Transcript Slide 1

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Lost and Found in Knowledge Translation
B McCoy
Knowledge Integration Specialist
Fraser Health Research
Administration and Development
M Sandrelli
KTE Coordinator
Mental Health and Addictions
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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
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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
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Terminology?
Push / Pull
KTE
KSE
Knowledge
Translation
Knowledge Sharing
KT
Knowledge
to Action ?
Knowledge management
Dissemination
Utilization
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
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Terminology- Knowledge Creation/Generation

Creation of
“evidence-based”
knowledge
through scientific
research/study or
evaluation
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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)
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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)
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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-)
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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.
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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.
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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
Lavis, Lomas et al (2006). Bulletin
of the WHO.
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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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TerminologyDiffusion 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)
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Terminology
Research Utilization

The process by which specific researchbased 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
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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 predetermined 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
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Dissemination Activitieswhen 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
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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?
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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?
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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
Grol and Grimshaw (2003)
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Who is your target audience?
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……
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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
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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?
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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?
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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?
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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)
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What are successful techniques ?
‘Mixed effects’
Educational Materials
 Conferences
 Use of opinion leaders
 Education with different educational
strategies
 Feedback on performance
 Continuous quality improvement

Grol and Grimshaw (2003)
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Dissemination Activities

Aim for
INTERACTION!!



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Face-to-face meetings
Small groups
All party involvement
Aim for two-way
dialogue---avoid one
way flow of information
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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
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Time to spread the message……..
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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

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
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Develop and distribute public reports
Media releases, interviews
Government
Organise public forums
Other ideas?
External Communication
Strategy




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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
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“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.
2.
3.
4.
Whiplash & WCB in Ontario
Female Condoms in DTES
Risk Assessments in Harare
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
MHA Employees & Contractors
Researchers
MHA
KTE
Community Partners
Clients & Families
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
Marika Sandrelli
604-219-2028
bonnie.mccoy@
fraserhealth.ca
Marika.Sandrelli
@fraserhealth.ca
Knowledge
KTE Coordinator
Integration Specialist
Mental Health &
Addictions
Research
Administration &
Development
Fraser Health
Fraser Health
Useful KTE
Resources-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
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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
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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
Makers
Dealing With the Media
Self-Editing: Putting Your Readers First
Designing a Great Poster
Communications Primer
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