The First Stage Study: The MCTT in Formation

The initial 15 interviews were conducted with three Co-PIs, six Co-Is, and six staff members while the MCTT prepared the grant. The interviews were conducted and recorded on Zoom, lasting an average of 38 minutes. Respondents were asked about initial steps taken to assemble the proposal, their expectations for its completion, and – hopefully – implementation. We identified three themes from the first round: (1) importance of the research topic; (2) meaning and perception of “team” within the MCTT context; and (3) the importance of leadership at different levels of the team.

Importance of the Topic

All respondents felt that the proposal topic was timely, for four general reasons. The COVID-19 pandemic was experienced across the entire US population, and more intensely by marginalized groups. Funding opportunities were increasing as government agencies sought to establish research programs, including in terms of long-term effects and care (i.e., PASC/long COVID). The topic is a “fashionable cause,” as several respondents described it. Getting involved with COVID research marked respondents as being – in the words of several different participants – “up-to-date,” “aware of contemporary clinical needs,” aware of “opportunities for institutional growth,” and “commit[ed] to our constituencies.”

A common perception among scientists was that the pandemic provided an ideal context for exercising the principles of translational science with potential benefits for population health [Reference Cullen, Baiocchi and Chamberlain18]. For example, the high-level involvement and value of what are sometimes seen as merely supportive or ancillary elements of biomedical research – such as community engagement, ethics, and staff – were never questioned. There was some legitimate concern voiced, however, that rapid changes in sub-types of SARS-CoV-2 could make current and ongoing research “obsolete.” This perception was especially common among scientists and again reflected the opinion that responses to calls for proposals should be expedited so as to allow existing studies to proceed while also launching new ones.

Meaning and Perception of “Team” Within the MCTT Context

One enduring area of interest in Team Science is how translational scientists understand the “team” concept [Reference Kotarba2,Reference Norman, Hamm and Schenker19]. All participants explained that the meaning and perception of “team” and its value were affected by the PASC MCTT but for different reasons. These included the effects of trying to coordinate three universities in different locations, the status positions of the universities in higher education, and shortcomings in staffing, among other factors. We observed differences in these respects among scientists and staff. The definitions of “team” used by participants were varied and fluid, revealing that understandings of this key term were more multifarious than most participants’ individual conceptions of the term could accommodate.

However, there were some consistencies across definitions. The scientists felt that – in principle – the design, activities, and staffing of a team ought to be determined by the criteria present in the funding call. As one scientist noted, “We can't invoke personalities much anymore [in assembling teams]. If NCATS says we need a high level of patient involvement, we need to dedicate resources in that direction and find the personnel we need.” In sum, the structure and functioning of translational teams ought to be determined in relation to NCATS’s priorities and institutions’ capacities to execute projects, teammates’ availability, and comfort with collaboration. This approach contrasts with the selection of teammates by personality or likeability.

Staff discovered that the efficiency of the team should be determined in terms of the completion of assigned tasks. The primary example here is “how actual everyday tasks in which staff engage in helping with the proposal do not change as much as with whom they do it,” as one respondent put it. The division of labor in the proposal still required staff at all three universities to do similar tasks and to work together, but they conducted their respective activities somewhat differently. For example, community engagement was handled differently at the three universities, and this problem of misalignment resulted in difficulty in arriving at a shared set of research aims.

The everyday, routine tasks assigned to staff did not change when compared to previous non-MCTT submissions. What did change was who they had to collaborate with across the institutions. Contrasting strengths across the three universities resulted in uneven contributions to the proposal that affected team dynamics, although not uniformly negatively or positively. While respondents acknowledged that the language of “teams” has proliferated across the health sciences, they noted the particular form of the MCTT and the challenges and opportunities that this new style of inter-institutional formation poses for translational science.

The Importance of Leadership at Different Levels

The Co-PIs worked well together, although this did not translate to well-defined aims. In interviews, junior faculty members and staff assigned to task-oriented teams such as community engagement voiced concern over the difficulty coordinating their activities during proposal assembly. Many participants attributed the failure of the MCTT to arrive at well-defined aims to department-level leadership whose skills in implementing inter-organizational tasks varied. The general expectation was that the learning curve for mastering cross-institutional team dynamics would be short. As a nurse-researcher put it, “I’m not sure how we can improve [our leadership skills]…given the tight deadlines.” This participant and others emphasized that leadership was needed not only from the Co-PIs but throughout the team across all levels. However, the tight submission deadline allowed little time for team formation or “teaming.”

The Second Stage Study: Post-Decision Reflections

The second round of interviews allowed us to formalize themes from the first stage while also clarifying what participants perceived went well and what went poorly during proposal writing. The topics differed from those in the first round for at least two reasons. First, the interviewer posed different, largely retrospective questions. Second, respondents’ perceptions of the project changed following the unfavorable decision. The original funding call made it clear that researchers could not resubmit unfunded proposals, in contrast to many NIH funding calls that permit resubmission after an unfavorable review. Topics discussed in the second round included (1) leadership and design; (2) specific proposal assembly tasks; (3) communication; and (4) critical events. We explore how each of these issues was discussed by participants.

Leadership and Design

All respondents spoke positively about the tripartite team structure and leadership. Staff and scientists noted that the Co-PIs were able to get along and build a vision for the project without ego or tensions, although this did not translate to cohesive aims. According to respondents, the leaders were experts in their disciplines and made fairly good decisions in assembling team members. The leaders were aware of the scientific and clinical value of an interdisciplinary translational PASC/long COVID study. In the words of one staff participant, “this is exactly where we should be directing medicine: this is where funding matches need.”

Many MCTT members critiqued the overall proposal design, which resonates with responses from the first round that emphasized difficulty in arriving at shared aims. There was a delay in the MCTT formation and creation of its aims. (The call for proposals was distributed on March 24, 2020; the assembly of the teams began in February, 2021; and the proposal was submitted on July 9, 2021.) This required the MCTT leadership to quickly assemble topical teams, locate resources, generate relationships among scientists and staff, and develop scientific goals. This left little time for the full group to engage in “teaming” activities that could have made the MCTT a more coherent entity. As one participant said, “we thought we all had our lab teams together at our own schools, but we did not have all the labs we needed on the agenda.” Staff worked overtime to prepare documents for internal review and integration. Both scientists and staff agreed that this distress eroded staff morale and proposal quality. The scientists also agreed that they tried to incorporate too many activities. One leader characterized the project as “overly ambitious,” reflecting group consensus.

There was general agreement that horizontal leadership (i.e., across specific research specializations represented at each institution) seemed more important to plan for than high-level leadership (i.e., across Co-PIs). The total list of horizontal or specialty groups included community engagement, genomics, bioinformatics, and imaging. The three Co-PIs generally fulfilled the need for them to communicate often and well among themselves, but relations were more uneven among staff and Co-Is. The aspects of the MCTT that involved horizontal leadership generally involved the execution of specific topics and proposal sections. Horizontal leaders thus had to negotiate different styles of operation and paradigms across institutions and many team members. This especially affected the quality of nonscientific sections of the proposal such as facilities pages and budgets.

Staff noted that relationship work among leadership in MCTTs was more important than in previous translational team configurations; this was partly attributable to the inter-institutional nature of the proposal and MCTT form. Among the staff members who were unsure of their forthcoming role in the proposal assembly, there was a hope and expectation that team leadership would be charismatic, an expectation resulting from the innovative nature of the proposal. This affective dimension of leadership was seen as necessary to successfully lead members through unknown territory. Simply being an accomplished scientist was not a sufficient credential for “trail blazing,” as one staff respondent put it. Staff also noted that, in a three-institution partnership with co-equal leadership, the “team” concept too easily evolved into a bureaucratic construct, resulting in less negotiation and more direction. As the project moved along, selling the idea was less critical than working out specific tasks, time schedules, and other logistical matters. Respondents generally felt that these observations would be valuable in planning for subsequent inter-organizational projects, including future MCTTs.

Specific Proposal Assembly Tasks

According to respondents, the “Writing Team” turned out to be a critical staff-centered team. It consisted of the people who attended the meetings, talked through the ideas, gathered information, and then assembled drafts for review. Writing Team members worked well together and communicated openly across the three universities. The strong working relationships that staff built were largely because they all have experience doing this work in different contexts and understand the expectations of scientific team leaders.

Perhaps the most difficult aspect of the staff-centered team’s work was understanding and integrating the various scientific and lay “languages” used by each institution’s team members. Two members of the writing staff suggested that frequent and specific training in technical writing would have helped them. Some staff also felt they were not getting the morale boosts from the local leadership they thought they needed and deserved.

There was concern among staff that there was not a specific “prime point person” at each school that all personnel could contact for information and direction. This caused numerous issues ranging from questions from participants such as “Whom do I contact regarding IRB?” to “Are we going to do MRIs?” per two respondents. As expected, the scientists were not always available, owing to busy schedules and other factors.

Overall, the medical imaging team was considered an advantage of the proposal. This group was composed of scientists and staff. One scientist noted that the imaging at the three universities “is as good if not better than imaging at the Mayos and the Dukes.”

Communication

The scientists did not see cross-institutional communications as a major problem. Their sharing of paradigms produced a common language that facilitated conversations and resolutions. For example, communicating with a neurologist at another university is no more difficult than communicating with a neurologist at one’s own university, owing to shared paradigms.

However, the social and behavioral scientists involved with community engagement did not necessarily share paradigms. This was because the community engagement Co-Is came from different disciplinary backgrounds. Therefore, they had difficulty generating productive communication. Some of this was because, although they appear to share research problems and an understanding of the field of community engagement, they worked in somewhat different cultural worlds owing to their regional locations and institutions’ clientele. The everyday life issues facing African Americans in an urban Rust Belt city, Latinx folks in a mixed urban-suburban region in the southwest, and rural Whites in rural Appalachia can vary in intensity, probable solutions, and cultural interpretations of reality. Therefore, the three institutions’ different patient populations were simultaneously a key strength of the proposal and a source of challenges for the MCTT to effectively form. These factors led to communication breakdowns and disconnectedness among the community engagement team members, weakening a critical aspect of the proposal.

Respondents reported little feedback or debriefing of staff by team leadership after the proposal was not funded, as was promised; there was only one brief meeting at each university. PIs are generally geared and conditioned to move from one proposal to the next, while continuously working on existing grants and projects. However, for staff and support personnel, working on a complex, inter-institutional proposal may be their main scheduled task for a relatively lengthy period. Because of the complex, time-constrained, and multi-institutional nature of the proposed research, this MCTT proposal was also seen as an unusually unique and intense experience for staff. We observed more personal investment in this project among staff than among leaders, and this might be a phenomenon to further explore in studies of MCTT formation.

Despite communication issues during proposal assembly, there were overall good feelings among community engagement staff looking ahead toward potential future MCTTs. These feelings were more a result of the collaboration involving shared hard work and dedication than the end product. For example, a senior community engagement leader noted that they were successful in instructing the biomedical scientists that community engagement “is best perceived as an expertise and not a technique.” To paraphrase this respondent’s view, expertise refers to the training, experience, solid theoretical foundation, and especially good judgment that prepares and allows someone to accomplish a specific, complex task. A technique is a practical approach to solving a problem that does not require sophisticated decision-making or judgment. The respondent clearly objected to the related perspective that occupations like social workers are less important than medicine.

Communication across the full MCTT turned out to be even more troubled than reported communication challenges among community engagement teams. A common complaint by both staff and scientists was that genomics was generally given top priority in agenda placement and time allotted in meetings. Much of the science was difficult for non-biomedical scientists to comprehend, even following attempts to explain it. This discomfort was exacerbated by having community engagement teams present materials last and with limited time to make their “pitch” in full MCTT meetings.

The leaders all agreed that working together via Zoom was an aggregate plus for them. The contingency, of course, was the COVID-19 pandemic, which made in-person meetings impossible. However, as institutions returned to face-to-face meetings, they realized that meeting via Zoom misses the very important side conversations over coffee, before the meetings, and after the meetings where much scientific discussion and intangible “teaming” work takes place. If future MCTTs wish to integrate an in-person or hybrid model, they will need to budget time and resources accordingly to ensure that an adequate balance of in-person and remote meeting strategies is used to maximum effectiveness.

Critical Events

In understanding how a group experience like the PASC/long COVID MCTT unfolds, it is valuable to pinpoint events that move the activity in different directions, redefine the activity, support its success, or set up its failure. A sociological concept to address these issues is the critical event – described by Garcia-Montoya and Mahoney as “a contingent event that is causally important for an outcome of a particular case” [Reference Garcia-Montoya and Mahoney20]. Participants highlighted several critical events.

Loss and turnover among senior staff were disruptive. These positions were heavily involved in the integration of proposal sections and converting this material into a common language. Negative staff issues, however, were the result of extra-proposal issues beyond the control of the PASC MCTT teams. Therefore, there is very little indication of negative impact from routine and predictable intra-organizational conflict. Loss of one senior scientist was a cause of conflict within the MCTT, but it did not cause the team to collapse; it represented a loss of value in terms of energy, dedication, and substance.

The irony of conducting an experimental project design and team formation (MCTT) that was intended to experiment with theorizing and treating a complicated and novel disease (PASC/long COVID) became increasingly visible during proposal writing. The general sentiment of both biomedical scientists and staff was that future collaborations need to be focused, prepped scientifically and administratively, and aligned with expectations. Working across all levels to enhance shared values among team members is important. As one senior scientist put it, “the MCTT is not the best place to learn how to do science; it is the place to apply one’s scientific skills.”