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2. 2 2 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

3. 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

4. 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

5. Knowledge Transfer ? Knowledge Synthesis?? Knowledge Exchange? Knowledge to Action ? Knowledge Dissemination? KT KSTE Knowledge Utilization Terminology? Dissemination Utilization Actionable Message KTEKSE Knowledge Sharing diffusion Push / Pull Linkage & Exchange Knowledge Translation Knowledge Mobilization Knowledge management

6. 66 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

7. 777 Terminology- Knowledge Creation/Generation Creation of “evidence-based” knowledge through scientific research/study or evaluation

8. 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)

9. 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)

10. 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-)

11. 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

12. 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

13. 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

14. 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)

15. 151515 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 -5 th 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)

16. 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

17. 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

18. 1818 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

19. 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

20. 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?

21. 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?

22. 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

23. Who is your target audience?

24. 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

25. 2525 Developing key messages……

26. 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

27. 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?

28. 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?

29. 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?

30. 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

31. 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

32. 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

33. 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)

34. 3434 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

35. 3535 Time to spread the message……..

36. 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?

37. 3737 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

38. “Found” in KT “We know what’s promising and what may work better in practice, so, now what?”

39. “ 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”

40. “ 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 ”

41. “ Found ” in KT ? “The closer I look at the material presented, the more impossible it seems to make it work at my site”

42. Found in KT There is hope & some promising practices in applying KTE for health service improvements But first some important information from our experiences..

43. 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....

44. 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...

45. 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

46. 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

47. Found in KT A few examples: 1. Whiplash & WCB in Ontario 2. Female Condoms in DTES 3. Risk Assessments in Harare 4. 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

48. 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

49. 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

50. Found in KT Some Thoughts....from MH&A About Knowledge Generation MHAKTE Community Partners Clients & Families Researchers MHA Employees & Contractors

51. 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.

52. “ Lost & Found ” in KT

53. Bonnie McCoy 604-587-4412 bonnie.mccoy@onnie.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

54. 5454 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

55. 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.cawww.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

56. 5656 Useful KTE Resources: Canadian Health Services Research Foundation http:// www.chsrf.ca The Foundation's Communication Notes:  Developing a Dissemination Plan Developing a Dissemination Plan  Reader-Friendly Writing - 1:3:25 Reader-Friendly Writing  How to Give a Research Presentation to Decision Makers How to Give a Research Presentation to Decision Makers  Dealing With the Media Dealing With the Media  Self-Editing: Putting Your Readers First Self-Editing: Putting Your Readers First  Designing a Great Poster Designing a Great Poster  Communications Primer Communications Primer