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Lost and Found in Knowledge Translation

B McCoyKnowledge Integration

SpecialistFraser Health Research

Administration and Development

M SandrelliKTE Coordinator

Mental Health and Addictions

33

Objectives

1) Understand terminology and concepts pertaining

to Knowledge Translation aka Knowledge

Transfer and Exchange (KTE)

2) Understand the process of KTE

3) Understand best practice methods for KTE---

tried, true and otherwise novel !

4) Understand the challenges of KTE in practice

44

Beware! Be aware of the fact that the science of KTE has a

deluge of terminology which is often used interchangeably (and often incorrectly !)

terms actually all have a specific meaning and action(s) associated

In today’s presentation, we will introduce the same terminology from two (or more) perspectives:

1) the academic research perspective –CIHR / CHSRF 2) the continuing health education perspective-CACHE

The key is to remember the source and its objective

Kno

wledge

Trans

fer

?

Knowledg

e Synthesis

??

Knowledg

e Exchange

?Knowledge to Action ?

Knowledge Dissemination?

KT

KSTE

Knowledge Utilization

Terminology?

Dissemination Utilization

Actionable

MessageKTE KSE

Knowledge Sharing

diffusion

Push / Pull

Linkage & Exchange

Knowledge Translation

Knowledge

Mobilization

Knowledge management

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What is most important?

To understand:

That KTE is an iterative process that takes time How the KTE process works That a range of stakeholders need to be involved Effective strategies for KTE Useful frameworks for facilitating the use of best

evidence in practice or decision making

777

Terminology- Knowledge Creation/Generation

Creation of “evidence-based” knowledge through scientific research/study or evaluation

888

Terminology- Knowledge Translation

“The exchange, synthesis & ethically-sound application of knowledge---within a complex system of interactions among researchers & users----to accelerate the capture of benefits of research for Canadians through improved health, more effective services & products, and a strengthened health care system”

• Canadian Institutes of Health Research (CIHR-2000)

“The purpose is to bridge the gap between what we know (evidence) with what we actually do; any KT strategy takes into account that translation and learning occurs in a complex social system, thus, it requires a learner-centered approach”

• Canadian Association of Continuing Health Education (CACHE)

99

Terminology- Knowledge Synthesis

The importance of understanding how the results from a single research study mesh with the larger body of knowledge / research on the topic

Conducted by completing a synthesis of the global literature on the topic

Allows determination of the effectiveness of interventions or practices

Canadian Institutes of Health Research (CIHR-2000)

1010

Terminology- Knowledge Exchange

The interactions between the research user and the research producer that result in mutual learning

• Canadian Institutes of Health Research (CIHR-2000)

Emphasizes a collaborative approach that spans knowledge creation to its implementation.

• Canadian Association of Continuing Health Education (CACHE-)

Lavis, Lomas et al (2006). Bulletin of the WHO. 11

The Push Model

Push

the researcher is the catalyst for change• packages tools (syntheses, policy briefs, videos) in

order to make research more accessible for decision-makers & other research users

Decision-maker is the target of information in the push model, but may be involved in the research also

Lavis, Lomas et al (2006). Bulletin of the WHO. 12

The Pull Model

Pull

Focus is on the decision-maker’s desire for information

They may be looking for new evidence that will change programs/services

They may be learning how to critically appraise the evidence or learning how to use the evidence in decision-making

Lavis, Lomas et al (2006). Bulletin of the WHO. 13

Linkage and Exchange Model Researchers and research-users

collaborate for mutual benefit May be a short or long-term

collaboration and may occur at any point in the research / policy process

May include priority setting exercises, collaborative research projects, or projects with a developmental product at the end eg. database

1414

Terminology- Knowledge Transfer

“A systematic approach to capturing, collecting & sharing tacit knowledge in order for it to become explicit knowledge”

Government of Alberta

KT is about transferring good ideas, research results & skills between universities, other research organizations, business & the wider community to enable innovative new products and services to be developed

UK Office of Science and Technology

“Successful knowledge transfer involves much more than a one way, linear diffusion of knowledge & skills from a university to industry; it depends on access to people, information and infrastructure”

UK Particle Physics & Astronomy Research Council

Refers to the process of having all forms of knowledge used by stakeholders; has been criticized for implying a unidirectional process.

Canadian Association of Continuing Health Education (CACHE)

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Terminology-Diffusion and Dissemination

Diffusion: The process by which an innovation is communicated through certain channels over time among members of a social system

• Rogers (1995 -5th ed.)

Dissemination: targets a specific audience and (inter) actively uses specific styles and levels / types of communication (small group discussion, one-one meetings, didactic pres) of information to improve knowledge or skills or elicit change

The spreading of knowledge or research eg in journals or at conferences

Concerns the transmitting of knowledge, but does not emphasize the development of knowledge, nor the context of the receiver of knowledge.

• Canadian Association of Continuing Health Education (CACHE)

1616

Terminology

Research Utilization The process by which specific research-

based knowledge is implemented in practice• Estabrooks et al, 2003

Implementation The execution of the adoption decision where

the research or decision is put into practice

171717

Terminology

Adoption and Uptake: To implement and sustain the innovation or

program over time as a regular ingredient of practice/policy

Evaluation: Measure how successful knowledge

exchange activities are based on a pre-determined set of outcomes or indicators

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Knowledge Transfer and Exchange (KTE)

WHAT IS THE GOAL OF KTE?: To produce and disseminate information that

is useful for intended end-users (managers, decision makers, policymakers)

The style, format, content, and process of reporting information influences the ability for the information to be used

1919

Dissemination Activities- when and who?

What is the preferred order of these dissemination activities and why?

Who will take the lead on each of these?

Suggest: Each committee member responsible for at least one dissemination activity with report-back at next meeting to group

2020

Consider the goal…..

What is the goal of disseminating?

A single change in a program?

A change in practice?

A change in culture?

Are there both short-term & long-term goals

to consider?

2121

Consider the context….

In creating a plan, we will need to consider the context or the environment that it is being completed within

• political, organizational, social, cultural context?

• utility?• relevance?

Grol and Grimshaw (2003) 2222

Consider the Barriers…..Potential barriers exist- examples :

The practice environment / organizational context

• Financial disincentives (lack of re-imbursement)

• Lack of time

• Risk of formal complaint

The social context

• Usual Routines

• Opinion leaders do not agree with the evidence

• Obsolete knowledge

Professional Context aka knowledge and attitudes

• Clinical uncertainty

• Self confidence in skills

• Need to do something

• Inability to appraise the evidence

Who is your target audience?

2424

Who is your Target Audience?

Who are the people who can

use these findings/results?• Primary Audience?• Secondary Audience?

Target audiences should be identified and engaged early in the process to

build their interest and give them a sense of ownership in the program

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Developing key messages……

262626

Develop Key Messages ….

identify the most important, and locally relevant

findings, results, information

What does it mean? why it is important? How does it fit

into the local context?

Consider: How is this information potentially useful to

your target audience?

develop clear, simple, action-oriented messages

the tone, content, and language of a key message needs

to be appropriate for its intended audience

2727

Tips on tailoring the messages

Messages should be tailored to each audience

based on what is relevant and of interest to them

Consider your specific target audience- how would

you tailor your message so that it becomes what

the audience wants to hear?

2828

Identifying Spokespeople

Need to identify credible / influential spokespeople to spread messages in order to spread the message and increase uptake:

Champions / messengers should be people or organizations that are credible and influential within each target audience

Aim to engage them early in the process

WHO are these spokespeople? What makes them credible?

2929

Dissemination Activities-what?

What activities will be undertaken for dissemination of the key messages to each of the target audiences? What is appropriate and

effective?

Grol and Grimshaw (2003) 30

What are successful techniques ? ‘Mostly effective to effective’

Multi-professional collaboration Interactive small group meetings Regular reminders Educational outreach visits Computerized decision support Mass media campaigns

Grol and Grimshaw (2003) 31

What are successful techniques ? ‘Mixed effects’

Educational Materials Conferences Use of opinion leaders Education with different educational

strategies Feedback on performance Continuous quality improvement

3232

Dissemination Activities

Aim for INTERACTION!!

Face-to-face meetings Small groups All party involvement

Aim for two-way dialogue---avoid one way flow of information

3333

Other considerations for dissemination..

While planning, don’t forget: COSTS

print or web-based support materials: cost of design,

layout, translation if required

travel costs: whose budget? how much is required?

venue, equipment, technicians, catering costs

resources for future activities (meetings) and actions

that pertain to messages (eg new initiatives)

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Note to self:

What is the timeline for dissemination?

Remember: Dissemination is an iterative process of several

months / meetings, not a one-off task Meetings will provide an opportunity to assess

progress, adjust and fine-tune activities as required

3535

Time to spread the message……..

Who else needs to know?

Raise awareness internally- who else needs to know? What will they do with the information?

Managers, Directors, Executive, Front Line staff Others?

Externally-Raising public awareness Develop and distribute public reports Media releases, interviews Government Organise public forums Other ideas?

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External Communication Strategy

Is one required? Who needs to know? What do they need to know and

why? For media releases to the public, use plain language and

tell a story that will generate human interest Consider informing other groups e.g. rotary clubs, chamber

of commerce Enlist outsiders (public, media and externals) to assist in

spreading the messages

“Found” in KT

“We know what’s promising and what may work better in practice, so, now

what?”

“Found” in KT ?

“Continuing Professional Education? It’s frustrating because I never have the time or energy to figure out a way to include it in my practice. It’s better not to even go to workshops. They become a burden for me & managers expect us to include this new information into our practice”

“Found” in KT ?“What could any ‘outside expert’ possibly teach me? I

have been doing this for years, and it has been working. I’ll go, but don’t expect me to learn anything”

“Found” in KT ?

“The closer I look at the material

presented, the more impossible

it seems to make it work at my site”

Found in KT

There is hope & some

promising practices

in applying KTE for health service improvements

But first some important

information from our

experiences..

Found in KT

Definitions of KTE are socially and politically situated.

 

No matter which definition you ascribe to, knowledge translation & exchange ultimately involves the: • contextualizing of knowledge to different settings,• while ensuring knowledge efficacy.

For example, check this out . . . .

Found in KT CROSS SECTIONAL SURVEY IN ONTARIO, 2006

Executive Directors (N=161)

Clinicians (N=217),

Organization’s use of research evidence (access, assess, adapt, adopt)

* 55% of executive directors perceived their services and programs to be “somewhat” supported by research evidence;

* 31% of clinicians and managers perceived  their services and programs to be “somewhat” supported by research evidence;

Determining Factors for Using Evidence from

Research . . .

Found in KT

WHY IS KTE SO DIFFICULT FOR Health Services?

The implementation of high quality evidence in Health Services is inconsistent. Changes to clinical practices in response to high quality evidence can:

·        be disproportionate in magnitude;·        vary between geographic area, institute/program, clinician, context;·        altered by dominant opinion due to lack of accountability;·        be watered down due to lack of resources or employee will. Interventions known to provide the best outcomes may not be employed OR interventions may be prematurely employed when there is insufficient evidence to be confident in their effect. 

(Grol, 2001; Grimshaw et al., 2004)

Hand Outs “Lost in Knowledge Translation: Time for a Map?” in package

Found in KT

KTE’s Chances to SUCCEED depends upon:

• Employee & Health Service’s Stage of Change Access to Resources that Promote Shared Meaning (not

technology alone – collaborative inquiry) Defined ROI- return of investment (time saved, client

satisfaction, etc) Opportunity to Apply Knowledge in Field & Generate More

Knowledge (experiential learning cycle) Employee Incentives including encouragement of

creativity, celebrations, etc

Found in KT

A few examples:1. Whiplash & WCB in Ontario

2. Female Condoms in DTES3. Risk Assessments in Harare4. Motivational Interviewing in

MH&A

Now, it’s our turn to plan a Roll Out with KTE ingredients . . . .

Details of these case examples are in your hand-out packages

Found in KT KTE Roll Out for Metabolic Monitoring

Get into groups of 3 or 4 Read the instructions from the worksheets

in your package titled “Metabolic Monitoring”

Have one person ready to share your plan

Found in KT

Key ingredients for a successful KTE experience introducing “KT Alignment Measures”

Shared Meaning in both content & context Customized content to context/capacity (constructivism & social

learning theory) ROI – return of investment Opportunities for knowledge generation

Celebration & Acknowledgement

Hand outs for KT Alignment Measures are provided in your package

Found in KT Some Thoughts . . . .from MH&A About Knowledge Generation

MHAKTE

Community Partners

Clients & Families

Researchers

MHA Employees & Contractors

Found in KT

KTE is not a quick fix’.

Knowledge translation research can help address organizational, social, political and individual factors that impact client care and decision-making. Knowledge translation will not simplify complex issues in addictions & mental health care, but rather it will treat them as the complex issues that they are.

“Lost & Found” in KT

“Lost & Found” in KT

Bonnie McCoy

604-587-4412

bonnie.mccoy@

fraserhealth.ca

Knowledge

Integration Specialist

Research Administration & Development

Fraser Health

Marika Sandrelli

604-219-2028

Marika.Sandrelli@fraserhealth.ca

KTE Coordinator

Mental Health & Addictions

Fraser Health

5454

Useful KTEResources-practical examples

From CIHR, the KT Casebook titled Moving Population and Public Health Knowledge Into Action

–A casebook of Knowledge Translation stories

From CIHR, the KT Casebook titled Evidence in Action. Acting on Evidence. A casebook of

health services and policy research knowledge translation stories

http://www.cihr-irsc.gc.ca/e/30739.html

5555

Useful KTE Resources Canadian Association of Continuing Health Education

http://www.cachecanada.org

Institute of Health Economics Report (2008). Effective Dissemination of Findings from Research. www.ihe.ca

Canadian Health Services Research Foundation: www.chsrf.ca

Molapo, D (2007). Knowledge dissemination: Determining impact. IFLA Conference, Knowledge Management Workshop, Howard College Campus, University of KwaZulu-Natal, Durban.http://researchspace.csir.co.za/dspace/bitstream/10204/1255/1/Molapo_2007.pdf

Developing an Effective Dissemination Plan (2001).http://www.researchutilization.org/matrix/resources/dedp/#ten

5656

Useful KTE Resources: Canadian Health Services Research Foundation http:// www.chsrf.ca

The Foundation's Communication Notes:

Developing a Dissemination Plan Reader-Friendly Writing - 1:3:25 How to Give a Research Presentation to Decision Maker

s

Dealing With the Media Self-Editing: Putting Your Readers First Designing a Great Poster Communications Primer