“Slow science” for 21st century healthcare: reinventing health service research that serves fast-paced, high-complexity care organisations

Abstract

PurposeThe purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.Design/methodology/approachThe paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.FindingsCurrent approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.Originality/valueThere is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.

Systematic Review of Socio-Emotional Values Within Organizations

“…This study did not only consider emotional ( Lombard, 2021 ) or social ( Micaelson, 2021 ) values because these constructs are often used interchangeably, even if there are some important differences. In contrast to the “hard” sciences, we treated a research area full of disturbing variables as decision science, where we must adopt a complexity paradigm ( Jorm et al, 2021 ). Considering a negative attitude through socio-emotional influence, people who use an emotional approach are irrational and potentially target manipulation ( Lenidou and Lenidou, 2009 ; Yang, 2016 ).…”

When Health Systems Consider Research to Be Beyond the Scope of Healthcare Delivery, Research Translation Is Crippled Comment on "Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study"

“…"By having deferred engaging with the messiness of reality until it gets to the point of knowledge translation, elegant knowledge has in effect exempted itself from negotiating its contents with end users, from adapting itself to complex situations, from reinventing itself in response to emergent problems and from having to acknowledge that local practices embody their own ecologies and their own wisdoms. " 5 Accepting the broader current understanding, terms knowledge translation and KM are still often used interchangeably by many clinicians and managers so it is not entirely clear what significance the use of the older term translation by a Board member, as singled out by the authors, might have. However, authors claimed they also found limited development of KM processes, a matter of concern for an RTC.…”

“…"…such research fails to spend sufficient time on learning … and then elevates the problem of why its advice does not take root in practice as yet requiring more (implementation) 'science, ' perpetuating the problem on a different front. " 5 We can do better to support Australian RTCs. We must also accept that development of complex organisational partnerships takes time and that co-designed solutions will be context dependent.…”

Editorial

“…Jorm et al (2021) present a model for health services research that engages with the complexity of the health system and the organisations within it. The authors argue that traditional academic research struggles to understand the complexity of the health system and the implementation and sustainability of innovations in this setting.…”

“…However, they note that the complexity and bureaucracy of health systems can be a barrier to interprofessional practice, and they call for more research, in particular around the implementation of best practice, so that research, policy and practice can test and learn. Jorm et al (2021) present a model for health services research that engages with the complexity of the health system and the organisations within it. The authors argue that traditional academic research struggles to understand the complexity of the health system and the implementation and sustainability of innovations in this setting.…”