Towards learning healthcare systems: Collaboration and boundary crossing in research and practice

Abstract

The complex balance between scientific evidence, clinical expertise and the patient’s experience makes healthcare systems prone to inefficiency and fragmentation. This sparks the interest into a care system that aligns the input from researchers providing scientific evidence, healthcare professionals building their clinical expertise on that, and patients experiencing outcomes: a Learning Healthcare System (LHS). Yet, to build such a system requires insight into the role of, and interplay between, researchers, healthcare professionals and patients.

In the first part of this thesis, we zoom in on the role of researchers. Using a Social Network Analysis (SNA) perspective, we explore with whom they collaborate, how, and why. The second part of this thesis focuses on the role of healthcare professionals and patients. We assess how the process of collaboration between them unfolds from a Cultural Historical Activity Theory (CHAT) perspective.

We conclude that combining different units of analysis (researchers, healthcare professionals and patients) and theoretical frameworks (e.g. SNA and CHAT) is necessary to understand and develop a complex system as the LHS. We should increasingly think in, design and invest in healthcare networks and research communities – and, essentially, include herein the patient perspective as one on which developments and changes are based.