Radical innovation: crossing knowledge boundaries with ...

kinds of knowledge led to negotiation of power relations between the disciplines.
(Lingard L, Espin S, Evans C, Hawryluck L. (2004) The rules of the game:
interprofessional collaboration on the intensive care unit team. Crit Care. 2004
Dec;8(6):R403-8.)
When we looked beyond the ‘functional’ multidisciplinary team, to contexts where
medical research is the main focus, we were able to identify particular tensions
between the open-ended nature of research, and the stricter definition of professional
disciplinary responsibility. One of these came in a public health related context, from
a research immunologist who described a joint scientific and clinical investigation of
dementia in the population of a city with a substantial Bangladeshi population. There
had been concerns that in Bangladeshi patients diagnosed with Alzheimer’s dementia,
the condition advanced far more quickly than in the local European population.
However research in the community was eventually able to attribute this to the fact
that Bangladeshi families did not recognise early stage dementia as a disease,
considering the symptoms to be a normal part of ageing. As a result, Bangladeshi
people with Alzheimer’s only came to the attention of medical researchers when the
disease was unusually far advanced. This difference in cultural perception had
disrupted the disciplinary knowledge assumptions of those professional and research
fields concerned with dementia care. This was recognised by the team as an
innovative insight that had arisen from encounter across different knowledge
communities - here emphasised by the cross-cultural dimension alongside the
interdisciplinary one. It appears that public health is particularly likely to result in
such disruptions to disciplinary knowledge, however. The point in time where a
patient is admitted to hospital also requires that the patient be ‘classified’ according to
the hospital department that should own that patient, and hence according to the
disciplinary descriptions and hierarchies that apply in that department. Up until the
point that the patient is admitted, he or she is still a member of ‘the public’, and not
necessarily subject to medical disciplinary descriptions. Presumably public health
(and perhaps general practice, if conducted in a reflective manner) constantly
encounters these undisciplined problems, in a way that raises the problem-directed
innovation and boundary-breaking that other expert witnesses have noted during our
research. The organisation of hospitals, just as much as the hierarchy in teams within
the hospital, may be an example of how to prevent the kinds of interdisciplinary
innovation that we describe.
We interviewed in depth a hospital-based clinician who is a member of an
interdisciplinary clinical research unit, yet confirmed these observations. She
described what she sees as an enormous cultural gap between scientists and clinicians,
underpinned by a series of power games and prejudices, each about the others.
Despite programmes spanning many years she sees this gulf today and likely to
endure into the future. Her perception is that the role of the clinician is very much
secondary in the eyes of the scientists. She chose her language carefully,
encompassing ‘clinical’, ‘academic’, ‘scientist’ and ‘clinician’ to precisely distinguish
between practitioners who seem to work along a spectrum from pure science to a
focus primarily on clinical work. She agreed that clinical teams themselves
Innovation and Interdisciplinarity 79