Session 2 – Knowledge utilization and transfer and the organization

Discussants:

Cheryl B. Stetler & Shannon Scott-Findlay

Unpack issues relevant to development of the science Highlight important contextual factors in knowledge

utilization and transfer (KU/T) Research utilization (RU) Evidence-based practice(EBP)

Explore commonalties & differences of presented approaches.

Enhance dialogue

Observations re: KU/T within Health Care Organizations

A. What we (seem to) know about “making it happen”

B. What we don’t (seem to) know about “making it happen”

A. What we (seem to) know …(albeit)

1. There is no one “inductive” or “deductive” approach that has been substantiated:

a. There is some evidence re: individual strategies & the need to use multiple strategies

Often per Rogers’ work on innovations (but largely re: individuals)

Mostly per research re: physicians, whose “organizational” links vary

1. …no one…approach…

b. There is a growing body of funded RU/EBP/translation research Interventional: Often, “medical” or “interdisciplinary”

focus; in few cases, with a KU framework; usually project- or condition-focused.

Descriptive: In many cases, nursing focused, exploratory, and barrier focused.

c. Effective approaches may be an adaptation/“mix” & relate to: Definition of evidence & its strength Nature of evidence-based practice

A. What we (seem to) know …(albeit)

2. There is increasing recognition in research of the potential influence of “context,”including leadership and culture, in transfer/utilization:

Interventional studies: Often within the perspective of an isolated project, as a correlate/barrier

Descriptive studies: Just beginning to be explored in-depth beyond barrier perceptions

B. What we don’t (seem to) know about …

1. Approaches to implementation Association of QI & EBP/KU-T Impact on tailoring/adaptation “Facilitation” of implementation efforts

2. Context of implementation Meaning/measurement “RU/EBP”exemplar organizations

1. Approaches to implementation

a. What is the association between Quality Improvement Models & KU-T/RU/EBP?

Meaning of “EBQI” models? Degree/importance of QI function involvement with

KU/T/EBP research or projects?

b. What is the impact of alternative approaches on the tailoring/adaptation of “evidence”?

Relation to strength of evidence or nature of evidence/innovation?

“Intelligently adapt evidence-based (clinical) interventions” (rather than “tailor”)

(Goldberg & Horowitz)

c. What is the extent, nature, or influence of “facilitation” or “researcher change agentry” needed for implementation efforts?

Within individual (“research”/implementation) projects Internal facilitation (content champion or QI role?) External facilitation (researcher role?)

Within an EBP organization Role of service-based nurse researcher? A generic facilitation mechanism?

2. Organizational Contexta. What is the meaning of context & culture?

Variable meanings/variable measures Inconsistent terminology used to describe the

context

Organizational context of nursing practice Powerful determinant which influences the

work in the organization (Hall, 1991).

Organizational culture Multitude of definitions Trends in the definition: 1) SHARED; 2) UNIQUE

“Organizational”research issues Measurement Approaches Who forms the sample Unit of analysis Impact of multiple use of translation

solutions

b. Nature of “RU/EBP exemplar” organizations or “naturally occurring experiments”?

Identifiable Nursing departments (&…?) Use an RU/EBP Model Focus on both project and departmental level

There is a lack of organizational-level research about such departments/organizations:

Descriptive or interventional Issue in terms of cost-effective implementation Issue in terms of role of a researcher/facilitator

Organizational Context & KU/T (EBP) at the Macro

Level

There is knowledge on organizational change potentially applicable to “routine, cost-effective, sustained, and integrated KU/T”

There are frameworks that could be evaluated/tested.

(Sample Framework)

EBP Organizational Implementation Framework:

Leadership Support for an EBP Culture Capacity Building

RU Model Infrastructure to Support and Maintain

Handout

Managing Change in the NHS: Organizational Change(Iles &

Sutherland: )

“…time is ripe for investigation of… alternative models of organization and management … emerging in service settings” Integration of KU/T & EBP

Recommendations:

1. Multi-site research at the organizational/ departmental level re: KU & Transfer in, at least, Nursing

Naturally occurring experiments Interventional

2. Collaboration across research projects to refine/create/use standard measurements, at a minimum, for:

Culture, as Relevant to EBP Organizational culture Professional practice culture Propensity to innovate (Iles & Sutherland)

Organizational (and Project) Capacity Facilitation, internal and external (Kitson et al.; Harvey et al.) Self-audit tool (Lomas) Organizational readiness (Sales et al)

Critical Infrastructures: Formal goals/priorities Information systems Roles/expectations

“Adaptation,” relative to: Strength of evidence Nature of evidence/innovation

“Intensity” of implementation Character/format of the clinical innovation

3. Innovative “research”/evaluative designs with service-based EBP projects

Beyond case studies Multi-site, networking

Knowledge utilization and transfer and the Knowledge utilization and transfer and the organization: How to Make organization: How to Make It Happen (Routinely)? It Happen (Routinely)?