Bergman Alicia A, Delevan Deborah M, Miake-Lye Isomi M, Rubenstein Lisa V, Ganz David A
Research Health Scientist, VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, USA.
Health Science Specialist VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, USA.
J Health Serv Res Policy. 2017 Jul;22(3):139-148. doi: 10.1177/1355819617693871. Epub 2017 Apr 3.
Within many large health care organizations, researchers and operations partners (i.e., policymakers, managers, clinical leaders) join to conduct studies to improve the quality of patient care. Yet optimal approaches to conducting partnership research and evaluation are only beginning to be clearly defined. The Veterans' Health Administration (VA) Quality Enhancement Research Initiative (QUERI), funded by operations leaders and administered by the VA's research service, now has nearly two decades of experience in fostering research-operations partnerships for improving quality of VA care. The work reported here is part of a national evaluation of QUERI. Because individuals in research and operations often have differing backgrounds and perspectives, we aim to identify the main sources of tension in research-operations partnerships and strategies for maximizing partnership success, through the eyes of QUERI participants.
We conducted semi-structured interviews with 116 researchers and operations partners chosen randomly from within pre-identified key participant groups. We conducted inductive qualitative analysis of verbatim interview transcripts, limited to the 89 interviews of individuals reporting at least some familiarity with QUERI.
Tensions in research-operations partnerships were primarily related to diverging incentives and to differing values placed on scientific rigor or integrity versus quick timelines. To alleviate these tensions, operations' partners highlighted the importance of 'perspective-taking' (i.e., putting themselves into the shoes of the researchers) to ensure a mutually beneficial and attractive partnership, whereas researchers identified the importance of overcoming the need for recognition to be apportioned between either research or operations for achieved results. Both researchers and operations participants identified jointly designing each partnership from the beginning, minimizing research bureaucracy burdens, and prioritizing in-person communication and long-term relationships as key partnership building blocks.
QUERI research and operations participants had largely concordant views on partnership tensions and approaches for improving partnership success. The fact that only researchers mentioned moving beyond recognition for the results achieved and only operations staff mentioned the importance of 'perspective-taking' suggests, however, that there may be unresolved tensions. These results suggest that researchers may benefit from better aligning of academic incentives with contributions to the health care organization and establishing formal recognition of operational impacts of research, while preserving some flexibility and independence of the research process.
在许多大型医疗保健机构中，研究人员与运营伙伴（即政策制定者、管理人员、临床负责人）携手开展研究，以提高患者护理质量。然而，开展伙伴关系研究与评估的最佳方法才刚刚开始得到明确界定。由运营负责人资助、退伍军人健康管理局（VA）研究服务部管理的退伍军人健康管理局质量提升研究计划（QUERI），在促进研究与运营伙伴关系以提高VA护理质量方面已有近二十年的经验。此处报告的工作是对QUERI进行的全国性评估的一部分。由于研究人员和运营人员通常背景和观点不同，我们旨在通过QUERI参与者的视角，确定研究与运营伙伴关系中紧张关系的主要来源以及使伙伴关系成功最大化的策略。
我们对从预先确定的关键参与者群体中随机挑选的116名研究人员和运营伙伴进行了半结构化访谈。我们对逐字记录的访谈文本进行了归纳定性分析，仅限于对至少对QUERI有一定了解的个人进行的89次访谈。
研究与运营伙伴关系中的紧张关系主要与激励措施不同以及对科学严谨性或诚信与快速时间表的不同重视程度有关。为缓解这些紧张关系，运营伙伴强调了“换位思考”（即设身处地为研究人员着想）对于确保互利且有吸引力的伙伴关系的重要性，而研究人员则指出克服在研究或运营之间分配对已取得成果的认可需求的重要性。研究人员和运营参与者都将从一开始就共同设计每个伙伴关系、尽量减少研究官僚主义负担以及将面对面沟通和长期关系作为伙伴关系建设的关键要素列为优先事项。
QUERI研究人员和运营参与者在伙伴关系紧张关系以及提高伙伴关系成功率的方法上基本达成一致。然而，只有研究人员提到超越对已取得成果的认可，只有运营人员提到“换位思考”的重要性，这表明可能存在未解决的紧张关系。这些结果表明，研究人员可能会受益于使学术激励措施与对医疗保健机构的贡献更好地保持一致，并对研究的运营影响建立正式认可，同时保留研究过程的一些灵活性和独立性。
