Case Study 2

In the field of health services research, there is a growing trend toward large-scale applied studies that involve multidisciplinary research teams (trialists, statisticians, social scientists, qualitative and quantitative experts, implementation scientists) working in partnership with clinicians and service users.

Project members are ordinarily drawn from different departments and/or institutions that may span international boundaries and the research itself must be progressed in multiple research sites. Research projects typically begin with a lengthy planning phase in which members must agree on study design and roles and responsibilities. It is not unusual for the research protocol to require adjustments as the work proceeds, however, and maintaining alignment of all actors in interdisciplinary projects can be challenging.

The strategic action field framing a research project will comprise of the different higher education institutions, academic departments, and health care organizations represented by immediate team members; the research funding body; regulatory frameworks relating to ethics and research governance; the potential users of the research (patients, public, and providers); as well as the wider research communities.

These generate the institutional context—the structures, organizing logics, materials, and interpretative repertoires—that condition the possibilities for action.

Most research is driven by common logics relating to the requirements of methodological and scientific rigor, research ethics and governance frameworks, and the relevance and transferability of the study findings to clinical practice. Within this overarching framework, however, different disciplines have their own discourses, canons, and interpretative repertoires. The qualitative social scientists are concerned with the depth of understanding, accessing a full range of perspectives, and the generation of empirically grounded concepts and theories; the health economists are concerned with accurate costing of all inputs; and the statisticians are concerned to identify appropriate and reliable outcome measures and generate robust data sets with sufficient power to undertake predictive modeling.

Whereas academic team members’ overriding focus may lie with the quality of the science, clinical team members may be more concerned with the practical implications and transferability of the research. The success of an applied project hinges on the management of these different frameworks. Projects are also shaped by the availability of materials and resources that condition the possibilities for action, for example, the funding envelope, access to technology, and the type and volume of data that can be generated.

The mobilization of a research study typically begins with a collective act of object formation through the development of a funding application.

This begins the process of enrolling relevant actors into the project, agreeing to the research question and study design, negotiating roles and responsibilities (chief investigator, principal investigators, research managers, workstream leads, clinicians, researchers, and patient/public representative—and advisory and/or steering group membership), and identifying the resources required and how these are distributed. While methodologies and techniques are to some extent standardized, these must be adapted in response to the technical and logistical requirements of the project, the relationship between elements of the research must be formalized, and research aims must be aligned with the possibilities for investigation.

Communicating across disciplinary boundaries can be challenging and there is a need to develop understanding among team members. This may not simply be a case of finding a common language, but thinking about a problem in an entirely different way and working through the logic of this reformulation for the study. Actors may have different degrees of interpersonal familiarity; some may have worked together on previous projects, for others these relationships need to be developed de novo. These connections take time to develop and maintain, a factor rarely taken into account by research funding bodies.

Research projects typically require considerable start-up time to ensure that all the structures necessary to proceed are in place.

This involves the creation of new objects of practice: data analysis plans and associated artifacts (data extraction templates, interview schedules, coding frames), research ethics materials (research protocol, study information sheets, consent forms), and communication resources (project website, business cards, news letters, media launch, and conference presentations).

Each of these examples represents a sensemaking practice in which the meaning of the protocol is negotiated and translated into the tools and materials designed to accomplish the work. These are important mechanisms through which projects are articulated across the research team and study sites although rarely do they act alone. Additional effort by human agents is necessary to enable them to work as intended and keep action in alignment with project goals.

Another mechanism of research project articulation is through the designation of clearly defined workstreams. Holding network elements apart in this way is an important translational technique; as long as they remain in alignment with the study protocol, they can be mobilized in parallel. Of course, this separation may be time-bounded, with some form of synthesis across project workstreams required in the final analysis, requiring other kinds of translational work. For example, qualitative data might be deployed to make sense of quantitative outcomes; quantitative modeling might be applied to test qualitative propositions. Funding bodies often seek assurances that such syntheses will be forthcoming.

While proposal writing and study setup are important moments of object formation that enroll actors, resources, materials, and interpretative repertoires into a network, these are rarely one-off events.

Research is an emergent activity, necessitating adjustments and revisions to the original plans and a renegotiation of practice objects. This is an acknowledged challenge for health services researchers, as the institutional context in which research projects are mobilized is predicated on a biomedical model of science, and demands high degrees of stability and centralization.

Any changes to the study necessitate a restatement and approval of new structures and standards to bring these in line with the emerging nature of the research. Unsurprisingly, then, much of the reflexive monitoring, in the context of research projects, is driven by the need to ensure alignment with the formal study protocol and hinges on formal processes of mapping progress against an agreed plan of activity and reviewing efforts across different elements of the study to ensure coherence.

The funding body and steering group have a role here in monitoring progress against objectives and making critical decisions about the study’s continuation in the face of delays in progress.