Team Science: Challenges and Opportunities in the 21st Century
Alma Vega and Mary D. Naylor
[Enhancing our] ability to work across disciplines and professions may well be the hallmark of the 21st century.
—Grady (2010, p. 165)
The sheer complexity of the phenomenon “health” provides the most compelling argument in support of team science. Health is influenced by a vast interplay of individual factors such as genetics, as well as environmental influences such as socioeconomic status and neighborhood safety. Thus, it follows that substantive advances in knowledge about health will require the engagement of scholars representing multiple disciplines and perspectives. Epistemological arguments reinforce the critical nature of a team approach to generating and translating knowledge designed to inform and positively impact the health of individuals, families, communities, and societies. The exponential growth in the pool of available knowledge, coupled with the rapid proliferation of information sources, demands the participation of a diverse group of scientists who are on top of their respective areas of inquiry and can position others to meaningfully build upon extant research (Institute of Medicine, 2013).
In this chapter, scholars from demography and nursing join forces to explore the current state of team science in the area of health and offer recommendations designed to accelerate this critically important orientation to knowledge development and translation. Particular attention is paid to teams in which nurse scholars play a key role. To frame our recommendations, we suggest a definition of team science, provide examples of initiatives to strengthen collaboration among scholars from multiple disciplines, describe selected contributions of teams in advancing knowledge about health, and identify barriers to foster successful scholarly teams within academic environments and potential strategies to address these challenges.
DEFINITION OF TEAM SCIENCE
Cooke and Hilton (2015) defined team science as “scientific collaboration, that is, research conducted by more than one individual in an interdependent fashion, including research conducted by small teams and larger groups” (Cooke & Hilton, 2015, p. 22). These and other scholars also have been explicit about the need for teams to include representatives from a range of disciplines (referred to as multi-disciplinarity; e.g., Cooke & Hilton, 2015; Disis & Slattery, 2010). In their analysis of 28 innovative teams at 14 Industrial Research Institute member companies, Post, De Lia, DiTomaso, Tirpak, and Borwankar (2009) provided insight regarding the value of multidisciplinary teams. Their findings suggest that teams with diverse membership engage in more connective thinking (joining previously unconnected ideas) than sequential thinking (i.e., using logical thinking), with the former resulting in bolder ideas.
Increasingly, the unique contributions of scholars who cross traditional boundaries and share perspectives to address significant research questions (referred to as interdisciplinarity) have been stressed (e.g., Aboelela et al., 2007; Fuqua, Stokols, Gress, Phillips, & Harvey, 2004). Indeed, Rosenfield (1992) argued that true interdisciplinarity involves more than juxtaposing the independent results of a group of scientists from different disciplines, but rather requires a true melding of perspectives. The National Academy of Sciences (2005) echoes this sentiment with the statement that “[r]esearch is truly interdisciplinary when it is not just pasting two disciplines together to create one product but rather an integration and synthesis of ideas and methods” (p. 27). In this chapter, we use the phrase “team science” to reflect the generation and translation of knowledge related to health that is grounded in interdisciplinarity.
INITIATIVES TO STRENGTHEN TEAM SCIENCE
A growing appreciation of the value of team science has led to a number of public and private initiatives designed to stimulate interdisciplinary research (IR) in the area of health. The National Institutes of Health (NIH) Roadmap for Medical Research’s Interdisciplinary Research program is a prime example of a federally supported effort. Over an 8-year period (2004–2012), the IR focused on four major initiatives: (a) the establishment of nine consortia comprising multidisciplinary experts to address complex health problems; (b) an interdisciplinary training initiative, which included postdoctoral training in a new interdisciplinary field; (c) a program that fostered innovation in interdisciplinary methodologies using technology; and (d) the introduction of the multiple principal investigator policy. Collectively, the IR contributed to many changes in research-intensive environments, such as the creation of departments with an explicit IR focus and statistical packages that better accommodated the participation of multiple disciplines (NIH, 2015). The program also enabled the investigators’ home institutions to recognize the leadership of researchers from more than one discipline in federally funded projects.
A number of other NIH-funded efforts established to foster team science have yielded similar positive results. For example, K. L. Hall et al. (2012) compared the number of publications produced by National Cancer Institute (NCI)-funded Transdisciplinary Tobacco Use Research Centers (TTURCs) grants to similar investigator-initiated tobacco studies that relied on the traditional R01 grant mechanism. The authors found that the 10-year TTURC grantees produced 100% more publications than the investigator-initiated R01 grants during this same period. The National Institute of Nursing Research (NINR)-funded Training in Interdisciplinary Research to Reduce Antimicrobial Resistance (TIRAR) initiative was developed to prepare pre- and postdoctoral scholars who would effectively engage in team science related to antimicrobial resistance. Among a number of metrics to assess TIRAR’s success, the number of trainees who completed the program and maintained interdisciplinary collaborations was calculated. Larson, Cohen, Gebbie, Clock, and Saiman (2011) reported that all of the 11 scholars trained between 2007 and 2011 continued to pursue interdisciplinary scholarship.
The Interdisciplinary Nursing Quality Research Initiative (INQRI) program, funded by the Robert Wood Johnson Foundation (RWJF) from 2005 to 2013, is illustrative of a major commitment by selected private foundations to advance team science. INQRI was designed to stimulate rigorous IR that would uncover nursing’s contributions to the quality of patient care. Equally important, the program also was focused on promoting the use of such evidence by a diverse range of stakeholders, including health system leaders and policy makers. Led by a nurse scientist (Mary Naylor, co-author) and a health care economist, the INQRI program funded 48 multidisciplinary teams, each with scholars from nursing and another discipline as principal investigators, who developed and implemented innovative research in targeted areas such as measurement of the value of nurses to high-quality health care and the impact of nurse-led interventions designed to enhance patient outcomes (Naylor, Lustig, et al., 2013). Early findings from an analysis of peer-reviewed papers suggested that the evidence linking nursing to the quality of patient care had grown since the launch of INQRI, as demonstrated by increased numbers of reported studies in this line of inquiry, higher quality of publications, enhanced methodological rigor, and stronger interdisciplinary reach (Naylor, Volpe, et al., 2013). INQRI teams also were successful in using their findings to advance the measurement of outcomes important to patients, including pain management (Beck et al., 2013) and increased use of evidence-based interventions in areas such as fall prevention (Titler, Wilson, Resnick, & Shever, 2013).
While we describe the core elements of successful team science, we must acknowledge the limitations of current measurement efforts. Unquestionably, commonly used metrics of team science used by current programs such as publications in prestigious interdisciplinary journals are important. Yet, multiple challenges associated with a comprehensive assessment of the short- and long-term impact of team science remain. Such measurement requires not only navigating diverse research agendas, but also obtaining agreement on desired outcomes (Feller, 2006). Klein (2008) offers parameters to consider in assessing the effects of team science, including the extent to which the various goals of team members are accomplished, the degree to which integration of knowledge is achieved and leveraged, and the impact of the science. Mâsse et al. (2008) developed a set of scales that capture multiple dimensions of team science, including satisfaction with the collaborative process; the impact of collaboration on knowledge production; trust and respect in the team science setting; and cross-disciplinary integration (Mâsse et al., 2008).
From our perspectives, the hallmarks of successful team science are the findings produced through rigorous research conducted by interdisciplinary scholars and the effects of their findings on the health of individuals and the public. In the following section, we offer a few examples of the impact of team science.
ADVANCES IN KNOWLEDGE ABOUT HEALTH
There are numerous examples of major advances in the science of health that have been contributed through interdisciplinary teams. As highlighted in the NIH Roadmap for Medical Research (NIH, 2015), team science has led to an increased understanding of the association between genes and behavioral inflexibility (Laughlin, Grant, Williams, & Jentsch, 2011) and the role of brain cells in mediating antidi-abetic actions of the brain (Xu et al., 2010). Advances in the treatment of patients with cancer also have resulted from interdisciplinary science (Raj et al., 2011). Nurse scholars have played a key role in teams that have increased our understanding of the relationship between genetics and chemotherapy-induced mucositis (Coleman et al., 2015), the role of high-sensitivity C-reactive protein (hsCRP) in determining cardiac events (Frazier, Vaughn, Willerson, Ballantyne, & Boerwinkle, 2009), and the neuropsychological patterns of patients with ventricle dysfunction in heart failure (Bratzke-Bauer, Pozehl, Paul, & Johnson, 2012).
In addition to their contributions to basic science research, nurse scholars in collaboration with colleagues from other disciplines have contributed strong evidence to address significant and complex health care issues through clinical and translational research. Findings derived from rigorous designs, including large-scale randomized controlled trials and longitudinal analyses of nationally representative health care databases, have been reported in high-impact journals that reach multiple disciplines, such as the Journal of the American Medical Association and Health Affairs. Consequently, the body of evidence in support of nurses’ central role as partners in redesigning health care is stronger and increasingly used to inform changes in health care practices and policies. The following are a few examples of such research contributions.
The Nurse-Family Partnership (NFP) is a community-based program that includes prenatal and infancy/toddler home visits by public health nurses to economically disadvantaged mothers and young children. The first clinical trial demonstrating its effectiveness was conducted by individuals representing the fields of pediatrics, obstetrics, gynecology, human development, and family studies, among others (Olds, Henderson, Tatelbaum, & Chamberlin, 1986). The NFP was initially funded by a federal grant (U.S. Public Health Service), which was followed by private foundation support (RWJF); subsequent support has been provided by numerous private and public sources (Goodman, 2006), including an NINR grant to assess the effects of an intimate partner violence component to the program.
For decades, the NFP has been recognized as being highly effective in improving maternal and child outcomes. Since 2010, NFP has been a flagship community program under provision H.R. 3590 of the Affordable Care Act (H.R. 3590), which established a $1.5 billion federal funding stream to help expand home visitation programs. Currently, the program serves the needs of more than 31,000 families in more than 550 economically disadvantaged communities across the United States. Recent studies reveal that the NFP has demonstrated significant improvements in a range of longer term outcomes for economically disadvantaged mothers and infants, including reduced mortality, better mental health, and enhanced socioeconomic outcomes. Economic analyses demonstrate that the NFP also was cost-effective over a 20-year period in reducing welfare dependency by more than the NFP program costs. The following are among the more recent NFP outcomes:
• Participation in the NFP was associated with a significant reduction in all-cause mortality for mothers and preventable mortality for infants throughout the 20-year follow-up period (Olds et al., 2014).
• Infants participating in the NFP had lower rates of being arrested or convicted of criminal acts as adults; had more stable partner relationships (Olds et al., 2010); were less likely to be welfare-dependent (Eckenrode et al., 2010; Olds et al., 2010), or to use tobacco, alcohol, and illegal drugs (Kitzman et al., 2010; Olds et al., 2010); had a lower incidence of mental health disorders; and scored higher on academic achievement tests (Kitzman et al., 2010; Olds et al., 2014).
• From infancy to age 12, the NFP was cost-effective, with $12,300 in discounted savings compared with a program cost of $11,511 for 594 urban economically disadvantaged, primarily African American families (Olds et al., 2010).
For more than two decades, the Transitional Care Model (TCM), an advanced practice nurse coordinated, team-based model, has been rigorously tested among at-risk, chronically ill older adults via multiple NINR-funded, multisite randomized clinical trials. From initial conceptualization and testing through ongoing expansion to different patient populations and contexts and subsequent efforts to study implementation of TCM by local health systems across the United States, the TCM has been grounded in interdisciplinarity. Ideas and perspectives from scholars representing nursing, medicine, social work, health care economics, social science, and biostatistics, among others, have influenced advances in this body of knowledge.
The TCM has consistently demonstrated improved health and quality of life outcomes and reduced rehospitalizations and total health care costs for this at-risk population when compared to standard care (Naylor et al., 1999; Naylor et al., 2004; Naylor, Aiken, Kurtzman, Olds, & Hirschman, 2011). For example, all-cause reductions in rehospitalizations were demonstrated through 1-year postindex hospital discharge among older adults hospitalized with heart failure. After accounting for program costs, the cost savings per Medicare beneficiary were estimated at $5,000 per year (Naylor et al., 2011). Initially, the TCM focused on the transitions of older adults from hospitals to home. More recently, the team has extended application of this model to prevent avoidable hospitalizations among older adults living in their communities (Naylor, Hirschman, O’Connor, Barg, & Pauly, 2013).
Multiple provisions of the Affordable Care Act incorporated the core components and research findings generated from the TCM as the basis to advance evidence-based transitional care services in emerging models of health care delivery, including accountable care organizations and patient-centered medical homes (Naylor et al., 2011). A 2015 survey funded by the RWJF revealed that approximately 60% of 582 responding health systems or communities in the United States have adopted or adapted the TCM (M. Naylor, personal communication, May 25, 2016). The Coalition for Evidence-Based Policy has recognized the TCM as a “top-tiered” evidence-based approach that, if scaled, could have a positive impact on the health and well-being of chronically ill adults, while ensuring wiser use of societal resources.
In recent years, the effects of the TCM, when compared to other evidence-based approaches and when translated into health systems and communities, have been reported. The following are among key findings reported during this period:
• A National Institute of Aging (NIA)-funded comparative effectiveness study revealed that hospitalized cognitively impaired older adults who transition to home experienced a significantly longer time to first rehospitalization and fewer all-cause rehospitalizations through 6 months postindex hospitalization when compared to other evidence-based approaches (Naylor et al., 2014).