محدودیت در سازمان های بهداشتی دانشگاهی  Boundary-spanning in academic healthcare organisations

1. Introduction Science is funded primarily on the promise of increased economic competitiveness in an era where science and engineering capabilities are seen as crucial in the new knowledge economy (Gibbons et al., 1994; Owen-Smith, 2001). Science policy makers encourage research collaboration between universities and the private sector as a condition for funding (Atkinson-Grosjean, 2006) and almost all research universities in the USA and Europe have established technology transfer offices that connect the university and private sector (Siegel et al., 2007). These policies draw on the assumption that strong connections between universities—seen as producers of new knowledge—and the private sector—seen as producers of new products—are necessary for economic development (Etzkowitz and Leydesdorff, 1999). The majority of previous innovation studies related to healthcare take this traditional innovation focus, concentrating on the private sector and product development through analyses of biotechnology, pharmaceutical, and medical device innovation. The focus on innovation—or the interrelated and more commonly used terms ‘translational science,’ ‘knowledge translation,’ and ‘implementation science’—within hospitals is relatively new, gaining popularity in the 1990s. Here improving health (not economic development) and translation from research to diagnoses and treatments in a linear fashion are often perceived as primary goals (Kerner, 2006; Khoury et al., 2007). Since the 1990s translational science has permeated policy documents and funding programmes (Lander and Atkinson-Grosjean, 2011). The focus on innovation—or the interrelated and more commonly used terms ‘translational science,’ ‘knowledge translation,’ and ‘implementation science’—within hospitals is relatively new, gaining popularity in the 1990s. Here improving health (not economic development) and translation from research to diagnoses and treatments in a linear fashion are often perceived as primary goals (Kerner, 2006; Khoury et al., 2007). Since the 1990s translational science has permeated policy documents and funding programmes (Lander and Atkinson-Grosjean, 2011). This linear conception of translational science is in contrast to bi-directional innovation models (Kline and Rosenberg, 1986). An older model of translation within healthcare also exists based on ‘experiments of nature.’ This concept has a history in both the science and technology studies literature and within scientific and medical practice. Ben-David (1960), in his sociological study of roles and innovations in medicine, argued that experiments of nature involve analysing puzzles from clinical practice through the scientific research process. Good (1994) similarly described an experiment of nature as originating as a clinical problem and moving to the bench. Good was a clinician–scientist who is commonly regarded as the founder of modern immunology. He was also the most cited author in science from 1965 to 1978 (Cooper, 2003).