The role of boundary maintenance and blurring in a UK collaborative research project: How researchers and health service managers made sense of new ways of working

Abstract

The paper investigates whether, how and in what circumstances boundary blurring or boundary maintenance is productive or destructive of sense in collaborative research based on a case study involving researchers from two universities and two principal organisational stakeholders in a local healthcare system in England between 2009 and 2012. Adopting a narrative method, using meeting observation, document analysis and interviews, we describe two key sets of activities in the evolution of collaboration, which allows us to tackle the question at two levels. Studying the production of documents and their use as boundary objects in project management meetings, we show how these were used to enable cooperation by establishing a truce between worldviews, giving participants a better feel for the game and a clearer perception of its stakes. Studying how the partnership expanded to take in other organisations besides the two formal partners, we show how the project accommodated pre-existing organisational interests but thereby sacrificed its experimental ethos. In showing how actors needed to subvert their experimental script to enact collaborative partnership, we argue for understanding and evaluating the latter as the co-produced outcome of disputes and coorientations towards a practical ideal, not as an organisational format for knowledge co-production.

The challenge of inclusive coproduction: The importance of situated rituals and emotional inclusivity in the coproduction of health research projects

“…It is widely acknowledged, for example, that patient and public groups should play a more meaningful role in the deliberation and formulation of policy options to ensure both their legitimacy and relevance to service users (Martin, ). In the field of health research, coproduction is promoted as bridging the “translation gap” between research and practice, where it is suggested that decision‐makers, frontline professionals, service users, and other stakeholders should play an active role in problem definition, methodological design, data collection and analysis, and the application of evidence into practice (Smith & Ward, ). Coproduction facilitates the sharing of resources and expertise in ways that is often inhibited by organizational or occupational boundaries (Greenhalgh, ).…”

Knowledge exchange in the UK CLAHRCs

“…Policy makers in the United Kingdom funded the establishment of CLAHRCs to facilitate knowledge exchange between academics and clinicians. While previous studies of CLAHRCs have highlighted the role of governance mechanisms in inter-professional knowledge exchange D'Andreta et al, 2013;Evans & Scarbrough, 2014;Fitzgerald & Harvey, 2015;Smith & Ward, 2015), this study demonstrates how knowledge exchange between academics and clinicians can be influenced by their social position based on the ownership of symbolic and social capitals.…”

The role of patients and carers in diffusing a health‐care innovation: A case study of “My Medication Passport”

“…Greenhalgh et al 5 pharmacists and other health-care professionals suggesting there is a blurring of boundaries between roles and this aligns with a principle of co-production. 7,42,43 This study demonstrated what can occur when patients innovate and are supported to develop their innovations for wider use by others. Infrastructural support from health-care organizations and external funding to enable and make the MMP available underpinned its diffusion, and without this, diffusion was unlikely to have occurred.…”

“…What was observed was a non‐linear set of interactions during diffusion. Greenhalgh et al suggested that a question, which had been under‐researched, was “what mix of factors tend to produce adoptable innovations which are readily adaptable to new contexts?” One key factor in considering determinants of diffusion of MMP is the recognition and attribution of the multiple roles that patients and carers played alongside pharmacists and other health‐care professionals suggesting there is a blurring of boundaries between roles and this aligns with a principle of co‐production …”