Intra-professional dynamics in translational health research: The perspective of social scientists

Intra-professional dynamics in translational health research:
The perspective of social scientists
Graeme Currie*, Nellie El Enany, Andy Lockett
Warwick Business School, The University of Warwick, Coventry CV4 7AL, United Kingdom
a r t i c l e i n f o
Article history:
Received 23 May 2013
Received in revised form
18 April 2014
Accepted 27 May 2014
Available online 27 May 2014
Keywords:
Translational health research
Epistemic communities
Social scientists
Professional dynamics
CLAHRC
England
a b s t r a c t
In contrast to previous studies, which focus upon the professional dynamics of translational health
research between clinician scientists and social scientists (inter-professional contestation), we focus
upon contestation within social science (intra-professional contestation). Drawing on the empirical
context of Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) in England, we
highlight that although social scientists accept subordination to clinician scientists, health services re-
searchers attempt to enhance their position in translational health research vis-a-vis organisation sci-
entists, whom they perceive as relative newcomers to the research domain. Health services researchers
do so through privileging the practical impact of their research, compared to organisation scientists'
orientation towards development of theory, which health services researchers argue is decoupled from
any concern with healthcare improvement. The concern of health services researchers lies with main-
taining existing patterns of resource allocation to support their research endeavours, working alongside
clinician scientists, in translational health research. The response of organisation scientists is one that
might be considered ambivalent, since, unlike health services researchers, they do not rely upon a close
relationship with clinician scientists to carry out research, or more generally, garner resource.
© 2014 Elsevier Ltd. All rights reserved.
1. Introduction
In this paper we draw on the sociology of professions literature
(Abbott, 1988; Freidson, 1984) to explore the extent to which it is
possible for different epistemic communities within social science
to integrate into, and thrive in the domain of, translational health
research, within which the experimental paradigm occupies a
hegemonic position. Extant studies have focused on interactions
across epistemic communities of clinician scientists and social
scientists in translational health research (Albert et al., 2008; Albert
et al., 2009; Wilson-Kovacs and Hauskeller, 2012). In contrast, we
view the challenge of translational health research from the
perspective of social scientists, a neglected focus of empirical study
(Albert et al., 2008; Wilson-Kovacs and Hauskeller, 2012). Further,
we treat social scientists as a variegated, epistemic community
(Becher and Trowler, 2001), and disaggregate those involved in
translational health research into two distinct epistemic commu-
nities: health services researchers and organisation scientists.
Finally, rather than focussing on the interaction between clinician
scientists and social scientists (inter-professional dynamics), we
focus upon interaction between health services researchers and
organisation scientists (intra-professional dynamics). In so doing,
we adopt a relational perspective across and within epistemic
communities, which enables us to explore the discordance be-
tween social scientists involved in translational health research
about the value of others' research (Albert et al., 2009).
In exploring the discordance between social scientists in
translational research we address the call for research to under-
stand how different epistemic scientific communities perceive and
judge one another, through consideration of the professional dy-
namics of the translational health research domain (Albert et al.,
2008, 2009; Wilson-Kovacs and Hauskeller, 2012). As Albert et al.
(2009: 174) state: “in the current move towards inter-disciplinary
research, it is vital to understand how scientists from different
backgrounds and with different degrees of scientific authority
perceive and judge one another”, since this shapes not only their
attitudes towards collaboration, but has material resource conse-
quences. In particular, researchers are asked to consider how sci-
entific epistemic communities attempt to establish a distinct field
of expertise, maintain professional jurisdiction, and consolidate or
enhance status and collective standing as leaders of translational
health research (Wilson-Kovacs and Hauskeller, 2012).
* Corresponding author.
E-mail address: [e-mail] (G. Currie).
Contents lists available at ScienceDirect
Social Science & Medicine
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / s o c s c i m e d
http://dx.doi.org/10.1016/j.socscimed.2014.05.045
0277-9536/© 2014 Elsevier Ltd. All rights reserved.
Social Science & Medicine 114 (2014) 81e88

In the remainder of the paper, and based on the above, we
address the following research questions: (i) on what basis, and
with what effect, do health services researchers and organisation
scientists interact (or not) in translational health research? And, (ii)
assuming policymakers are justified in their investment in trans-
lational health research, embedded within which disciplinary
collaboration is necessary, how might better interactions between
health services researchers and organisation scientists be
supported?
2. Conceptual framework
Our study conceives disciplinary and scientific practices as social
institutions (Albert et al., 2009), which are manifested as ‘epistemic
communities’ (Knorr-Cetina, 1999) or ‘academic tribes’ (Becher and
Trowler, 2001). Epistemic communities constitute, “taken-for-
granted ways of thinking about and doing science; e.g. shared as-
sumptions about what ‘good’ science is, what method is best to
generate valid results, how data should be collected and inter-
preted, and what constitutes productive science” (Albert et al.,
2009: 173).
In considering the interaction of epistemic communities within
translational health research, scholars have highlighted that the
experimental method is privileged (Albert et al., 2008, 2009;
Wilson-Kovacs and Hauskeller, 2012), which positions biomed-
ical scientists and clinician scientists at the top of the hierarchy of
epistemic communities involved in translational health research.
The process through which hierarchy is derived is one whereby
certain procedural assessment criteria are applied to evaluate the
science of an epistemic community. Albert et al. (2008, 2009)
describe how the interaction of biomedical or clinician scientists
and social scientists is framed by epistemic culture and position
(dominant or subordinate), and differential power to set out what
constitutes legitimate science. The current dominant scientific
criteria in translational health research are primarily atheoretical,
quantitative and hypothesis-driven, whereas social science is more
theoretical, qualitative and interpretive (Albert et al., 2008). The
effect of procedural assessment criteria about value of science is
one that privileges the epistemic community of clinician scientists,
and renders subordinate the epistemic community of social sci-
entists. Thus, Albert et al. (2008, 2009) anticipate that the growth
of social sciences will continue to meet obstacles, derived from the
dominant position of the episteme of biomedical and clinician
scientists, within the health research field. Reflecting the pessi-
mism of Albert et al. (2008, 2009), other academic commentators
report that current attempts to integrate social scientists into the
translational health research domain are encountering significant
difficulties and resistance from clinician scientists (Bernier, 2005;
De Villiers, 2005; Grol, 1997; Kislov et al., 2011; Rowley et al.,
2012).
The aforementioned studies focus upon interactions between
biomedical or clinician scientists and social scientists (a matter of
inter-disciplinary contestation), but treat social science as a
monolithic epistemic community. We suggest, however, that in-
teractions within the epistemic community of social scientists are
likely to be rather more dynamic than recognised in extant litera-
ture. In recognition of a gap within social science, as applied to
healthcare, Currie et al. (2012) edited a collection of studies pro-
duced by organisation scientists to draw to the attention of medical
sociologists and health policy academics the value of their work. In
reflecting upon why such integration of epistemic communities
within social science has been slow to realise, we suggest that
attention should be focused on the procedural assessment criteria
in framing the intra-disciplinary relations between organisation
scientists and health services researchers in translational health
research. We suggest that the sociology of professions literature
might provide insight into this issue.
The sociology of professions literature suggests that the dy-
namics of professional organisation relate to stratification and hi-
erarchy designed to protect or extend jurisdiction through expert
claims about exclusivity of knowledge, in a way that simultaneously
enhances professional status (Abbott, 1988; Freidson, 1984). Those
in privileged positions in the professional hierarchy (in the case of
translational health research, clinician scientists), may accommo-
date substitution of their labour where they are not competing for
resource. Simply stated, abundance or scarcity of resource is likely
to shape professional dynamics. Competition for resource has been
noted as a significant issue in contestation between scientific
epistemic communities in translational health research (Albert
et al., 2008, 2009). The incentive for social scientists to engage in
translational health research is to gain higher status in the field,
exert more influence on health policy, and perhaps most impor-
tantly, to access more resources (Albert et al., 2008). Even where
resource constraints are less significant, however, powerful pro-
fessions may seek to control that labour with which it has been
substituted; i.e. a delegation tactic, which renders the substitute
labour subordinate to the powerful profession (Martin et al., 2009).
Thus, perhaps unsurprisingly, when engaging in translational
health research, social scientists are positioned as subordinate to
clinician scientists, meaning that they only have access to limited
financial resource (Albert et al., 2008, 2009). How such processes
play out between organisation scientists and health services re-
searchers within the social science epistemic community is not
clear, but similar dynamics around knowledge claims and stratifi-
cation are likely to be evident.
3. Data and method
3.1. The empirical case
Our empirical case is CLAHRC, a translational research inter-
vention in the English National Health Service (NHS) (Dzau et al.,
2010), which is one of many such translational health research
interventions evident globally. For example, in the United States,
Veterans' Health Administration's Integrated Health and Research
System (Graham and Tetroe, 2009), American Quality Enhance-
ment Research Initiative (www.queri.research.va.gov), and Clinical
Translational Science Centres (Butler, 2008); in Canada, the Cana-
dian Health Services Research Foundation (Dussault et al., 2007);
and in the Netherlands, the Dutch Academic Collaborative Centres
for Public Health (Wehrens et al., 2012).
Nine pilot CLAHRCs were established in 2008, funded £100
million by the National Institute of Health Research (NIHR) for five
years, with a similar amount of matched funding from participating
universities and healthcare organisations. Recently, further funding
of £120million, again with a similar amount of matched funding
from participating universities and healthcare organisations, was
awarded for 13 CLAHRCs, encompassing continuation of funding for
the earlier pilots, for a further five years from 2014.
The intention of the CLAHRC initiative was promote trans-
lational research to move beyond linear models of translating ac-
ademic evidence into practice (Nutley et al., 2007). In doing so the
nine CLAHRCs were tasked with three key interlocking functions:
(i) conducting high quality applied health research; (ii) imple-
menting the findings from research in clinical practice; and (iii)
increasing the capacity of NHS organisations to engage with and
apply research. The nine CLAHRCs are regionally focused, with their
agendas being determined by the partnering organisations and
tailored to healthcare needs in their respective geographical areas.
Whilst mandated by policy, CLAHRCs were regarded by the NIHR as
G. Currie et al. / Social Science & Medicine 114 (2014) 81e8882

experimental in nature during their inception, with considerable
variation allowed for their structures and processes. Social sciences
were variably integrated into CLAHRC plans, with some involving
input from health services researchers located in or near to medical
schools, and others involving input from organisation scientists in
business schools; academic research and clinical practice were
blended in different ways; and there were differences in the disease
emphasis of CLAHRCs, although all nine CLAHRCs focused upon
translational health research around long-term conditions.
Regarding the constituent epistemic communities upon whom
we focus within CLAHRC, we asked our respondents to self-define
themselves as clinician scientists,1 health services researchers,
organisation scientists, NHS managers, and clinical practitioners.
We corroborated their self-definitions with our own assessment of
which epistemic community towards which they orientate (in all
cases, we agreed with the self-definition). We recognise, however,
that our categorisation is rather crude, and operates as a heuristic
device to aid theoretical analysis. Some academics, as discussed in
our empirical presentation, are not easily categorised and present
themselves as ‘hybrid’ academics that cross the boundaries of
epistemic communities.
Regarding the authors' own position, we are located in the
category of organisation scientists, located in a business school
(although at least one of us might characterise himself/herself as
‘hybrid'). We remained reflexive in our analysis to mediate any
partiality in analysis; e.g. analysis was presented to CLAHRC Di-
rectors (clinician scientists), other audiences where health services
researchers and clinician scientists were present. In support of our
impartial stance, we highlight analysis within the manuscript is
somewhat critical of our own community; e.g. as theoretically
driven with little concern for practical impact, as just chasing
research funding wherever its source and focus.
3.2. Data collection and analysis
We employed a longitudinal research strategy over a period of
three years to analyse interactions between constituent epistemic
communities of CLAHRC. Ethics approval was sought and gained
prior to commencing research (Research Ethics Committee refer-
ence: 10/H0402/6 Leicestershire, Northamptonshire and Rutland
Research Ethics Committee 2). CLAHRC Data presented in this
article is mainly drawn from 174 qualitative interviews carried out
between 2009 and 2012, encompassing a first, exploratory phase
across all 9 CLAHRCs (104 interviews), followed by a second phase
of data collection across four in-depth comparative cases (Cases B,
C, D, G: 70 interviews). Details of the interviewees are presented in
Table 1.
The interviews were focused on the challenges of collaborating
across epistemic communities of organisation scientists and health
services researchers, and how these might best be mediated. All
interviews were fully transcribed. Interviewing stopped when we
reached a point of theoretical saturation; i.e. when interviews were
only adding marginal increases to our knowledge (Glaser and
Strauss, 1967).
Complementing the interview data, the research team spent
extensive time carrying out observational work, involving: atten-
dance at key meetings; workshops; presentations; other educa-
tional events. During all meetings and observations, detailed notes
were taken. Documentation was collected including: initial CLAHRC
bids; annual reports; study protocols; corporate publicity material;
minutes of operational and CLAHRC Board meetings. In Gephart's
terms, we developed ‘a substantial archival residue’ (1993: 1469)
from the different published sources. All interviews, observational
and documentary material were collated into a database, which
was organised on a case-by-case basis.
Data analysis was iterative and undertaken in an inductive
manner, but was informed by key concepts set out in the literature
review (Miles and Huberman, 1994; Pope et al., 2000). Each inter-
view transcript, set of observational notes, and document was read
several times, generating and coding themes iteratively, in part
framed by literature; i.e. the sociology of professions literature
(Abbott, 1988; Freidson, 1984) framed our analysis of the epistemic
boundaries between organisational scientists and health services
researchers. In part, codes emerged inductively, such as the sig-
nificance of hybrid academics in mediating epistemic boundaries
within social sciences. Analysis was conducted with the assistance
of NVivo 8, with material inputted into a database and coded ac-
cording to each high level category.
To preserve anonymity of respondents and cases in line with
ethics approval, but to reveal comparative analysis around the
dimension of epistemic boundaries, and reflecting our substantive
research concerns, we identify our respondents according to their
academic discipline or whether NHS employed, rather than by case.
We also identify each CLAHRC by label, Case A to Case I.
4. Findings
As a starting point for empirical analysis, we draw upon one of
many interviewees that called for further five year funding,
following the five year CLAHRC pilots, to sustain the CLAHRCs'
mission to bridge the translation gap:
The original plan on commissioning CLAHRCs was for the first
five years funding to be followed up by a further five years of
Table 1
Summary of interviewees.
Case Phase 1
interviews
Phase 2
interviews
No. clinician
scientists
No. organisation
scientists
No. health services
researchers
No. NHS
managers
No. clinicians Total no.
interviewees
A 6 3 0 1 2 0 6
B 21 16 14 11 2 5 5 37
C 5 23 7 8 9 2 2 28
D 16 16 14 3 2 9 4 32
E 18 7 1 3 6 1 18
F 10 2 3 2 3 0 10
G 13 15 5 2 2 16 3 28
H 12 4 0 3 3 2 12
I 3 1 0 1 1 0 3
Total no.
interviews
104 70 57 28 25 47 17 174
1 Albert et al. (2009: 175) use the term, ‘clinician scientists’ because clinicians'
research activities are not restricted to clinical research, such as clinical trials and
case reports, but may include activities intersecting to some degree either with
social science or basic science.
G. Currie et al. / Social Science & Medicine 114 (2014) 81e88 83