Methods
Data is drawn from conversations with policy and practice partners as part of the scoping of enquiries that the service received between June 2013 and March 2017. Individual conversations with over 150 enquirers and academic supporters were documented in summary notes (mostly handwritten on paper) and all email communications with both were stored in separate data folders on the University servers to keep a record of these conversations. More than a quarter of enquiries (27%) originated from public health teams in local authorities who wanted to rapidly evaluate their interventions and programmes; another quarter (23%) was submitted by voluntary and community sector organisations that provided public health-related services in their communities (e.g. social activities for elderly people living in isolation), while a fifth (21%) was initiated by academic researchers across the North East who were keen to collaborate with health practitioners and community organisations in their research and get access to participants, data and additional funding.
These summary notes and emails were analysed in the first instance by the AskFuse Research Manager (ARM) using an auto-ethnographic approach [
14]. This approach applies a cultural analysis and interpretation of the ARM’s behaviours, thoughts and experiences in relation to the policy, practice partners and researchers accessing the service. This method was chosen in recognition of the sensitive nature of the dialogues that take place between the ARM and enquirers and the importance of these dialogues for shaping collaborative research in response to their enquiries. The auto-ethnographic approach allowed for a safe deconstruction of these conversations that was sensitive to the ARM’s own input to these conversations.
The ARM read through all the notes and emails (field texts) collected from enquirers, and noted down his thoughts and reflections on barriers and facilitators for brokering enquiries through the service. The field texts facilitated the recalling and organisation of the ARM’s memories of the conversations and supported self-introspection to analyse these memories and select memories. To select memories, a series of questions was used, such as what helped to bring policy-makers and academics together and agree a protocol for a research project? What stopped some projects from advancing or academics from getting/staying involved? Memories were evaluated against these questions, searching for recurrent patterns to analyse and interpret the field texts and related memories.
The findings are based on the reflections of the ARM, which may limit generalisability to other settings. In response to this, emerging themes and categories were refined in discussions with four members of Fuse’s Translational Research programme to include a wider range of reflections and to develop his interpretations. As a group, the members reflected on the usefulness and accuracy of the themes, summarising the different experiences of the brokerage process through AskFuse and particularly the barriers and opportunities identified for collaborative working on local research projects.
While these themes adequately represent the most significant issues experienced in knowledge brokering through AskFuse, we are mindful that the service is set within an English context and therefore different themes might apply in other countries with different governance and health systems. However, the literature suggests the ubiquity of these challenges [
3] and, whilst there may be much to learn from other jurisdictions where the health systems and governance arrangements may differ, some of the underlying issues that determine translation may be similar [
15].
An institutional knowledge brokering service: introducing AskFuse
AskFuse aims to respond to a broad range of research requests from the health, well-being or social care sectors. The post of AskFuse Research Manager was created to provide a single point of contact for all AskFuse enquiries and to coordinate this service for each client from start to finish. Anyone with an interest in public health (e.g. health service providers and commissioners, local government, national infrastructure organisations, and voluntary and community sector organisations) can contact the service with an enquiry, either by email, phone or by completing an online form. In an initial conversation, the ARM explores the needs of the enquirer in more detail; the nature and timescale of any further work is then agreed (with no obligation or fee), resulting in a research brief. The costs of any work are agreed, and outputs discussed at this stage. The ARM then liaises with Fuse senior investigators and staff at the five universities in the North East of England (Newcastle, Northumbria, Durham, Sunderland and Teesside) to identify capacity and skills to develop, commission, lead and undertake research projects that address the brief.
Academics are encouraged to collaborate on responsive research projects with at least two of the five universities in the Fuse collaboration when feasible. During the delivery of a project, the ARM liaises closely with the health professional(s) on the progress of the research and offers opportunities for joint reflection on the data analysis and interpretation of findings to ensure their usefulness for the enquiring organisation.
Findings from research projects and evidence synthesis brokered through AskFuse are made directly available to the health professional in short reports (20 pages) with actionable recommendations, including a one-page summary. Where appropriate and with permission from the enquirers, findings are made available to other policy-makers and health professionals through summary briefs, blogs and case studies on the Fuse website (
www.fuse.ac.uk). The service is promoted through regular communication activities (e.g. press relations, newsletter, social media), presentations at events and meetings, branded materials and through a dedicated space on the Fuse website.
Discussion: a bleak picture for institutional brokering services?
The five challenges outlined above to collaborative working on local research projects through an institutional brokerage service paint a rather bleak picture for the sustainability of these services. However, we now apply Goffman’s dramaturgical perspective to these challenges, which present them in a new light, suggesting that the challenges can be better understood as differences in performances by academics, practitioners and policy-makers that need to be effectively managed by responsive research services. In doing so, we build on what is known about these challenges in the existing literature and use a new perspective to identify how these challenges arise and could be addressed in an institutional knowledge brokering context.
Services like AskFuse provide an important back stage for conversations between academics, practitioners and policy-makers, away from public view, where informal conversations can get at the heart of what policy-makers want to know or do, and what limits there might be around academics’ ability to respond to that (as outlined in Challenge 1). Time spent back stage with AskFuse helped, not only to negotiate performances, but also to decide on the staging. What is the real research question (or questions behind the question)? What type of evidence is most valued? What resources are available to conduct the research? This also helps to address Challenge 5 (Changing evidence bases) by enabling negotiation between knowledge producers and users about the type and mix of evidence that is needed for different performances.
As Challenge 2 highlighted, there are different audiences with whom academics and health professionals must communicate. Each group needs to present a different reality to their audience (for example, the rigour of their research, its usefulness for patients, and the cost-effectiveness of projects for commissioners) and these different realities can cause problems in the knowledge exchange process. For example, scientific rigour can clash with the timescales for developing an intervention, wherein lengthy ethics procedures that academics need to follow can draw out the research process and delay the start time of an intervention. Additionally, increasing quality of care is not always value for money. Moreover, public health interventions, no matter how effective and evidence informed, can be in direct conflict with other local interests; for instance, alcohol licensing can be perceived as a threat to the local night-time economy.
Goffman compares this to the problem of actors having to perform on different stages, giving different messages to various audiences. To keep each performance intact, ideally performers prefer to segregate their audiences so that the individuals who witness them in one role will not be the same individuals who witness them in another role, at least not simultaneously or consecutively [
11]. Performing different roles is part of being a competent actor; the audience needs to believe that an actor personifies each role separately and therefore keeps the different roles separated in time across different audiences.
When audience segregation fails
Unfortunately, Goffman points out that this is not always possible – sometimes audience segregation fails. As practitioners and academics maintain a range of networks and partnerships, their separate performances are bound to overlap and clash. Goffman proposes two solutions. First, all those in the audience may be suddenly accorded temporarily back stage status and “
collusively join the performer in abruptly shifting to an act that is fitting to the one for the intruders to observe” [
11]. In other words, the audience become performers themselves to present the right message to the new arrivals. This is done not to mislead or exclude the other audience (‘intruders’ sends the wrong message in this case), but to focus the performance on the new audience. This also avoids having to do two different performances simultaneously, which would lead to confusing messages. This solution suggests a certain amount of fluidity between audience and performers.
A second way outlined by Goffman to handle the problem of failed audience integration is to accord the intruder a clear-cut welcome as someone who should have been in the region all along and adopt them as members of the existing audience to keep the current performance on track [
11].
The back stage functions of AskFuse
The solutions outlined by Goffman for common performance problems point to various back stage functions that are provided by AskFuse. Firstly, differences in roles and audiences can be discussed back stage and more synchronised performances can be rehearsed that present the right message for the right audience at the right front stage.
Secondly, AskFuse can help with the management of ‘destructive’ information, namely messages that challenge the coherence of the different performances and discredit the impressions of the actors. To make their audiences believe in their performances, it is vital for actors to be coherent in their performance. This will require the over-communication of some facts and the under-communication of others and, for Goffman, herein lies the inherent problems that many performers face: “
There are usually facts which, if attention is drawn to them during the performance, would discredit, disrupt or make useless the impressions that the performance fosters (destructive information)” [
11]. Therefore, a basic problem for many performances is that of information control; the audience must not require ‘destructive’ information about the situation that is being defined for them. Challenge 3 highlighted that limited funding for applied research and lack of time and interest among academics can be classified as ‘destructive’ information for Fuse. It discredits or disrupts the claim that Fuse is focused on the translation of research evidence into practice and that it values collaborative working to enhance knowledge exchange. Therefore, a key function for AskFuse is how to manage this ‘destructive’ information from ruining the collaborative performances.
AskFuse provides a safe space for what Goffman calls ‘staging talk’, namely reflections between (different teams of) performers on past performances and rehearsing new ones. An important element of stage talk is ‘collective moaning’, that is moaning between different actors when back stage about past performances gone wrong, rowdy audience members and props that did not work. In order words, they share ‘destructive’ information. Goffman describes moaning as the surest sign of back stage solidarity [
11]. Back stages, such as AskFuse, provide a perfect forum for a little moaning and sharing of discrediting knowledge with trusted policy and practice partners to build solidarity. In turn, this solidarity can be used for developing collaborative research projects and shared funding applications with our policy and practice partners.
In addition, AskFuse provides a medium for defusing these ‘destructive’ messages. Goffman has suggested that ‘destructive’ information can be made less harmful by ‘over-communicating’ other facts that draw attention away from these messages, for instance, by emphasising Fuse’s free Quarterly Research Meetings and Knowledge Exchange Seminars, where practitioners and policy-makers meet with academics to talk about their research and its usefulness. Alternatively, attention could be drawn to the money that has been made available through Fuse and its membership of the NIHR School of Public Health Research. The need to tailor messages to different audiences has been highlighted by other studies, suggesting that knowledge translators need to identify key messages for different target audiences [
22].
Dealing with change: ‘deviant’ roles
The back stage functions of AskFuse address some of the challenges identified in the knowledge brokering process of institutional services. However, the service does not provide a solution to rapid changes. Challenge 4 highlighted that, when health systems are restructured, the fluidity between front and back stages appears to increase, wherein new front stages are developed (for example, transfer of United Kingdom Public Health responsibility from the National Health Service to local government in 2013) and old back stage areas disappear (for example, United Kingdom Regional Health Authorities were abolished), while demarcations between audiences and performers are still unsettled. Moreover, Challenge 5 suggests that not only the stages are changing but also the types of information that need to be communicated on these stages.
To maintain (academic and health professional) performances in times of shifting contexts and stages, Goffman argues that it is necessary for actors to adopt discrepant roles and communicate out of character. One of the discrepant roles Goffman discusses is the go-between or mediator: “
The go-between learns the secrets of each side and gives each side the true impression that he will keep its secrets; but he tends to give each side the false impression that he is more loyal to it than to the other” [
11].
This role is comparable with the position of the ARM, who acts as the go-between amongst policy-makers, practitioners and academics on various shifting stages. We do not reject Goffman’s characterisation of the need to give false impressions, but we subscribe to a particular interpretation that emphasises providing different impressions to different audiences as outlined by Goffman in his description of one of the key functions of the role: “
Sometimes, the go-betweener may function as a means by which each side is given a slanted version of the other that is calculated to make a closer relationship possible” [
11].
This makes the role of the ARM not only relational but also translational – they must translate differences in performances between policy-makers, practitioners and academics into a view that is more acceptable collectively than the original projection [
11]. For instance, writing a research brief together with health practitioners can help to translate initial enquiries into researchable questions that academics can relate to the existing evidence base. It helps academics to understand what evidence is valued by practitioners and helps the practitioners, in turn, to understand what research is feasible within available resources and timescales.
Conclusions
Key findings
Herein, we reflected on the experience of a particular knowledge-brokering model (AskFuse) developed within Fuse, the Centre for Translational Research in Public Health, in the North East of England. We identified five challenges in the brokering process of institutional services like AskFuse, related to brokerage time, scarcity of resources, lack of institutional incentives and willingness of academics to collaborate with health professionals, and ongoing structural changes in the United Kingdom health system.
Applying Goffman’s dramaturgical perspective, we reframed these challenges as differences in performances by academics, practitioners and policy-makers that need to be effectively managed by responsive research services. The AskFuse service gives these partners access to an informal conversation space that enables them to reflect on performances gone wrong, as well as to construct new impressions that will help them to cope when they act on different front stages and to different audiences.
We distinguished between different functions that responsive research services could provide in the back stage:
1)
Providing a conversation space for health practitioners and academics in which to meet and engage in conversations about local research needs;
2)
Discuss the different audiences with whom each actor communicates (e.g. elected members, funders, service commissioners, service users);
3)
Rehearse and synchronise their performances across different stages (e.g. conferences, research events, council sessions, staff meetings);
4)
Share and hide ‘destructive’ information about their performances (e.g. lack of funding, limited appetite for collaboration); and
5)
Negotiate new evidence bases (e.g. affordability versus impact) by considering multiple types of evidence and applying new review [
15] and research methods to make them accessible and affordable to different contexts and needs [
16,
21].
In addition, knowledge broker roles in responsive research services are important to facilitate situations where audiences overlap and where back stage performers are suddenly thrown in the lime light of the front stage. Knowledge brokers can act as the go-between or mediator to translate differences in performances between policy-makers, practitioners and academics into a collective acceptable presentation.
Limitations to a dramaturgical lens
Goffman’s dramaturgical perspective helpfully reframes the identified challenges to allow for new solutions to be explored for knowledge brokering problems identified in the literature and reiterated in this paper. However, we recognise that there are limitations to applying this metaphor to institutional knowledge brokering; not all readers will agree with some of Goffman’s solutions, such as keeping audiences separated and hiding information that could discredit performances. Knowledge brokering often aims to reach across boundaries and unite different audiences. Therefore, failed audience segregation might be more often than not a reality rather than an inconvenient anomaly for knowledge brokers. What Goffman’s dramaturgical lens helps us to do is to reflect on how this reality impacts on our performances and how we can adjust for it. Other solutions offered by Goffman appear counterintuitive at first sight, for example, temporarily hiding information that makes performances less believable. Open communication is often highlighted as an important trait of knowledge brokers; however, the dramaturgical lens suggests that sometimes being selective with the evidence and the format in which it is presented make performances more credible and knowledge brokering more effective. In strategically communicating between different parties, the knowledge broker can choose to ‘over-communicate’ some facts and ‘under-communicate’ others for different performances.
In summary, what these reflections point to is that the messiness of institutional knowledge brokering can be turned into a strength by applying a dramaturgical perspective. The messiness also means that the challenges faced by the AskFuse service will likely change over time and will require new solutions from a dramaturgical perspective, as highlighted by Challenge 4 (Working with change).
Recommendations
As the five challenges have illustrated, institutional knowledge brokering is not a straightforward process. By understanding the dynamics of the underlying brokering process as staged performances across various stages and in front of different audiences, a more productive back stage can be created. The identified functions of responsive research services can help to develop this stage and foster collaborative partnerships between policy-makers, practitioners and academics, which ultimately increase the flow of evidence into practice.
This takes, time, resources and capacity development, which are limited in the current climate of austerity. However, the need for brokerage services is increasingly recognised by universities across the globe to facilitate the impact of their research and to encourage early conversations between academics and practitioners for developing collaborative research. Continuous investment in institutional brokerage services and research on their operation and effectiveness is required to support impact and address the challenges highlighted in this paper.
Acknowledgements
We would like to thank all AskFuse enquirers who have contacted the service over the years to discuss their research needs.
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