164 CHAPTER 6 sharing between clinical practice and research, and ongoing cyclical improvement processes (from performance to data, data to knowledge, knowledge to performance, and so forth) (18). This second, more ‘rapid’ process of learning requires (recent) data and a data infrastructure as key elements (18, 20, 61). PHM-literature refers to continuous testing, quality improvement processes and learning cycles, using data-driven insights (10, 16, 19, 62). Fewer papers discuss the third process of learning: recurrent interaction between stakeholders for collaborative learning (18). This facilitates the sharing of bestpractices, evaluating processes, identifying opportunities for improvement, setting goals and discussing underlying values (18). Less is known about this form of learning in crosssectoral collaboration, despite its crucial role in “constantly adapting strategies to changing circumstances and unanticipated situations”(57) (p. 1). Possibly, collaborative learning could also facilitate the other learning processes (i.e. research and cyclical improvement). It also often occurs together with one or two of the others (18). In this thesis, we did not dive into these learning processes in detail, but previous studies described that learning and reflection to support a transformation process was time-consuming and requires certain conditions and competencies (e.g. suitable data and indicators, openness, self-reflection, leadership- and teamwork skills, expertise, regular reflection moments and a supportive culture/climate) (20, 63). We believe that all three types of learning are relevant in the context of Solid Start. Cross-sectoral collaboration requires an adaptive strategy in order to manage upcoming challenges and changing contexts, while simultaneously work towards the goals and aims that were set. Although learning has been used to some extent (e.g. based on DIAPER), there is untapped potential, for example regarding up-to-data data and opportunities for collective learning. Therefore, it is important to think about how to facilitate learning in a more structured way, together with all relevant stakeholders from policy, research and practice, including experts-by-experience. METHODOLOGICAL CONSIDERATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH Several methodological considerations should be kept in mind when interpreting the results from this thesis. Most were discussed in the separate chapters. The following three sections provide overarching methodological considerations, along with recommendations for future research. A broadened scope in monitoring The monitoring efforts described in this thesis illustrate a growing link between research, policy and practice. In the monitoring of the action program Solid Start conducted by the National Institute for Public Health and the Environment, we have broadened our traditional research role, building upon the foundations laid by previous efforts. Conventionally, the National Institute for Public Health and the Environment offers a cyclical annual update
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