Based on the literature review, we identified eight mechanisms (‘how and why’) that are conditional for effective collaboration within PKIs. Without these mechanisms, it is plausible that collaboration will not be established or will not lead to any or less sustainable impact.
The starting point for identifying mechanisms was the publication of Kaats and Opheij [18] about collaboration between individuals and organisations in the public domain. Based on interdisciplinary scientific research as well as applied research, Kaats and Opheij distinguish five conditions for effective collaboration:
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Defining a shared ambition
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Doing justice to everyone's interests
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Investing in personal relationships (formal / non-formal)
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Having a professional organisation or structured process in place
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Having a meaningful process oriented towards collaboration (right steps, right sequence, win/win process, dialogue)
In addition to these mechanisms, we found in the literature that there is also a need for mutual trust between partner(s), as well as sufficient time for and continuity of the collaboration [21], adding up to seven mechanisms. The online survey of participants of the European Implementation Event 2021 yielded similar findings, although the number of respondents was low (n = 4). Muhonen et al. [13], studying mechanisms through which collaboration in the field of social sciences and humanities leads to societal impact, also came to similar conclusions. Finally, transdisciplinary collaboration - also referred to as knowledge cocreation – was found to generate impact in (complex) knowledge and innovation processes, such as PKIs [13, 22]. This totals to eight mechanisms for effective collaboration.
These mechanisms can be enhanced or hindered by factors that relate to individuals involved in the partnership, their interrelationships and/or the working environment (see Fig. 1). For example, a shared set of values and ground rules, shared ownership for goal achievement, and activities supporting knowledge functions (measuring, analysing, integrating results) together contribute to mutual trust.
From the literature, we identified a range of potential hindering factors, including lack of ownership of knowledge users, insufficient budget/structural funding and knowledge transfer, hobbyhorses of researchers, poor timing of results, unfavourable policy context (e.g. corona crisis, budget cuts, reorganisation), power relations and conflicts of interest. Facilitators found in the literature include the role of project leaders and/or policy officials, combination of different 'types' of knowledge, stakeholder commitment, embeddedness of the collaboration in the organisation/policy, and translation of knowledge (e.g. turning conclusions into practical recommendations and/or proposals). Several factors can play a role in hindering or facilitating each of the identified mechanisms but we were not able to identify a systematic pattern of factors for each mechanism.
Below, we describe the eight mechanisms for effective collaboration in more detail and focus on potential facilitating factors while also addressing some barriers. We illustrate the findings with examples from the different PKIs studied.
Transdisciplinary collaboration
PKIs are an ideal setting for transdisciplinary collaboration; it involves research in which joint problem solving plays a key role, it deals with collaboration between scientific disciplines and domains, includes the active participation of societal stakeholders, and implies epistemic pluralism and science-internal reflexivity. An example is the academic collaborative network focusing on adolescents, which comprise a formal, long-term partnership between youth sector organisations, municipalities, universities, universities of applied science, parents and young people. These parties organise themselves regionally in a PKI that enables continuous interaction between them. The questions to be addressed are provided by adolescents and their parents, policymakers and health professionals. Researchers translate these questions into a (research) project. Together, the participants develop knowledge that can be directly used by health professionals, youth organizations and municipalities. To enhance the use of the knowledge developed within the academic collaborative network five learning networks were established in 2018. In a learning network, universities of applied science and practice organisations, work together, also with others like policy makers, experts, adolescents, lecturers, and researchers with the aim of sustainable exchange between training and practice organizations to enhance the quality of the work in the youth sector. Even though transdisciplinary collaboration is an important mechanism for collaboration, we found that the participation of for-profit organizations, citizens as well as collaboration between different domains (e.g. cure and care) are still at the early stages in the PKI studied. For example, citizens were involved in six out of the twenty PKIs: three academic collaborative networks (Public Health, Youth and Elderly Care), one disease/care-related network (Palliative Care Netherlands) and the living labs Sport and Exercise. Companies and health insurers are involved in two academic collaborative networks (Public Health, Integral approach to obesity), one consortium (Microplastics & Health) and the living labs Sport and Exercise.
Shared ambition
Collaboration is effective when it provides something to all stakeholders involved. It is essential that there is a shared ambition among the stakeholders operating in the PKI (bottom-up initiative). A shared ambition consists of a combination of strategies, goals and missions that are supported, pursued and adhered to within the PKI. To add societal value, stakeholders from different domains should be involved as early as possible in the process. The joint drafting of an impact pathway creates a shared picture of the (end) situation prompted by the interests of involved stakeholders. However, from our analysis it became clear that among the PKIs studied there is much emphasis on (international) scientific output and knowledge sharing, and less on creating a shared set of values (culture) to perpetuate knowledge implementation. One positive example is the collaborative network of organizations centred around pregnancy and birth. Before applying for funding from ZonMw, the relevant professional groups met at regional level to determine what goals they would like to achieve and what is needed to achieve the goals. According to those involved, this alone provided a big boost to better care for pregnant women and their babies. With the help of ZonMw grants, nine regional consortia were established, resulting in a nationwide pregnancy and birth network, collaborating with youth health services. The task of the Perinatal Care Board of the network is to stimulate and, where necessary, facilitate and organise knowledge exchange to support regional collaboration and to disseminate and make knowledge available to all stakeholders involved [23].
Doing justice to everyone’s interests
Different interests may simultaneously play a role in a PKI: these could be organisational, individual and/or public interests. The interests determine how the knowledge issue at hand is being viewed, defined and perceived. Effective collaboration does as much as possible justice to everyone's interests. An example concerns the living labs Sport and Physical Activity, comprising fifteen municipalities and universities of applied science. With the help of a network grant, the partners and citizens mapped out their joint ambition. By involving citizens in the initial phase, the labs focus on citizens' needs. Important insights emerge by analysing local issues together with citizens and giving them responsibility to finding solutions. Involving citizens in all steps of the process and adapting to their pace remains a challenge, especially when it comes to involving vulnerable groups. The labs use various tools for collaboration and engaging citizens, such as the flat puzzle (interaction by working on a puzzle together) [24] and kitchen table talks [25].
Effective collaborations aim for a win-win situation and include a continuous assessment of whether the collaboration creates value for involved stakeholders (individual, organisational and public). If there is room for mutual understanding of the interests of all stakeholders, the process will be smoother and more effective. To enable this open dialogue, fully participating (active) stakeholders, and transparent information exchange are essential. This should be defined from the end users perspective, to avoid mutually incorrect perceptions. Our analysis showed that organisational and individual interests have most often been taken into account in the PKI studied. However, there is insufficient commitment to public interests and insight into societal added value of each PKI.
Personal relationships
Relationships between different stakeholders can affect effective collaboration. Possible opportunistic behaviour of stakeholders hinders knowledge collaboration. For example, researchers need to publish in journals that have a high-impact factors, and policymakers would prefer to receive concrete results on the short term. Our analysis shows that a weak project leader is, like hobbyhorses of researchers, a barrier for good collaboration. The role of the project leader is therefore essential for the relationship between/with parties and for the creation of a trusted environment. An example is an action programme of local initiatives, needed to provide an integrative approach, regarding troubled people in the province of Limburg. In this action programme learning networks are set up or expanded. Given the involvement of a large number of relevant parties including the police, safe houses, health insurers, and care providers, a strong project leader is necessary. The project leader fulfils a connecting role, manages cohesion and drives initiatives for a comprehensive approach targeted to troubled people. Thanks to the project leader partners are better able to reach out to each other, have a better understanding of what they can do for each other and have a better understanding of each other's position. This lays the foundation for participatory partnerships in the future.
Our analysis also shows that there is insufficient insight regarding the challenges to collaboration, the existing knowledge base within PKI, and that less active partners may hinder collaboration. Connecting stakeholders enhances building personal relationships. The availability of a physical location is an important factor that contributes to a shared vison and personal contacts. Complementarity in thinking and doing is essential for effective collaboration. This requires attention to bringing together/synthesising from the outset necessary scientific knowledge from different disciplines (team science), experiential knowledge, professional knowledge (including practical experiences, research experiences outside the research setting and implementation skills) as well as artistic knowledge (creativity). An example in which art is used for connecting stakeholders and strengthening personal relations is the Beautiful Distress Madness meets Art initiative, part of Action Programme local initiatives for troubled people. The project takes a broad approach involving collaboration with people with mental health problems, their networks, artists, staff of mental health and community organisations, policymakers and adolescents and students. The recommendations have been discussed with all relevant parties, and collaboration has been used to further implement the results [26]. Finally, there are tools available such as the Involvement Matrix [27] that stimulate connecting with end users (e.g. patients, persons with disabilities, young people, parents, and relatives).
Mutual trust
Trust is fundamental to effective collaboration and can be defined as “a psychological state of willingness to be vulnerable based upon positive expectations of the intentions or behaviour of another party in uncertain situations” [28]. Due to uncertainty, especially with regard to the future, trust is not a static element and can vary over the length of the relationship. It is apparent that mutual trust often stems from previous successful collaborations. Previous collaborations and bottom-up initiatives are enabling trust. Besides trust, an open attitude and mutual respect are important. For example, in the care network Palliative Care South-East collaboration between research partners, educational organizations, and health professionals is strengthened by joint agenda-setting and alignment in focus and priorities. Based on shared values and the development of a joint vision, projects and activities are carried out in the region, with trust forming the basis of collaboration [29].
Professional organisation
The operational quality of the collaboration depends in part on the ability of the different stakeholders to engage organisationally and substantively, and the extent to which the collaboration can spur action [18]. Our analysis shows that there are different working routines/cultures (e.g. risk appetite) between research and practice (local government, healthcare professionals) that could potentially hinder this. A professional organisation is therefore essential for sustainable, effective collaborative partnerships. This involves establishing ground rules, procedures, agreements, relationships, ways of working (such as independent and agile working), (variable) roles and positions. We found that a supported culture, formalisation of responsibilities (e.g. declarations of intent and administrative consultations), (co)financing (in cash/in kind), effective (scientific) communication, a long-term vision, and thus long-term financing, are important facilitators. For example, experience from the regional oncology networks in the Netherlands shows that agreements on a national level are needed to explore – via large-scale experiments – how the networks financially can be sustained [30].
Meaningful process
Facilitating and securing sustainable and learning infrastructures for development and implementation of knowledge are important factors for effective collaboration. This also applies to less protocolled and less complicated grant application processes as well as to strategy development of organisations. An example is the programme on how to effectively work in the youth sector, which is part of the academic collaborative network in the Youth sector. The aim of this programme is to increase, combine and disseminate knowledge on promoting the psychosocial development of children and adolescents. This is useful for the youth healthcare sector, local policy targeting prevention and/or clients at the interface of youth care/youth mental health/youth with mild intellectual disabilities. One of the projects within the programme focuses on professionals and their organisations (n = 21) to support them in developing a new way of working to transform the youth sector. Learning organisations is the key concept, requiring organisations to be flexible and innovative [31]. It is also important to ensure transparency of information and to harmonise the way in which knowledge infrastructures can be assessed. Data management (Open Science) facilitates communication and accountability with regard to research funding, analysis, and decision-making on resource allocation [32].
Sufficient time and continuity
Our analysis shows that within PKIs there is a lack of processes that provide sufficient time, people and resources to: learn to speak each other's language, develop the soft skills needed for collaboration, have regular personal contact, room to experiment, reflect, implement and embed the collaboration in practice. The creation of connecting functions or linking pins (e.g., duo appointments, staff exchange) can be conducive factors to address these limitations. In addition, long-term programming based on knowledge questions and active steering of the funder promotes collaboration. An example of a PKI where linking pins have been instrumental is the academic collaborative network for Elderly Care South Limburg (AWO-ZL). This is a structural collaboration between a university, several healthcare organisations, a university of applied science and a secondary vocational education institution since 1998. Through scientific research, the AWO-ZL contributes to improving quality of life, quality of care and quality of work in the field of elderly care. To expand the AWO-ZL's impact, its infrastructure is being strengthened, based on a reciprocal 'linking-pin' construction: senior scientific staff and care professionals work in duo jobs at the organisations involved. Researchers and care professionals work together in an interdisciplinary way to generate and implement knowledge and they execute scientific research agendas set by the target population (elderly) and health professionals [33].