Background: Increasingly, it is being suggested that translational gaps might be eradicated or narrowed by
bringing research users and producers closer together, a theory that is largely untested. This paper reports a
national study to fill a gap in the evidence about the conditions, processes and outcomes related to collaboration and implementation.
Methods: A longitudinal realist evaluation using multiple qualitative methods case studies was conducted with three Collaborations for Leadership in Applied Health Research in Care (England). Data were collected over four rounds of theory development, refinement and testing. Over 200 participants were involved in semi-structured interviews, non-participant observations of events and meetings, and stakeholder engagement. A combined inductive and deductive data analysis process was focused on proposition refinement and testing iteratively over data collection rounds.
Results: The quality of existing relationships between higher education and local health service, and views about whether implementation was a collaborative act, created a path dependency. Where implementation was
perceived to be removed from service and there was a lack of organisational connections, this resulted in a focus on knowledge production and transfer, rather than co-production. The collaborations’ architectures were
counterproductive because they did not facilitate connectivity and had emphasised professional and epistemic boundaries. More distributed leadership was associated with greater potential for engagement. The creation of boundary spanning roles was the most visible investment in implementation, and credible individuals in these roles resulted in cross-boundary work, in facilitation and in direct impacts. The academic-practice divide played out strongly as a context for motivation to engage, in that ‘what’s in it for me’ resulted in variable levels of engagement along a co-operation-collaboration continuum. Learning within and across collaborations was patchy depending on attention to evaluation.
Conclusions: These collaborations did not emerge from a vacuum, and they needed time to learn and develop.
Their life cycle started with their position on collaboration, knowledge and implementation. More impactful attempts at collective action in implementation might be determined by the deliberate alignment of a number of features, including foundational relationships, vision, values, structures and processes and views about the nature of the collaboration and implementation.
1. Harvey G. The many meanings of evidence: implications for the translational science agenda in healthcare. Int J Health Policy Manage. 2013;1:1–2.
2. Rycroft-Malone J. From knowing to doing - from the academy to practice. Comment on “The many meanings of evidence: implications for the translational science agenda in healthcare”. Int J Health Policy Manage. 2014;2:1–2.
3. Rycroft-Malone J, Kitson AL, Harvey G, McCormack B, Seers K, Titchen A, et al. Ingredients for change: revisiting a conceptual framework. Qual Saf Healthcare. 2002;11:174–80.
4. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26:13–24.
5. Damschroder L, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.
6. May C, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, et al. Development of a theory of implementation and integration: normalisation process theory. Implement Sci. 2009;4:29.
7. Van de Ven AH. Engaged scholarship: a guide for organisational and social research. Oxford: Oxford University Press; 2007.
8. Best A, Holmes B. Systems thinking, knowledge and action: towards better models and methods. Evid Policy. 2010;6(2):145–59.
9. Jansson SM, Benoit C, Casey L, Phillips R, Burns D. In for the long haul: knowledge translation between academic and non-profit organizations. Qual Health Res. 2010;20(1):131–43.
10. Rycroft-Malone J, Burton C, Wilkinson J, Harvey G, McCormack B, Baker R, et al. Collective Action for Knowledge Mobilisation: a Realist Evaluation of the Collaborations for Leadership in Applied Health Research and Care. Health Serv Deliv Res. 2015; 3(44).
11. Olson CA, Balmer JT, Mejicano GC. Factors contributing to successful inter-organisational collaboration: the case of CS2day. J Contin Educ Health Prof. 2011;31(S1):S3–12.
12. Stokols D, Misra S, Moder RP, Hall KL, Taylor BK. The ecology of team science: understanding contextual influences on transdisciplinary collaboration. Am J Prev Med. 2008;35(2S):S96–114.
13. Ovretveit J, Bate P, Cleary P, Cretin S, Gustafson D, McInnes K, et al. Quality collaboratives: lessons from research. Qual Saf Healthcare. 2002;11(1):345–51.
14. Shortell SM, Zukoski AP, Alexander JA, Bazzoli GJ, Conrad DA, Hasnain-Wynia R, et al. Evaluating partnerships for community health improvement: tracking the footprints. J Health Polit Policy Law. 2002;27(1):49–91.
15. Roussos ST, Fawcett SB. A review of collaborative partnerships as a strategy for improving community health. Ann Rev Public. 2000;21(1):369–402.
16. Kegler MC, Steckler A, McIerou K, Malek SH. Factors that contribute to effective community health promotion coalitions: a study of 10 Project ASSIST Coalitions in North Carolina. Health Educ Behav. 1998;25:338–53.
17. Lasker RD, Weiss ES, Miller R. Partnership synergy: a practical framework for studying and strengthening the collaborative advantage. Milbank Q. 2001;79(2):179–205.
18. Lesser J, Oscos-Sanchez MA. Community-academic research partnerships with vulnerable populations. Annu Rev Nurs Res. 2007;25(1):317–57.
19. Blevins D, Farmer MS, Edlund C, Sullivan G, Kirchner JE. Collaborative Research between Clinicians and Researchers: a multiple case study of implementation. Implement Sci. 2010; 5(76).
20. Clinical Effectiveness Research Agenda Group (CERAG). Implementation Research Agenda Report. 2008. Retrieved from: http://preview.implementationscience.com/content/supplementary/1748-...
21. Eccles M, Armstrong D, Baker R, Clearly K, Davies H, Davies S, et al. An implementation research agenda. Implement Sci. 2009;4:18.
22. Confederation NHS. Integrating research into practice: the CLAHRC experience. Health Serv Res Netw Brief. 2012;245.
23. Rycroft-Malone J, Wilkinson JE, Burton CR, Andrews G, Ariss S, Baker R, et al. Implementing health research through academic and clinical partnerships: a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC). Implement Sci. 2011;6:74.
24. Pawson R, Tilley N. Realistic evaluation. London: Sage Publications; 1997.
25. Pawson R. The science of evaluation. A realist manifesto. London: Sage Publications; 2013.
26. Rycroft-Malone J, Wilkinson J, Burton CR, Harvey G, McCormack B, Graham I, et al. Collaborative action around implementation in Collaborations for Leadership in Applied Health Research and Care: towards a programme theory. J Health Serv Res Policy. 2013;18(3):13–26.
27. Yin RK. Case study research: design and methods. 3rd ed. London: Sage Publications; 2003.
28. Spradley JP. Participant observation. Minnesota: Holt, Rhinehart & Winston; 1980.
29. Patton MQ. Utilization focused evaluation. 4th ed. Thousand Oaks: Sage Publications; 2008.
30. Guba EG, Lincoln YS. Fourth generation evaluation. Thousand Oaks: Sage Publications; 1989.
31. Dopson S, Fitzgerald L. Knowledge to action? Evidence-based health care in context. Oxford: Oxford University Press; 2005.
32. Crammer A, Morgan D, Stewart N, McGilton K, Rycroft-Malone J, Dopson S, et al. The Hidden Complexity of Long-Term Care: How Context Mediates Knowledge Translation and Use of Best Practices. Gerontologist. 2013; doi:10.1093/geront/gnt068.
33. Greenhalgh T, Humphrey T, Hughes J, MacFarlane F, Butler C, Pawson R. How do you modernize a health service? A realist evaluation of whole-scale transformation in London. Milbank Q. 2009;87(2):391–416.
34. Greenhalgh T, Robert G, MacFarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organisations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.
35. Wilson T, Berwick DM, Cleary PD. What do collaborative improvement projects do? Experience from seven countries. Jt Comm J Qual Saf. 2003;29(2):85–93.
36. Kreuter MW, Lezin NA, Young LA. Evaluating community-based collaborative mechanisms: implications for practitioners. Health Promot Pract. 2000;1:49–62.
37. Stacey R. Strategic management and organisational dynamics: the challenge of complexity. 4th ed. Essex: Prentice Hall, Financial Times, Pearson Education Ltd; 2003.
38. Bryne D. Complexity theory and the social sciences. Oxon: Routledge; 1998.
39. Martin G, McNicol S, Chew S. Towards a new paradigm in health research and practice? Collaborations for Leadership in Applied Health Research and Care. J Health Organ Manag. 2013;27(2):193–208.
40. Cooke J, Ariss S, Smith C, Read J. On-going collaborative priority-setting for research activity: a method of capacity building to reduce the research-practice translational gap. Health Res Policy Syst. 2015;13:25.
41. Jagosh J, Macaulay AC, Greenhalgh T. Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q. 2012;90(2):311–48.
42. Best A, Greenhalgh T, Lewis S, Saul J, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Milbank Q. 2012;90(3):421–56.
43. Orr K, Bennett M. Public administration scholarship and the politics of co-producing academic-practitioner research. Public Adm Rev. 2012;22(4):487–95.
44. Dickinson H, Glasby J. Why partnership working doesn’t work. Pitfalls, problems and possibilities in English health and social care. Public Manage Rev. 2010;12(6):811–28.
45. Dixon-Woods M. The problem of context in quality improvement work. In: Bate P, Robert G, Fulop N, Ovretveit J, Dixon-Woods M, editors. Perspectives on context: a series of short essays considering the role of context in successful quality improvement. London: The Health Foundation; 2014. p. 89–100.
46. Gherardi S, Nicolini D. Learning in a constellation of interconnected practices: canon or dissonance. J Manage Stud. 2002;39(4):419–36.
47. Kislov R. Boundary discontinuity in a constellation of interconnected practices. Public Adm. 2014;92(2):307–23.
48. Rowley E, Morriss R, Currie G, Schneider J. Research into practice: Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire Derbyshire, Lincolnshire (NDL). Implement Sci. 2012;7:40.
49. Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13:158.
50. Evans S, Scarborough H. Supporting knowledge translation through collaborative translational research initiatives: ‘Bridging’ versus ‘blurring’ boundary spanning approaches in the UK CLAHRC initiative. Soc Sci Med. 2014;106:119–27.
51. Oborn E, Barrett M, Prince K, Racko G. Balancing exploration and exploitation in transferring research into practice: a comparison of five knowledge translation entity archetypes. Implement Sci. 2013;8:104.
52. Star SL, Griesemer JR. Institutional ecology, ‘translations’ and boundary objects: amateurs and professionals in Berkeley’s Museum of Vertebrate Zoology. Soc Stud Sci. 1989;19(3):387–420.