Researcher-practitioner relationships in consortia: the Cancer Information Services Research Consortium.

Abstract

Consortia are becoming increasingly prevalent as organizations are faced with a number of pressing environmental demands, relating particularly to the growth of information technologies and associated economic pressures. This essay focuses on the factors that lead to the successful management of researcher-practitioner relationships in consortia from a symbolic interactionist perspective. We focus on the Cancer Information Services Research Consortium (CISRC), an interesting consortium of cancer control researchers and practitioners who formed a coalition to implement trials related to three major cancer control projects, to illustrate our major substantive points. The implications section discusses the relationship between symbolic interactionist approaches and postmodern dialogic approaches to organizations, as well as focusing on the pragmatic implications of this analysis for the rapidly evolving role of consortial relationships in today's organizations.

Introduction

This essay focuses on the factors that lead to successful research-practitioner relationships. These relationships are increasingly important because, one, they can lead to the development, implementation, and evaluation of useful new ideas; two, they can enhance the policy relevance of ideas that are tested; and, three, there is a greater likelihood of successful implementation if practitioners have input early in the development of pilot research projects. The question of what promotes cooperative relationships in social systems has been one of the central issues for social scientists in this century. Symbolic interactionists (Head, 1934; Fine, 1993), sociologists (Parsons, 1960), dramatists (Littiejohn, 1992), economists (Coase, 1937; Hollander, 1990), management scholars (Smith, Caroll, & Ashford, 1995), organizational communication researchers (Harter & Krone, 2001), and others have all grappled with this problem. Here we will use the Cancer Information Services Research Consortium (CISRC), an interesting consortium of cancer control researchers and practitioners who formed a coalition to implement trials related to three major cancer control projects, to illustrate our major substantive points.

A consortium can be defined simply as a collection of entities (e.g., companies, public sector organizations) brought together by their interest in working collaboratively to accomplish something of mutual value which is beyond the resources of any one member (Cullen et al., 1999; Fleisher et al., 1998; Webster, 1995). Given the interest in new organizational forms, heightened competition, and declining resources available to any one organization, this topic has captured the attention of researchers in a wide range of disciplines (Bouman, 2002; Cullen et al., 1999; Hakansson & Sharma, 1996; Medved et al., 2001; Osborn & Hagedoorn, 1997).

Researcher-Practitioner Relationships

   We seem to be constantly trailing after practitioners to determine
   why and how something they are innovating is or is not working,
   rather than leading practitioners to implement innovations that
   flow from the findings that we have uncovered in the course of our
   (we hope) rigorous investigations. (Porter, 1996, pp. 265-266)

Both parties have substantial potential common benefits from a successful researcher-practitioner relationship including securing both physical and material resources and intellectual stimulation (Cullen et al., 1999; March, 2000). It is also obvious that policy makers see substantial benefits to be had from interactions between the various parties in the research enterprise, with increasing calls from the National Institutes of Health and the National Science Foundation, among others, for holistic examinations of research problems through the development of synthetic relationships among often fractured disciplines. Indeed, participation of practitioners early on is positively related to utilization and favorable attitudes towards the results (Beyer & Trice, 1994). However, in spite of the these forces, the two parties seldom turn to each other (Amabile et al., 2001), in part because there are also substantial differences in the motives and perceptual frameworks of the parties stemming from the different cultures in which they are embedded (Rynes et al., 2001).

For researchers there are considerable benefits that can ensue from interacting with practitioners; in fact they may have more to immediately gain from these relationships than do practitioners. First, they gain access to research sites that are the sine qua non for conducting research (Walton, 1985; Amabile et al., 2001), that also can serve as training sites for students, and this access may be contingent on producing 'useful' results (Mohrman result from researcher-practitioner relationships and the solutions of practical problems (Keen & Stocklmayer, 1999). Fourth, researchers can be provided an opportunity for intrinsic satisfaction from seeing their ideas working in practice. Fifth, exposure to real world problems and preliminary thinking as to their solutions can potentially stimulate important new scientific discoveries (Rynes et al., 2001). Finally, 'real world' sites also offer the possibilities of income supplements and other resources (Walton, 1985). et al., 2001). Second, this access can result in 'new' knowledge from confirming, testing old knowledge or learning local knowledge that may lead to new fundamental knowledge (Cullen et al., 1999). Third, researchers can burnish their public relations image by demonstrating their 'engagement' in community problems that will enhance their relevance to policy makers on whom they depend for funding. Science in general has had a diminished role in various policy debates, especially with the rise of various advocacy groups over the last couple of decades; they need to be more sensitive to the public relations image functions that can

Practitioners also have much to gain, but often not as much as researchers, from practitioner-researcher relationships. First, ultimately their primary goal is the improved practice that can ultimately be gained by accessing intellectual resources to solve a problem (Cullen et al., 1999) and the insight of an outsider into its nature. Second, they can also gain a buffer to ultimate accountability by using researchers as stalking horses who float trial balloons for problem solutions that they might not want to be initial, sole source of. Thus, practitioners gain the considerable benefit of having someone else to blame for changes/failures thus spreading their risks (Cullen et al.,). Third, practitioners can enhance their professional status by appealing to professional standards (Cullen et al.,), especially in university and medical settings where degrees carry much weight in the status game. Fourth, especially when students or more junior faculty members are involved, practitioners can feel good about making a prosocial contribution to someone's education or career development. Fifth, in the knowledge economy where recruiting a highly skilled workforce is paramount a research relationship maybe the first step in a recruiting process for both students and researchers.

As we have seen both parties have things to gain from the researcher-practitioner relationship, but they often have even more to lose, and this is seldom explicitly mentioned. One of the paramount values of any science is the objectivity of the researchers and the preservation of their ability to maintain their independence and integrity. Often practitioners, by questioning some taken for granted assumptions threaten the researchers autonomy in ways that call into question these fundamental principals. Practitioners seldom have any great concern for the integrity of the research process, especially relating to traditional scientific verities associated with rigorous research and internal validity (Killman et al., 1994). They will change interventions if they sense they are not working to the benefit of their project, since this is after all what they do daily in their operations. "Because sponsors' needs come first, program improvement second, and evaluator's needs are only a third priority, in many evaluation studies you'll have little control over the evaluation itself and none, typically, over the object of evaluation" (Dearing, 2000, pp. 8). Practitioners also may not respect researcher's needs for confidentiality of privileged scientific information thus interfering with patent, publication, and other intellectual property rights (Keen & Stocklmayer, 1999). Unfortunately, citation analyses indicate that relationships in which researchers define the problems and pursue their own questions are most likely to be successful in academic terms (Rynes et al., 2001). Practitioners also have a different time focus with a concern for immediate application to practical problems (Killman et al.,).

Many researchers lack the skills (e.g., a sense of pragmatism) to work with practitioners and their professional education typically does not improve on this situation (Keen & Stocklmayer, 1999), since even the most trivial change in the research process may be viewed as threatening their scientific independence.

Relationships with practitioners can also be very threatening to researchers' self-concepts. First, as Goodall (1989) has articulated, researchers are often manipulated by skilled practitioners so that these practitioners can achieve their own ends. Second, critique from practitioners often centers around two opposing themes of common sense or naivete, respectively; either "you're not telling us anything we do not already know" or your ideas are so "pie in the sky," or abstract, that they could never work. Since these judgments are often based on professional experience and anecdote, they are not easily refutable. They also may be quite telling, since we seek to often describe the world as it is, we lag behind real world events and often merely describe the experience of a skilled practitioner. (In this regard critical scholars may have an advantage since they envision a world that hasn't arrived for most organizations.) So, practitioners often feel researchers lack real world practices (Rynes et al., 2001), a critical shortcoming in this fast moving world. Similarly, in our quest for methodological rigor, we often ignore variables, especially political and legal ones, that any practitioner must consider before implementing a new practice. Third, the faddism in academe often means that we flit from hot topic to hot topic in the process often moving on from Intractable process problems that are central to the lives of practitioners. As but one example, problems in distortion of vertical hierarchical communication have been with us from time immemorial and are still an essential practice problem, but very little new or interesting research on this issue has been published in the last decade. Practitioners, often quite embarrassingly, keep coming back to these issues, which we now conveniently ignore, because they are still part of their everyday life.

In many ways researchers can act very much as a bull in a china shop, upsetting preexisting understandings and delicate relationships in the organization. First, they typically are unaware of the unintended consequences of the implementation of their ideas and the potential changes created by the very use of their research methods (Van de Ven, 2000). For example, I have encountered problems in using human relations components of the ICA Audit instrument in some organizations because its assumed participative components are alien to many industrial organizations. The very act of asking about trust and openness of supervisors can open old wounds left over from past union-management struggles. Second, research results can challenge comfortable socially-constructed realities, when, for example, what was thought of as a caring organization is cast as merely a paternalistic one. Third, research can compel organizational members to learn things about their organization they did not really want to learn, such as nobody talks about innovation because they are so overwhelmed with the operational side of the enterprise. Fourth, because people are overwhelmed, the very act of participating in research can mean that important organizational work is not done (e.g., serving clients who may have life and death problems). The time and energy spent on research may literally be the straw that breaks the camel's back in some organizations. Fifth, research can result in embarrassing findings that may directly threaten an organization's survival. For example, the CIS was publicly embarrassed by research findings that reported they spent differential amounts of time with African-American and white callers (Freimuth, 1993). Sixth, researchers often are very insular in their world view, driven by narrowly ideological views associated with particular theories. Seventh, a true partnership with practitioners is very time consuming and the resulting rewards are typically slight since seldom is it valued institutionally (Keen & Stocklmayer, 1999).

"The journals most valued for publication by academics are the ones least likely to be read by practitioners" (Killman et al., 1994, p. 15) which conversely also inhibits the dissemination of useful scientific results because of academic reward structures (Rynes et al., 2001). As a result of these differences in reading preferences, a whole growth industry of intermediaries often handles the dissemination of results from academics to practitioners (Rynes et al.). (Adding to the few opportunities for common ground discussions, there may not even be a common language in which to begin dialogue (Rynes et al.)). Paradoxically, the more sophisticated our methods and theories, the less useful they appear to practitioners (Rynes et al.). The privileging of the hegemonic language/vocabulary of researcher (Deetz, 2000) and the language differences created by theoretical terminology and quantitative techniques (Beyer & Trice, 1994; Killman et al., 1994) further inhibit the development of a dialog. One interesting example of differences in language is involved in the central organizational communication concept of network which at times created confusion within the CIS. To practitioners, this word is used as a verb signifiying the creation of a web of relationships useful to one's career and in accomplishing ones work. Researchers more often view it as a noun capturing a methodological and theoretical approach to studying organizations (Mohrman et al., 2001).

Why Are Health Services Consortiums Important?

In this essay we will be examining a unique organizational form which, like other new forms, has emerged to meet a number of pressing environmental demands, especially pressures concerning health reforms, relating particularly to the growth of information technologies and associated economic pressures. Over the last decade considerable literature has developed related to new organizational forms (Romanelli, 1991), especially the proliferation of new types of quasi-forms associated with more complex interorganizational relationships (Ring & Van de Ven, 1994; Schopler, 1987). Examples of differing types of interorganizational relationships abound: trade associations, agency federations, joint ventures, social service joint programs, corporate-financial interlocks, agency-sponsor linkages (Oliver, 1990), hybrid arrangements (Bows & Jemison, 1989), franchises, strategic alliances, research consortia, network organizations (Ring & Van de Ven, 1994), and quasi-firms (Luke, Begun, & Pointer, 1989). A major subarea of this literature relates to health organizations (Arnold & Hink, 1968; Farace et al., 1982; Luke et al., 1989).

A host of environmental factors are contributing to the development of new organizational forms: concerns about personnel costs (e.g., pensions, health costs); external pressures to keep the number of members on their permanent staff low; uncertainty reduction; needs to pool knowledge and information or to create it in the case of R & D firms (Gibson & Rogers, 1994); increasing access to information by reducing institutional barriers (DeBresson & Amesse, 1991), lack of predictability in the health financing environment; the need for resources (McKinney, Morrissey, & Kaluzny, 1996); affiliation (e.g., with a more credible national organization); and, building a mutually supportive power base to lobby to various stakeholders. Ironically, corporate downsizing of research staffs, coupled with heightened competition, may have increased the receptiveness of corporations to researchers (Rynes et al., 2001). Fundamentally, consortiums are formed so that their members can accomplish more than they could do on their own.

While the need for new organizational forms and the pressures to create them are great, success is difficult to achieve (Podolny & Page, 1998), particularly in the health area (Arnold & Hink, 1968; Farace, et al., 1982; Judge & Ryman, 2001). Many barriers have been identified: the specific missions of cooperating agencies are often different (e.g., providing social support vs. treatment for cancer patients); relatedly, outcome and effectiveness measures differ between agencies; and the coordination costs are too heavy (DeBresson & Amesse, 1991) to truly integrate the efforts of diverse organizations (Arnold & Hink). In addition, members of coalitions may have multiple goals (Stevenson, Pearce, & Porter, 1985); they may also resent the loss of decision making latitude, and the cost of managing their linkages increases (Oliver, 1990). There is an increasing need to develop new theories and fresh perspectives (or as we are doing revisit old ones) of the operation of these new organizational forms (Kaluzny et al., 1993; Luke et al., 1989). The ability of a society to create new organizational forms directly affects its ability to adapt to new environmental circumstances (Romanelli, 1991).

The Cancer Information Service Research Consortium

The Cancer Information Service (CIS) is an award-winning national information and education network, which has been the voice of the National Cancer Institute (NCI) for more than 30 years (Marcus, Woodworth, & Strickland, 1993; Marcus et al., 1998). While the CTS has extensive outreach programs dedicated to reaching the medically underserved (Thomsen & Maat, 1998), it is probably best known for its telephone service that has a widely available 800 number (1-800-4-CANCER). This case study focuses on a unique, four-year longitudinal study of the CIS. During this time period the CIS was facing the sort of downsizing, reorganization, and survival threats that have so characterized the health services administration area in recent years (Johnson et al., 1998).

The most unique characteristic of the CIS is its geographic dispersion in 19 regional offices serving the entire U. S. (Marcus et al., 1993). What brings all of the regional offices together is a classic fee-for-services contract, which in effect hires existing organizations, for a specified time, to provide services toward the accomplishment of a common goal. Although the regional offices are technically temporary, many of the offices have been in service to the CIS for over twenty years and have successfully competed for contract renewal (Morra et al., 1993). These offices, however, still retain their membership in their local sponsor or parent organizations (e.g., cancer centers) and identify with and address their regional concerns. Yet there is also a strong normative thread that runs through the activity of this network, a commitment to providing high quality information, free to the public, concerning cancer (Marcus et al., 1993). The public has expressed very high levels of satisfaction with this service (Darrow et al., 1998; Maibach et al., 1998; Morra, 1998; Ward et al., 1998).

Many of the decisions relating to major national initiatives (e.g., prostate cancer, breast cancer, affiliations with other organizations) are made outside of the context of the CIS (by Health and Human Services, the National Institutes of Health, for example) with the CIS left to implement them. Performance standards are set nationally with regional office input and are monitored by an extensive formal evaluation effort (Kessler et al., 1993). However, critical personnel issues such as salaries and fringe benefits remain within the purview of the sponsoring organization.

The unique characteristics of the CIS become apparent when contrasted with more conventional organizational forms because, even though the regional offices are formally members of other organizations, the CIS network itself has many of the characteristics of traditional, unitary organizations: centrally determined goals, a formal bureaucratic structure of authority, a division of labor, formal plans for coordination (e.g., sharing of calls), and a high normative commitment to providing service to callers. (See Table 1 for the CIS Mission and Vision Statements and Figure 1. for an Overview of the CIS network).

[FIGURE 1 OMITTED]

Table 1

Mission and Vision Statements For The Cancer Information Service

Mission Statement

The Cancer Information Service (CIS), a national information and education network, is the voice of the National Cancer Institute, the Federal Government's primary agency for cancer research. Created in 1976, the CIS is the source for the latest, most accurate cancer information for patients, their families, the general public, and health professionals. The CIS provides the most recent scientific information in understandable language and assists other organizations in developing education efforts to meet the needs of underserved populations.

Vision Statement

The National Cancer Institute's Cancer Information Service (CIS), the foremost public resource for cancer Information, was founded based on the conviction that constant advances in scientific research combined with the public's knowledge, understanding, and use of these medical findings saves lives. Believing in the importance of person-to-person interaction as well as the application of advanced technologies, the CIS is committed to using a range of communications approaches to ensure that as many people as possible have access to our service. By providing the latest, science-based information bout cancer in understandable language, the CIS helps people become active participants in their health care.

Note. From Cancer Facts, National Cancer Institute, December, 1996.

The Cancer Information Service Research Consortium (CISRC) represented a strategic alliance between researchers from a variety of institutions and practitioners within the CIS to implement three new intervention strategies. Over-time, the CIS has, in addition to its original mandate, become a community-based laboratory for state-of-the-science communication research (Marcus et al., 1993). The Cancer Information Service Research Consortium (CISRC) was charged with implementing and evaluating preventive health innovations to reach traditionally underserved sectors of the American public (Marcus et al., 1993). In this endeavor, the CIS needed to be creative in its attempts to manage innovation in order to generate organizational members' acceptance of change that at times could be challenged by geographic, institutional, and other less tangible barriers.

In 1993 the CIS formed a collaborative alliance with several senior investigators to determine if it could serve as a dynamic laboratory for cancer control research at the same time it was providing regular service (Marcus, 1998b). To insure appropriate collaboration several committees served as means for the various groups to interact with each other including the Executive Committee, the Steering Committee, the Publications Subcommittee, Members Council and advisory committees for each of the projects (Marcus, Morra, et al., 1998). One unique feature of program projects of this sort is that they have shared resources that all of the projects can draw on including in this case Administration, Survey Research, and Biostatistics. As Figure 2 reveals in more detail, there was considerable complexity involved in the CISRC which was further enhanced by four out of the six major components being spread across the country at different host institutions.

[FIGURE 2 OMITTED]

During this time period, the CISRC was piloting three new intervention strategies to facilitate the dissemination of cancer information to the public. The first and third innovations were connected to the CIS 1-800-4-CANCER telephone service, utilizing the toll-free number as a nexus from which to disseminate cancer information to targeted populations. The second and third projects were tailored to the health information needs of traditionally underserved sectors of the American public. Project 1 (5-A-Day for Better Health) involved the use of proactive counseling in the CIS to offer information about fruit and vegetable consumption to callers who would not ordinarily receive this information as part of usual service. Proactive counseling was delivered at the end of a regular call, no matter what the caller had initially contacted the CIS about, in order to encourage callers to increase their fruit and vegetable consumption (Marcus, Heimendinger et al., 1998). Project 2 was concerned with encouraging women to receive regular mammograms. This new intervention strategy reached out to women by making cold calls from the CIS to low income and minority women in targeted communities in Colorado. This intervention strategy was unique in that it focused on making outcalls from the CIS, an activity that was substantially different from the traditional role of a telephone service that responds to calls placed by people in the community to a toll-free number (Crane et al., 1998). Project 3 ("Quit Today!" Smoking Program for African Americans) was a tailored, multichannel media campaign designed to increase the CIS call volume of low-income African American smokers and recent quitters. This project involved two interrelated studies. Study 1 focused on a paid media advertising campaign designed to motivate adult African American smokers to quit smoking and to call the CIS for help in doing so. Study 2 tested the efficacy of newly developed self-help smoking cessation materials and targeted CIS counseling tailored to the quitting barriers and concerns of African American smokers in motivating quitting compared with standard non-tailored CIS smoking cessation materials and counseling. To telephone information specialists, Project 3 was usual service, providing accurate, up-to-date information in response to caller requests (Boyd et al., 1998).

The CISRC was conducted within the larger political context of an evaluation of a federal government health information program: One implicit understanding related to the research was that the results would be utilized to demonstrate that the CIS could be used as a research arm of NCI. Thus, the CISRC was designed to develop the research potential of the CIS, to foster collaboration among investigators and the CIS network, and to move the service toward high-quality, peer-reviewed research (Fleisher et al., 1998). The CISRC innovations were clearly seen by leaders of the CIS as a way of satisfying key decision makers within the NCI by demonstrating that the CIS could also contribute to the NCI's research mission, but there was considerable debate within the CIS as to the centrality of research in relation to its traditional vision and mission statements (Fleisher et al.; Marcus, Morra, et al., 1998; Johnson, 2001). Ultimately none of the preventive health innovations were adopted on a system-wide basis (Marcus, 1998a), even though trials indicated a generally high level of pros on specific attributes (Boyd et al., 1998; Crane et al., 1998; Marcus, Heimendinger, et al., 1998).

Researcher-Practitioner Relationships From A Symbolic Interactionist Perspective

"The common thread running through all of these alliances is the need to manage based on shared vision, a commitment to common values, and an accountability exacted through communication and information." (McKinney et al., 1996, p. 33)

"We collaborate to gain some advantage. We can achieve something which would be more difficult or less likely to occur without collaboration." (Cullen et al., 1999, p. 132)

In many ways the same basic preconditions that govern all cooperative acts also govern the relationships between researchers and practitioners. Classically symbolic interactionists suggest six conditions are necessary for cooperation: co-presence must be established, parties must demonstrate reciprocal attention, they must reveal mutual responsiveness, they must create congruent functional identities, build a shared focus, and devise a social objective (Couch, 1987; Fine, 1993).

Co-presence

In the absence of physical proximity, because of geographic dispersion, electronic propinquity and periodic national face-to-face meetings were the primary means of accomplishing co-presence for members of the CISRC. Especially in terms of innovation processes, we have found that it was at these periodic national meetings that major decisions were made (Chang et al., 1997; Pobocik et al., 1997). It was also during these national meetings that the first initial contacts between researchers and practitioners occurred, although this was predated for many of the researchers and some of the practitioners by their involvement in a special Request for Application from NCI in the mid-1980's which established a core of cancer-control researchers who had done research projects with selected regional offices of the CIS.

The CISRC PI was one of the Principal Investigators on these early grants, and this solidified his long-standing involvement with the CIS that he continued through his voluntary participation in their task forces, particularly the Evaluation Task Force. This was essential to the project, the CISRC PI had essentially established his bona tides, and he had critical sponsors in the leadership of OCC and the informal leadership structure among Project Directors, which had evolved from these historical relationships (Marcus, Morra, et al., 1998). Meeting attendance and long-standing relationships have also been found to be important in other cancer control alliances (McKinney et al., 1996).

Reciprocal Attention

"Unless reciprocally-acknowledged attention is established, the most complex social action they can take is mutual avoidance; they cannot fit together their individual lines of action to produce cooperative action." (Couch, 1987, pp. 97-98)

During much of the project there was a real question as to whether this basic precondition for cooperative relationships was established, especially on a system-wide basis. While there were certainly examples of temporally focused attention during national meetings and local loci surrounding the implementation of trials, the overall pattern of research findings, especially related to innovation communication (Johnson, Bettinghaus, et al., 1997) and the pattern of "don't knows" in response to questions dealing with specific innovation attributes of the various projects (Meyer, Johnson, & Ethington, 1997) suggests that this basic precondition for cooperative relationships was not established.

While attentive listening, or reading, is also a form of cooperation (Browning, et al., 1995), during much of the project the various parties were not fully implicated in each others work. While it is not necessary that parties continuously attend to each other (Couch, 1987), there was a real question whether there was enough attention to each other throughout the project for cooperative action to occur. Indeed, for much of the project the various parties went about their business with a minimal amount of direct communication (Johnson, Bettinghaus, et al., 1997); although there was substantial formal mechanisms established for communication (Marcus, Morra, et al., 1998).

Mutual Responsiveness

"To remain viable over time, alliances must constantly reinvent, or at least reaffirm the 'common or mutually beneficial goals or interests' (Oliver, 1990, p. 244) that can be accomplished through collaboration." (McKinney et al., 1996, p.55)

In a real sense organizations are feeling their way in the development of relationships in consortia because there are not a lot of good models to follow (Gibson & Rogers, 1994). It is clear that some form of reciprocal exchange (both provide something of value) is critical to successful consortia (Sankar et al., 1995). Indeed, the Project Director's definition of collaboration stressed shared risks, responsibilities, and rewards which ultimately enhance parties capacity to achieve common purpose (Fleisher et al., 1998). But, for most of the project the more primitive bilateral responsiveness, where parties note each others action (e.g., research projects are ongoing), but did not engage in mutually responsive action (Couch, 1987) (e.g., full involvement, engagement in the design of research projects on the part of CIS staff where their feedback resulted in significant changes in the projects). One example of CIS Project Directors being taken for granted was that CISRC PI waited until two weeks before they were due to solicit letters of support from them for the CISRC renewal application (CISRC conference call, 9/5/96).

More direct and accurate communication may have resulted in conflicts that would have split this relatively fragile coalition apart. But, eventually members of the CIS, realizing their underlying assumed goals were not being satisfied, suggested in their lessons learned monograph, that future projects have formal memorandum of understanding at the outset (Fleisher et al., 1998). Because of the lack of mechanism for translating findings into usual service, and in search of some compensation, adequate financial compensation of CIS offices became more of an issue as the relationship continued (Fleisher et al.).

Coalitions are often faced with a major choice between formal and informal relationships, with commonly shared cultural norms resulting from mutual adjustment/socialization necessary for informal ones (Smith et al., 1995). The suggestions from Fleisher et al. (1998) that relationships be made more formal in future was an admission that there wasn't a shared, culturally related value structure. Interestingly both the Project Directors and researchers' major summative statements of the CISRC suggest a need to put more emphasis on constantly monitoring the project to insure it was not becoming one-sided (Fleisher et al., 1998; Marcus, 1998a). Generally a basic ingredient of successful alliances is that their terms and expectations be clear (McKinney et al., 1996).

Create Congruent Functional Identities

While co-presence, reciprocal attention, and mutual responsiveness are necessary conditions for cooperation action, they are not sufficient. The parties must also establish a social objective and create congruent functional identities (Couch, 1987). They must have compatible goals, purposes, visions, and values (McKinney et al., 1996). Unless a mutually understood social objective is established parties cannot coact with each other successfully. Ultimately, one would like to create self-organizing systems where all parties can (re)act based on common understanding of what needs to be done (Browning et al., 1995). Cancer control practitioners in prior innovation diffusion research have "also questioned the ability of university-based investigators to design cancer control research protocols that are appropriate for implementation in community settings" (McKinney, Bamsley, & Kaluzny, 1992, p. 276). In other words, there has been considerable historical difficulty in establishing shared, common purposes between researchers and practitioners, where both parties recognizing the synergism needed to bind their often disparate functional identities (Johnson, 2001).

Shared Focus

"Framing a change project in terms of readiness seems more congruent with the image of proactive managers who play the roles of coaches and champions of change, rather than those whose role is to reactively monitor the workplace for signs of resistance." (Armenikas et al., 1993, p. 682)

"Some organizations genuinely desire change, whereas others may desire the appearance of change without any change at all." (Sternberg, 1994, p. 231)

Frames have recently received renewed interest in organization communication, in part because they offer an approach to examining the context of cooperative relationships (Johnson, 1997b). The framing concept has a long history in the social sciences, especially in relation to more micro discourse processes. Frames perform many critical functions for interactants: they are shared conversational resources, they provide a common emotional tone, they insure quicker responses, and they also provide a basis for temporal stability by insuring more continuous responses. In short, frames are a basis for coordinated action in collectivities, since cooperation requires a "reading" of the other's actions and intentions (Johnson, 1997a,b). They also provide a shared focus for the activities of the various parties. Indeed, the only way parties can attain the sufficient conditions for cooperative action is through discourse, especially when there are considerably different underlying goals and assumptions contained in their functional identities (Couch, 1987).

Fairhurst and Sarr (1996) have recently suggested that managerial effectiveness rests on the management of meaning that is largely accomplished through framing. In part, readiness to change also reflects an individual's potential to gain (or lose) from particular innovations (Frost & Egri, 1991). Fairhurst and Sarr (1996) concentrate on framing 'skills' including context sensitivity, tools (e.g., metaphor, stories, and spin), avoiding mixed messages, framing preparation (e.g., more mindful awareness of your frames), and establishing credibility. Similarly, Bolman and Deal (1991) also see frames as tools for leaders: "The truly effective manager and leader will need multiple tools, the skills to use each of them, and the wisdom to match frames to situations" (p. 12). In the end, it appeared that framing innovations within the CIS in terms of their responsiveness to external stakeholders was the primary means of insuring adoption and member participation (Chang et al., 1997; Johnson, 1997a,b, 2000).

There is increasing recognition that leaders have a deep appreciation for framing issues at an intuitive level (Fairhurst & Sarr, 1996). Often frameworks are seen as tools for leaders (Fairhurst & Sarr, 1996; Schon & Rein, 1994): "The truly effective manager and leader will need multiple tools, the skills to use each of them, and the wisdom to match frames to situations" (Bolman & Deal, 1996, p. 12). This perspective argues that understanding the interplay of major competing frameworks can result in more effective individual and institutional change strategies.

Recent work also suggests that it is not only the content of the frameworks that is important. Fiol (1994) suggests that organized diversity can be accomplished by broad consensus on the breadth, acceptance of novel ideas, and importance of a problem, which permits a greater range of substantive positions. Thus, framing occurs not only around ideas, but also around more issue neutral dimensions such as the importance, timing, and breadth of coverage in which answers must be determined.

Leaders use their understanding of frameworks to implement organizational change processes, to develop visions of the organization (Fairhurst & Sarr, 1996), and to manipulate policy debates (Johnson, 1992; Schon & Rein, 1994). At a deeper level, frameworks determine whether people notice problems, how they understand and remember them, and how they act on them (Fairhurst & Sarr). Frameworks form deep communication structures that can be monitored and shaped to influence integrative processes (Drake & Donohue, 1996), thus focusing on the central organizational control problem of achieving cooperation among individuals who have partially divergent objectives (Ouchi, 1979).

A central issue for many organizations and consortia, then, is how to create contexts that promote cooperative climates and trusting relationships necessary to produce agreements on a course of action (Fiol, 1994), which some have argued is best accomplished by convergence on particular frames (Drake & Donohue, 1996) and the establishment of a common ground of shared perspectives (Mohrman et al., 2001). A basic prerequisite of successful alliances is that the participants be candid, open, and fair in dealing with each other (McKinney et al., 1996).

Devise a Social Objective

"Maximizing the full research potential of the CIS was viewed by many as helping the CIS become even more closely aligned with the primary mission of NCI which, like all of the National Institutes of Health, is primarily dedicated to research." (Marcus, Morra, et al., 1998, p. S13).

Industries often band together in consortia because of the perceptions of outside threats (e.g., competition with the Japanese) (Browning et al., 1995); a good phrase to capture the tensions involved is that they are cooperating to compete (Gibson & Rogers, 1994). In some ways, the overarching threats to the CIS during this period (Chang et al., 1997; Johnson, 2000; Pobocik et al., 1997) provided the most compelling motivations for the parties to maintain their relationships and the most readily acceptable frame for proceeding.

Another very interesting social objective, partly because of its echoes of economic development issues between sophisticated and unsophisticated parties, was in terms of research. Like many developing countries, some members of the CIS saw a possibility for increasing their own technical research skills, perhaps to the point of self-sufficiency, from their involvement in research projects.

Generally, during this period there was a movement to increasing autonomy, participation, and involvement in every aspect of CIS's operation. This was particularly seen in the operation of task forces (Pobocik et al., 1997). The operation of the Evaluation Task Force especially contained an evaluation research component, revealed most directly in the electronic call record form and electronic outreach contact form (Johnson et al., 1997). So, increasingly, research related activities were becoming an expectation within the network.

Some Project Directors were excited about the CISRC's potential role of teaching CIS members how to do research, or at the very least how to collaborate on the writing of research articles. In this sense researchers could act as change agents who would leave CIS members capable of doing what they do on their own, reducing their future dependence on the CISRC. Naturally, this would also reduce the need of CIS people for researchers in the future. While the sensitivity of CIS members to research issues and their grasp of research rhetoric certainly increased during this period, the gap between them and the premiere researchers involved in the project did not close. This failure to reach a point of self-sustaining mutual growth through true inclusion in research projects, became a major bone of contention for many Project Directors (Fleisher et al., 1997).

Thus, CIS participants had a basic expectation, which is characteristic of other successful alliances in cancer control, that "there should be multiple opportunities for members to learn from, and be strengthened by, participation in the alliance" (McKinney et al., 1996, p. 34). Thus, the echoes with classic economic development issues. By implication, a truly collaborative consortia involving groups with such different outlooks would have to deal with inevitable conflicts surrounding goals and means of attaining them. Lawrence and Lorsch's (1967) original research on differentiation and integration cited confrontation as the preferred conflict mechanism for maintaining integration, growth, and development. Individuals engaged in truly cooperative behaviors tolerate conflict and engage in give-and-take discussions to achieve more productive outcomes (Browning et al., 1995)- some of the CISRC meetings, especially the later ones, when it became clear that practitioner goals were not being met, were like this.

Indeed, the November 1996 CISRC meeting had several lessons-learned sessions in which Project Directors openly expressed many issues they had been articulating in their lessons learned monograph (Fleisher et al., 1998). They were especially concerned with developing mechanisms that would forestall the development of conflict and misunderstandings they had experienced in the operation of the first round of the CISRC that we have developed elsewhere in this paper.

In a way this was a very positive sign, since successful organizations rely on confrontation. "Managers must have had sufficient trust in the colleagues and ... their superiors to discuss openly their own points of view as they related to the issues at hand" (Lawrence & Lorsch, 1967, p. 151). Managers of innovation need to mediate conflicts that arise because of competing interests between research and practitioners (Weiss, 1983). Discussions arising from conflicts can also serve the function of simultaneously educating each other to the various needs/differing perspectives of the parties (Weiss), and this greater understanding can lead to more mutual, than bilateral, reciprocity.

In part, the Project Directors were motivated to speak out because it was clear that the research portion of the project had been successful and the researchers were clearly benefiting professionally (Fleisher et al., 1998; Marcus, 1998a). So in some ways you have the paradox of success, the more successful one unit in a system is in attaining its more limited individual goals, the more unlikely that the overall system will attain theirs (Senge, 1990). Herein lies a clear challenge for researchers; often we learn as much or more from failed organizational efforts we are involved in as from successful ones. So, our own individual goals are likely to be achieved regardless of the outcomes of the overall project.

Implications

The key issue this case raises is how do we manage relationships between parties which must interact for their own good and the larger good, but who, for sound reason, view each other with considerable distrust. We have suggested that symbolic interactionism offers us a conceptual framework for analyzing these critical organizational problems. As we have seen from the preceding analysis, the relationship between researchers and practitioners in the CISRC was characterized by only periodic co-presence, somewhat limited reciprocal attention, a primitive level of mutual responsiveness, surface attempts at creating functional identities, and an increasingly felt need to formalize the shared focus. However, there was an overriding social objective, the continued survival of the CIS, that eventually compelled the practitioners to articulate how their original goals were not being met, and thus started a dialog on how their grievances could be addressed, in a way emulating Giddens' (1979) classic observations on the production and reproduction of social life.

Dialogic Approaches to Organizations

   The Cooperative Research Centre approach to research management in
   Australia has shown that the boundary between users and providers
   of knowledge is a complex one, and the relationship does not work
   well if dominated by either party ... The CRC structure encourages
   sustained dialogue between users and producers of knowledge....
   (Cullen et al., 1999, pp. 136)

At the root of symbolic interaction is a focus on relationships between parties who must coact successfully to reach some end. In the last several years a new approach to organizational communication has emerged that also focuses on the communication relationships between disparate parties in organizations--a dialogic approach to examining organizational discourse. The merger of these two approaches may help us to gain insight into the fundamental problems represented in researcher-practitioner relationships.

As discussed by Deetz (2000), the fundamental goal of the dialogic approach is to reclaim conflict in the organization, recognizing the natural tension between parties in organizations and examining how they maintain relationships in the face of their inherent conflicts. Thus, a leader's conflict management style is critical to successful collaboration (Amabile et al., 2001). The point here is not that conflicts can be managed, minimized, and overcome, but that some relationships have inherent tensions that actually might result in the growth of the two parties and more effective collaborations. So, researchers and practitioners can continually learn from each other, but they must realize that it is not to their benefit for one to ever totally subsume the other, that creative tensions enhance both the quality and rate of knowledge production (Rynes et al., 2001).

It is also important that the two parties have roughly co-equal relations. Too often, they both marginalize each other, not in the same setting, but on their own turf. So, universities put practitioner based operations, like the CIS, very much on the periphery in their internal operations, ignoring them, save when a new proposal needs to be submitted for continued funding. Similarly, in their national meetings and in Washington, practitioners marginalize researchers, giving them only token status in their deliberations.

The aim in these relationships is at a minimum to create conditions where at least an elementary dialog can continue, and, at its ultimate, creates a climate where playful, creative discourse can emerge that respects and values the contributions that diverse parties can bring to cooperative relationships, in which it is never expected that consensus on a fundamental level will be achieved. Successful cooperative relationships must recognize the creative struggle that is an inherent part of living. As Sennet (1998) has observed, that conflict can lead to stronger relations than a focus on casual, facile teamwork. This separation of members of the CISRC may lead to the dynamic tension needed for truly innovative approaches, since it is not subject to the same forces that lead to homogenous approaches in industries that are too tightly clustered together (Pouder & St. John, 1996).

Pragmatic Implications

One advantage of looking at these processes from a dialogic perspective is that it highlights one of the most difficult pragmatic issues in these relationships that flies in the face of most accomodationist thinking in organizations. In effect, the parties must simultaneously find common ground for relating; at the same time they maintain their own unique identities. As we have seen, one of the best strategies for accomplishing this is to establish common frameworks for interacting, with shared stories and metaphors.

The individuals who ultimately were unsuccessful in this case were the ones who could not bend from their professional framework to see the potential benefits of interacting with the others and those who identified too much with the other, in the process losing some of their own identity. In large part that was the trap that the leadership of the TEAM fell into (Johnson, 2001). They lost sight of their intermediary role and became advocates for practitioners. On the other extreme, because of their myopic graduate training, too often researchers arrogantly assume that they can ride into a situation and conduct research and leave on the next train, because the inherent value of research is something everyone can recognize. One fundamental problem that needs to be addressed in the future is that the educational programs of these professions seldom prepare them for work with each other (Keen & Stocklmayer, 1999).

Another understandable trap that the aggrieved parties in the relationship fell into was to suggest that it become more formal, contractual in the future if it was to be maintained. This suggests both that problems could not be worked out directly between the two parties, that it was necessary to appeal to a judge, arbiter who could enforce an agreed upon set of guidelines. This, in effect, removes control from the parties. Even more troublesome is that it does not recognize that fluid adjustments are increasingly necessary in modern organizational relationships, especially those in consortia.

Conclusion

Hopefully this case study demonstrates the utility of symbolic interactionism, and how usefully it can be blended with more post-modern approaches to organizations represented by dialogic views, to address some of the most fluid, emerging organizational relationships. As we have seen, those most likely to succeed are those who can immerse themselves in multiple frameworks (Johnson, 1997), while still clearly maintaining their own identity. The ultimate goal of parties in these relationships must be sustaining dialogic conflict, while both parties are accomplishing some larger subordinate goal, such as the advancement of both management knowledge and practice (March, 2000).

Acknowledgments

I would like to thank the Office of Cancer Communications (the labels used here are those in use during the time period of this study, OCC has been supplanted by the Office of Cancer Information, Communication and Education), as well as the following CIS offices that participated in the data collections:

Region 1: (CT, ME, NA, NH,
          RI, VT)                CIS at Yale Cancer Center
Region 2: (NYC, Long Island,     Memorial Sloan-Kettering Cancer
          Westchester County,
          NY)                    Center Office of Cancer
                                 Communications
Region 3: (NY State, WestPA)     CIS at Roswell Park Cancer Institute
Region 4: (DE, NJ, EastPA)       CIS at Fox Chase Cancer Center
Region 5: (D.C., MD, NorthVA)    CIS at Johns Hopkins University
                                 Oncology Center
Region 6: (GA, NC, SC)           CIS at Duke Comprehensive Cancer
                                 Center
Region 7: (FL, PR)               CIS at Sylvester Cancer Center
Region 8: (AL, LA, MS)           CIS at University of Alabama at
                                 Birmingham
Region 9: (AR, KY, TN)           CIS at Markey Cancer Center
Region 10: (OH, WV, SouthVA)     CIS at Mary Babb Randolph Cancer
                                 Center
Region 11: (WI, IA, MN, ND,
           SD)                   CIS at University of Wisconsin
                                 Comprehensive Cancer Center
Region 12: (MI, IN)              CIS at Barbara Ann Karmanos Cancer
                                 Institute
Region 13: (IL, KS, MO, NE)      CIS at University of Kansas Medical
                                 Center
Region 14: (OK, TX)              CIS at M.D. Anderson Cancer Center
Region 15: (AK, NorthID, MT,
           OR, WA)               CIS at Fred Hutchinson Cancer
                                 Research Center
Region 16: (AZ, CO, SouthID,
           NM, UT, WY)           CIS at Penrose St. Francis Healthcare
                                 System
Region 17: (NorthCA, NV)         CIS at Northern California Cancer
                                 Center
Region 18: (SouthCA)             CIS at Jonsson Comprehensive Cancer
                                 Center/UCLA
Region 19: (HI)                  CIS at Cancer Research Center of
                                 Hawaii

Special Thanks

I would like to thank Dr. Sally Johnson for reviewing an earlier version of this manuscript. I would like to thank Deb Tigner for her help in preparing and mailing the questionnaires. I would also like to extend thanks to the other members of the Network Analysis Advisory Board for their help throughout the many phases of the research process: Donna Cox, Jo Beth Speyer, William Stengle, Harsha Woodworth, Maureen McClatchey, and Diane Ruesch. I would also like to thank the other members of the Team for Evaluation and Audit Methods: Hui-3ung Chang, Caroline Ethington, Toru Kiyomiya, Betty LaFrance, and Marcy Meyer.

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