Partnering to improve care: the case of the Veterans' Health Administration's Quality Enhancement Research Initiative.

Background: Within many large health care organizations, researchers and operations partners (i.e., policymakers, managers, clinical leaders) join to conduct studies to improve the quality of patient care. Yet optimal approaches to conducting partnership research and evaluation are only beginning to be clearly defined. The Veterans' Health Administration (VA) Quality Enhancement Research Initiative (QUERI), funded by operations leaders and administered by the VA's research service, now has nearly two decades of experience in fostering research-operations partnerships for improving quality of VA care. The work reported here is part of a national evaluation of QUERI. Because individuals in research and operations often have differing backgrounds and perspectives, we aim to identify the main sources of tension in research-operations partnerships and strategies for maximizing partnership success, through the eyes of QUERI participants.

Methods: We conducted semi-structured interviews with 116 researchers and operations partners chosen randomly from within pre-identified key participant groups. We conducted inductive qualitative analysis of verbatim interview transcripts, limited to the 89 interviews of individuals reporting at least some familiarity with QUERI.

Results: Tensions in research-operations partnerships were primarily related to diverging incentives and to differing values placed on scientific rigor or integrity versus quick timelines. To alleviate these tensions, operations' partners highlighted the importance of 'perspective-taking' (i.e., putting themselves into the shoes of the researchers) to ensure a mutually beneficial and attractive partnership, whereas researchers identified the importance of overcoming the need for recognition to be apportioned between either research or operations for achieved results. Both researchers and operations participants identified jointly designing each partnership from the beginning, minimizing research bureaucracy burdens, and prioritizing in-person communication and long-term relationships as key partnership building blocks.

Conclusions: QUERI research and operations participants had largely concordant views on partnership tensions and approaches for improving partnership success. The fact that only researchers mentioned moving beyond recognition for the results achieved and only operations staff mentioned the importance of 'perspective-taking' suggests, however, that there may be unresolved tensions. These results suggest that researchers may benefit from better aligning of academic incentives with contributions to the health care organization and establishing formal recognition of operational impacts of research, while preserving some flexibility and independence of the research process.