider’-approaches that are hard to generalize, or, alternatively, problematically reducing the rich life-worlds of patients to a set of indicators in a questionnaire. The main focus of this paper is theoretical and conceptual: explaining the Imitation Game method, discussing its usefulness in the health care domain, and exploring the ways in which the approach can be utilized for chronic illness care. The paper presents both a conceptual and empirical exploration of how the Imitation Game method and its underlying theoretical concepts of ‘contributory expertise’ and ‘interactional expertise’ can be transferred from the sociological realm to the field of health care, what kinds of insights can be gained from the method, which methodological issues it may raise, and what potentially fruitful research routes can be explored. I argue that the Imitation Game can be thought of as a ‘social learning experiment’ that simultaneously enables the participants to learn from each other’s perspectives, allows researchers to explore exciting new possibilities, and also offers the tools to intervene in the practice that is being studied.

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

Understanding Each Other In The Medical Encounter: Exploring therapists' and patients' understanding of each other's experiential knowledge through the Imitation Game

The ability of health-care professionals to understand the lived experiences of their patients has become increasingly important but has been a difficult topic to investigate empirically because it involves two distinctive research strands: interpretative phenomenological analysis and patient–provider communication. While interpretative phenomenological analysis focuses on experiences and illness narratives of patients, but not on therapist’s understanding of those, patient–provider communication surveys focus primarily on effective forms of communication without addressing the actual illness experiences of patients. There is a need for empirical research that combines both strands to investigate not only the experiences of patients but also whether professionals are able to understand these. This study combined both strands by means of a novel research method called the Imitation Game (combined with other qualitative methods). This sociological method was developed to investigate what different social groups know of each other’s lifeworld. It focused on the important domain of eating disorder treatment to investigate whether therapists were able to understand the experiences of their patients and vice versa. This study provides insights into the domains in which therapists and patients were able to develop insights into each other’s experiential knowledge (and where they had difficulties in doing so). The findings also implicate the high potential of the Imitation Game as an interdisciplinary research method. We propose that the Imitation Game may be particularly valuable as a ‘can opener’ that enables the development of in-depth, qualitative insights into the substantive themes that matter in the lifeworlds of patients and therapists.

Who is ‘in’ and who is ‘out’? Participation of older persons in health research and the interplay between capital, habitus and field

Abstract Inclusion and exclusion processes in community engagement do not take place in a vacuum, but are embedded in social, political and institutional contexts. To better capture the interplay between the individual agency of community participants and organizational structures in health research, we use a Bourdieusian framework. The notions of capital, habitus and field allow us to analyse how inclusion and exclusion of older persons in a Dutch healthcare research- and improvement programme are processually shaped overtime. The findings demonstrate that due to the influence of the medical and policy field, older persons with social, cultural and symbolic capital were included in target group panels. Frail older persons lacking these types of capital were often excluded. Despite the high amount of capital, the formally ‘included’ participants still experienced difficulties in engaging effectively in a medical research setting. We distinguish various strategies that older persons developed during the course of the programme to deal with this problem: (1) professionalization, (2) responsibilization, (3) pluralization, (4) opting out. Using these strategies older participants were able to incrementally change the medical field by shifting the focus to quality of life and welfare. We conclude that it is by definition impossible to ‘exclude exclusion’ at the start of care improvement programmes. It is only in the many pragmatic and mundane choices of ‘doing participation’ that more inclusive engagement can be realized.

Perspectives of nursing professionals and older adults differ on aspects of care for older people after a nationwide improvement program

BackgroundThe perspectives of nursing professionals might differ from those of older adults when it comes to care for older people. This cross-sectional study compares the views of older adults with the views of nursing professionals on the quality of care after a nationwide improvement program for care for older people was implemented (2008–2016) in the Netherlands.MethodsQuestionnaire data were used from 385 nursing professionals (response rate 51%) that were part of the Nursing Staff Panel, a nationwide representative group of nursing staff, and working in home care, hospitals or general practices. Additionally, questionnaire data were used from 73 older adults (response rate 81%) who were involved in regional networks to discuss project proposals and to represent the voice of older adults in the nationwide improvement program. Participants were asked to evaluate care for older people with regard to collaboration between healthcare organizations and with regard to the tailored service, accessibility, and quality of care within their organizations and in the region in which they lived.ResultsA majority of older adults (54%) and nursing professionals (61%) felt that collaboration with others had improved over the last few years. Approximately one third of the older adults stated that care for older people was tailored to fit individual needs and was accessible most of the time or always, as opposed to approximately two thirds of the professionals. Moreover, 17% older adults thought that the quality of care was good, compared with 54% of the nursing professionals. 77% of the nursing professionals and 94% of the older adults thought that improvements were still needed in care for older people, for example better integration of the different aspects of care and a more patient-centered approach.ConclusionOlder adults who were involved in networks of the improvement program generally gave a less positive evaluation of aspects of care for older people and its development than nursing professionals. Considering differences in the perspectives of key stakeholders is relevant for the development and evaluation of nationwide improvement programs, for a correct interpretation of findings, and for making appropriate recommendations.