The Health Services Researcher, multiple identities - Editorial Column

Health Services Research, Feb, 2002

This issue of the journal includes an updated definition of the field of health services research coming from a committee charged to do so by what was formerly known as the Association for Health Services Research (Lohr and Steinwachs 2002). The committee suggests that "health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations." As readers will note when they read this issue, the papers in this month's journal lend support to essentially all elements of a definition that while wordy captures the breadth and complexity of the field. To many outside the field, however, understanding who does health services research and the nature and produ cts of that work remains nebulous. Many of us have probably encountered this to some extent or another when we have been asked by colleagues to assist in some project where our skills and areas of expertise have been clearly misunderstood. This updated definition helps. However, I would argue that it would be important also for this and other journals in the field to strive to create distinguishing characteristics or a "signature" for the papers written by health services researchers.

The problem of being able to understand the researchers and their work is partially rooted in the multidisciplinary nature of the field and the fact that health services researchers identify to varying degrees with the field. To some, it is their primary if not complete professional disciplinary identity. For many others, it is only part of their disciplinary identity; they may have a secondary identity in health services research to complement one or more other home disciplinary fields such as economics, sociology, epidemiology, medicine and its specialties, or any of the other disciplines that contribute to the field. To further complicate the task of those outside the field, I suspect that some of us in the field self-identify as health services researchers more than outside colleagues would identify us as such (identifying us instead with one or more of our primary disciplines). For some in the field, this results in divided allegiances between disciplines (e.g., between health services research and medic ine) that gets translated to divided membership to professional associations and divided attendance at professional meetings. Additionally, our research products can often be characterized either as health services research, or alternatively as a product (e.g., clinical research) more commonly associated with one of the home disciplines.

Any ambiguity about who we are as health services researchers can be compounded by the lack of a clear academic home for the field in many universities. As we would expect for a multidisciplinary field, health services researchers are often found in parts of one or more academic departments with academic missions that go well beyond health services research. There are only a few exceptions in the small number of academic institutions with departments (usually of health policy and management) and institutes where health services research is an important and, in some cases, the predominant focus.

Because of the many disciplinary roots and academic homes, at times we write in different disciplinary "languages" that may not be shared by all in the health services research community. I, for one, admit to being unable to decipher some of the research methods described in one or more papers in each issue of the journal. Our different disciplines have different approaches to how data should be analyzed and presented. Apart from substantive methodological differences, we may have different approaches to more mundane issues, such as the expected length of manuscripts, the expansiveness of introductory and discussion sections, and the "style" of our manuscripts. Indeed, this editorial board has had several debates on whether the journal should convert to the referencing style more common to medical journals, as opposed to the current style which is more common to social science journals. At some level, these issues of disciplinary language and style could complicate the manuscript review process in that revie wers probably bring their own expectations about language and style into the process.

The issues noted above are rooted in the multidisciplinary focus that is, at the same time, our strength. Our research teams are multidisciplinary more often than not, and our audiences are always multidisciplinary--a claim that is not as easily made when we write in one of our home disciplinary journals. As readers of the journal, we should expect to accommodate some of these different languages and styles. That is one of the signature characteristics of the work of health services researchers. Not all manuscripts will come in the style that we expect from our home disciplinary journals (I have come to grudgingly accept the referencing style and page size that seem foreign to me).