‘To be more impactful would be to have more time to build relationships’

A few days before the first COVID-19 case in the Netherlands was confirmed, the head of Bert’s research group about healthcare governance at ESHPM discussed with the dean of Erasmus MC that they would like to do fieldwork there while this new situation was developing. Two days later, Bert showed up there to follow along and shadow people at management level during the first wave of the COVID pandemic. While they started this fieldwork just because they thought it was necessary to document this moment, shortly after they also gained funding for the project, which encompassed organisational ethnography around decision-making processes and reflection sessions with participants about the observations. For Bert this was “one of the most transformative experiences as a researcher” because he felt like he was doing something unique and useful, working “in the eye of the storm” on something so big that everyone was experiencing.

During his promotion study at the University of Amsterdam on citizen participation and health risk governance and a stint at the Athena Institute at the VU Amsterdam on patient participatory research, Bert encountered the importance of transdisciplinary research.  During his PhD he noticed the close link between practice, policymakers, and how to deal with uncertain risks in a way that would mitigate ‘wicked problems’. At the Athena Institute, Bert collaborated with a patient organisation and together with the patients, he drafted a research agenda and discussed what kind of research would be valuable to those patients.

Currently he is working on an academic collaboration with Zorginstituut Nederland (the Dutch National Health Care Institute) and Utrecht University, where Bert coordinates the collaboration. Together with PhD students, they research how to regulate innovative medical technologies on the front end instead of the back end from a governance perspective.

Collaborations in transformative research

These kinds of academic collaborations are a common thread in Bert’s work, and participation of- and collaboration with societal stakeholders is also characteristic for transformative research approaches. ESHPM has collaborated with Zorginstuut Nederland (ZIN) and other institutional actors for a long time in so-called ‘Academische Werkplaatsen’ (academic workplaces). This started out as a financial solution, but over time it developed into a community where policymakers and researchers are brought together to develop knowledge for and with ZIN. The nice thing with these kinds of collaborations according to Bert, is that you get to know each other very well, and that trust is built to work on strategic questions and create space for doubt and reflection, which can be quite ‘scary’ and hard to do otherwise. He realizes that these collaborative spaces are very valuable and fragile, seeing that sensitive topics and issues are being discussed that can come with ambivalent feelings.

“We bring researchers together and we try to build a community around it, and it works. I think that's one of the nicest things to it to be honest. We try to bring some interaction and energy going there. We try to develop knowledge together with ZIN.” Sometimes more specific questions arise from ZIN, and the collaboration group considers how to work with ZIN in a way that is beneficial for everyone: “So we're actually having these strategy meetings with them, and for us it is data as well, but for them it might help them reflect on their position.”

What is nice about the collaboration with ZIN is that it is a long-term relationship, “One of the big issues in our field is this projectification of our work … but here we are able to build a sort of research agenda which you can follow over time, and we can make sure that the stuff we did four years ago makes sense with what we do now”.

Challenges

Just like with the other interviews, we asked Bert about some struggles he encountered with the type of research he is doing.

• Proving and defining impact: In the research project about COVID-19 at Erasmus MC, Bert felt it was some of the most impactful and transformative research he had ever done. And yet, it was difficult to convince the funding agency of the impact of the project: “For instance, they are asking us what's your impact? and we were struggling to define it as well because we say, well, we've done all these sessions, we've been talking to everyone, and look at our successful hybrid symposium.. But this was still not enough, they really wanted a sort of measurable impact.” What makes this difficult is that ‘impact’ isn’t a clearly defined term and it can be hard to predict what follows from the earliest output. Of course the unpredictability of the pandemic made this even more difficult.
• Relation management: As mentioned before, creating long term mutually beneficial relationships is one of the most important things for Bert to do the research he does. “This sort of ethnographic action research, bringing stakeholders together, it takes a lot of work, and it takes a lot of time, and it takes a lot of relationship management. It's also hard to sort of hand it over to a student assistant, for instance, because, especially with people like [important key figures], those are sensitive relations, right? So, you need to mobilize power to be able to retain the access. It’s personal, and that is the nice thing, I like that part as well … but if we want to build impact in that sense on building relationships, there should be time … we should maybe ourselves, when we draft research proposals, include more time and budget for that kind of work as well, but generally we kind of overpromise and leave this thing implicit”.
• Building an academic career: The necessity of building a coherent set of ideas as part of your identity as a researcher can be difficult to combine with the dependant and flexible nature of collaborative work. Bert asks: “how do you maintain sort of your academic curiosity and your academic interests, and the bigger questions you want to work on yourself? Also as an assistant professor right? In my job now to be able to become an associate professor, I need to build research themes and it would be nice if I had two or three PhD who were kind of working on themes I like so as to make myself relevant for the research group as a whole, and to be able to work on that ... then as a bigger research group, we have our agenda and so how do you mesh that with the agenda and questions from practice, like ZIN for instance, who are paying for us?
• Ethics of ethnography: The methods Bert uses for his research don’t always fit in the formalized ethical norms that are set by the university, which can make it frustrating to go through the processes of applying for approval, even though Bert himself is also part of the Ethical Review Committee. “I notice that our more exploratory work, especially inductive ethnographic stuff, doesn't really fit nicely into this linear logic of informed consent forms and putting things in data repositories. Right now, there we go again, explaining that no I'm not going to put all my sensitive field notes in a data repository. No, this is not going to happen, or you are going to have me get rid of all context information. But then what’s the use? So yeah, this is also one part of the institutional struggle”

Bert hopes to continue building the research agenda together with ZIN. In previous collaborations he noticed that once the process of building the collaboration ends and it feels ‘finished’, the research questions dry up and the partnership comes to an end. However, the collaboration with ZIN has been ongoing for a number of years and with the limited amount of people involved they are able to have in-depth conversations about the narrative of the process and evaluations about new research questions.

As for the development of transformative research, Bert is interested in the research support being set up in various programmes, but sometimes struggles to see what is going on at EUR central level. “I think it's very useful for us as researchers to have some support on this level as well … as researchers, I think, we tend to identify with the research group we're in”. With the academic culture in universities, the workload is already quite heavy and most people tend to focus on what’s going on within their research group and department. The schools and then central level can seem like rather different organisations and this distance makes it hard to keep up with what’s going on. Still programs developed nationally such as Recognition and Rewards don’t go unnoticed and can be a step in the right direction of creating more space for transformative research and ethnographic work to fit into the academic reward system.