Collaboration across Health Research and Medical Care

Healthy Collaboration

Bart Penders, Niki Vermeulen, John Parker

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317164494
• Edition: 1
• Topic: Medicine
• Subtopic: Health Policy

Health research and health care practice are radically transforming as governments invest more in large scale, national and international health projects with increasing levels of interdisciplinarity as populations age and as nations grow wealthier. This volume examines the structures and dynamics of scientific collaboration in health research and health care. Bringing together detailed research from the US, Canada, Europe and Japan, Collaboration Across Health Research and Medical Care sheds light on the features, environments and relationships that characterise collaboration in health care and research, exploring changing patterns of collaboration and examining the causes and consequences of team work in the health domain. With attention to the increasingly porous boundaries between health care and research, the book not only investigates research settings, but also considers the manner in which knowledge produced in laboratories and clinics is translated into day-to-day medical and care practice and health initiatives. It offers a rich examination of the political, technical and organisational facets of collaboration and the implications of changes in collaboration for every day treatment and practice, Collaboration Across Health Research and Medical Care will be of interest to scholars of sociology and science and technology studies, as well as those working in the field of health policy and research.

Part I Introduction

1 When Scientists, Scholars, Clinicians, Physicians and Patients Meet

Bart Penders, John N. Parker and Niki Vermeulen

DOI: 10.4324/9781315572611-1

In 2011 a patient died as a result of poor collaboration between pulmonary surgeons in the Free University Medical Centre Amsterdam.¹ Such fatalities are not unheard of. The Dutch hospital ‘De Sionsberg’ was forced during the same year to close its cardiology department following a report by the Dutch Association for Cardiology noting that since 2009 the quality of collaboration between cardiologists, management, other specialists, and hospital staff had been consistently poor. Closure was a preventative decision made by the hospital board to avoid fatalities as a result of improper care.² Similarly, the cardiology department of University Hospital St. Radboud was shut down in 2006 because of unexpectedly high mortality rates. Again, the closure was not relatable to any one person’s actions. As the attending report notes, ‘The heightened mortality and morbidity cannot be attributed to the shortcomings of one individual or one group in the cardio-surgical chain of care’.³ In the United Kingdom, the Mid Staffs Hospital scandal – possibly associated with deaths of 400–1,200 patients over the course of five years due to a low level of care – was, amongst many other things, attributed to insufficient governance of the diverse professionals that ought to contribute to care.⁴ The safety and quality of care is thus closely intertwined with the organisation of care work and the ways in which carers work together.

1 See: http://medischcontact.artsennet.nl/actueel/nieuws/nieuwsbericht/106879/igz-vumc-reageerde-slecht-op.-calamiteit.htm. 2 The report is available online, see: http://www.skipr.nl/actueel/id7746-ziekenhuis-dokkum-onder-verscherpt-toezicht-.html and http://www.skipr.nl/actueel/id8242-de-sionsberg-sluit-cardiologie-vier-weken.html. 3 See: http://www.onderzoeksraad.nl/uploads/items-docs/364/rapport_hartchirurgie_sint_radboud.pdf. 4 See: http://www.theguardian.com/society/2013/feb/06/mid-staffs-hospital-scandal-guide?guni=Article:in%20body%20link.

These examples cover a few hospitals over the period of a few years, but let them stand in for many others. Our purpose is to highlight the expectation that health care professionals are expected to collaborate together as harmoniously and as efficiently as possible by the health inspectors, peers, managers, subordinates, the general public, and representatives of the people. Failure to do so may result in sanctions for specific individuals, or at a collective level into fines or even closures for hospitals, departments, and care organisations, to say nothing of insalubrious consequences for public health and for public trust in the healthcare system.⁵ Unsurprisingly, calls for expanding and enhancing collaboration in health care are regularly expressed, and increasingly promote the use of information technologies to realise ‘better collaboration’.⁶

5 This occurred at the Ruwaard van Putten Hospital in Spijkenisse. The hospital was passed over by prospective patients because of problems, initially at the cardiology department. It was the first hospital in the Netherlands to go bankrupt, in 2013. 6 See, for instance: http://www.theguardian.com/society/2007/jun/13/publicservices.comment and http://www.rvo.nl/sites/default/files/bijlagen/Minister%20Schippers%20zoekt%20innovaties%20die%20de%20zorg%20beter%20en%20goedkoper%20maken.pdf.

Collaboration is part of the archetypical image of the medical professional, health care, and social worker and is an elemental aspect of contemporary medical practice. Physicians, specialists, nurses and supporting staff are expected to operate as a well-oiled team. Even the family doctor, seemingly alone at her desk, must communicate, coordinate, and cooperate with apothecaries, specialists, and lab workers to provide even the simplest care. And while the health researcher crunching data behind her computer, performing experiments in her lab and reading up on the newest biomedical research on her iPad might be less associated with collaboration, they work within the same complex organisational ecology of health research and health care, although their work, tasks, collaborative profile, forms of social and cultural capital, and expert roles vary significantly from those of other health professionals. This volume works to better illuminate, characterise and problematise this complex ecology blending in various ways and degrees basic science, medical practice, and entrepreneurial activities by exploring different forms of collaboration across a wide variety of subjects, organisations, and national contexts.

This book follows a continuous line of inquiry beginning with our earlier collection Collaboration in the New Life Sciences (Parker et al., 2010), which documented the trend towards and reasons for increasingly large, diverse, and complicated forms of collaboration arising in the life sciences. Expanding these considerations into collective work in health sciences and health care, characterised by its own distinctive dynamics, institutional landscapes, and specific political motivations and implications, is a natural next step in the general quest for understanding how, why, and with what consequences knowledge workers conjointly operate in producing, translating, and employing new forms of information and understanding.⁷ In collecting studies of collaboration, the volume’s chapters tie into existing debates in literature on health sciences, translational research and care, while focussing explicitly on more general processes, structures and patterns of collaboration and collaborative work. As such, we present collaboration as a modus operandi for care and research work, or a specific ‘way of knowing’ which differs from previous and parallel ways.

7 This line of research that we have set-up over the last decade has resulted in separate and shared papers and books, including Parker (2006) Vermeulen (2009) Penders (2010) Parker et al. (2010) and Vermeulen et al. (2013).

Collaboration in Health

Historians have described the emergence of large biomedical complexes (Capshew and Rader, 1992; Creager, 1998; Neushul, 1993; Rasmussen, 2002; Seidel, 1992), which represent some of the first forms of complex, large-scale collaboration in health science and care. Collaborations between academic science and the biomedical industry can be traced back to the 1920s and 1930s when American pharmaceutical firms began investigating in research as a competitive strategy aiming to use science to inform therapeutic practice. These firms opened in-house laboratories and turned to university scientists as source of expertise: ‘In a typical collaboration, a firm would fund an academic researcher and stipulate that new processes and inventions be patented and assigned, or licensed on favourable terms, to the firm. Royalties to the university hosting the research would be part of the arrangement’ (Rasmussen, 2002: 120). In the context of World War II, alongside large-scale physics projects that produced the atom bomb, biomedical projects focussed on the development of penicillin and blood products. After the war the United States government became a leading patron of the expanding life sciences – funded by the National Science Foundation and the National Institutes of Health. Similar developments took place in other countries.

Turning our eye to the present, and painting with a broad brush, the study of collaboration in the health sector can for analytic purposes be separated, into three sets of studies. The first set, in line with studies of collaboration in other scientific fields, illuminates why, how, and in what ways health researchers join forces with each other. Building on De Solla Price’s (1965) seminal work on ‘big science’ and the growth of scientific inquiry, it assesses and measures collaboration through, for instance, quantitative analyses of the number of authors on a publication (Mattson et al., 2008). Such studies describe collaborative patterns in health and medical research, both internationally and regionally (e.g. Chinchilla-Rodríguez et al., 2012), often in connection to specific pathologies, such as stroke (e.g. Dirnagl et al., 2013). Simultaneously, in-depth qualitative empirical analyses of concrete cases explore the dynamics of health research collaboration, including its motivations, dynamics and consequences. Studies within this area also focus on laboratories, clinics, or larger, less tangible international collectives such as the Cochrane Collaboration (McKenzie et al., 2013) or clinical trials (Gennari et al., 2004; Petryna, 2009).

The second set of studies analyses collaboration between health care professionals, with clinics and hospitals as the main site for collaborative work. These studies research both policy and practice, and address themes such as the division of labour and the relative autonomy of diverse (semi-)professionals (e.g. Loxley, 1997; Hudson, 2002), leadership styles, language barriers, organisational boundaries, and the role of protocols and guidelines (e.g. Marshall et al., 1979; Ovretveit, 1990; McGrath, 1991; Leathard, 2003; Paradis et al., 2014). Medical sociology is a prominent source of this type of study (see e.g. Bird et al., 2010, esp. part iii), as are growing numbers of STS researchers studying medical practice and care (Strating et al., 2011; Van de Bovenkamp and Zuiderent-Jerak, 2013). Above all else, these studies highlight the social, political, and moral diversity within health care and their demonstrable effects on the work and infrastructures that shape it and the amount, relevance, and quality of care provided.

Finally, boundaries between research and care are fuzzy, as are boundaries between the institutions responsible for knowledge making and care-giving. A third set of studies spans the boundary between lab and clinic, that is, between research and care. Scholarship in this area deals with the interaction of professionals, disciplines, and sectors, and the translation of biomedical knowledge into a context of diagnosis, treatment or care. The concept of translational research – describing the movement of knowledge, data, and resources – can be traced back to the early 1990s, though it took until 2007 for the National Institutes of Health to propose a definition (Rubio et al., 2010). Still, Woolf (2008) commented immediately afterwards that ‘translational research means different things to different people’ (p. 211). He posited two ‘translational researches’, one dealing with ‘the transfer of new understandings of disease mechanisms gained in the laboratory into the development of new methods for diagnosis, therapy, and prevention and their first testing in humans’ and the other with ‘the translation of results from clinical studies into everyday clinical practice and health decision making’ (ibid.). Consequently, both translational ‘researches’ require different tools, skills, and resources and happen in different places.

This volume brings together studies of collaborative practice spanning these three sets of literature by investigating collaborations in and across research and care while paying special attention to intersections between these different bodies of literature since collaborations often cannot be confined to one domain. More specifically, within the health sector a rapidly changing landscape presents professionals operating within it with complexities and uncertainties requiring the combination of multiple social roles and collaborations with diverse sets of actors. Consider, for instance, the growing scale of health collaboration, in which large international consortia devoted to medical innovation are established, clinical trials are conducted simultaneously in various countries, and treatment guidelines are pushed globally. These processes are associated with increasing pressure to standardise through protocols or guidelines and increasing adoption of evidence-based medicine, again demanding coordination and ...

Table of contents

• Cover Page
• Half Title Page
• Dedication
• Title Page
• Copyright Page
• Table of Contents
• List of Figures and Tables
• List of Contributors
• Acknowledgements
• PART I INTRODUCTION
• PART II COLLABORATION IN HEALTH RESEARCH
• PART III COLLABORATIVE HEALTH INFRASTRUCTURES
• PART IV COLLABORATION IN HEALTH CARE
• PART V CONCLUSION
• Index