1. Kate Gerrish, PhD, RN Professor of Nursing Research University of Sheffield/Sheffield Teaching Hospitals NHS Foundation Trust NIHR CLAHRC for South Yorkshire

2. 5 year NIHR funded programme of applied research and implementation of research focusing on self management and self care for long-term conditions Barnsley Doncaster Rotherham Sheffield NIHR Collaboration for Leadership in Applied Research and Care for South Yorkshire (CLAHRC)

3. £20 million over 5 years – £10m from NIHR with matched funding from partners Collaborative between universities, NHS commissioners and healthcare providers Partnership working to support capacity building for research and implementation

4. Self-management and self-care of long term conditions NIHR CLAHRC for South Yorkshire Chronic conditions COPD Diabetes Stroke Obesity Application of technologies Genetics Tele-health and Tele-care User-centred Healthcare Design - Achieving translation Translating knowledge into action Intelligent commissioning Inequalities in health Mental Health

5. Aim: To develop step change in the way research findings are implemented in practice by … trialling and evaluating innovative implementation strategies to facilitate evidence-based care in order to … enhance service quality, contribute towards improving patient outcomes, and/or increase patient safety

6. Develop, pilot and evaluate implementation strategies to promote evidence-based practice in response to identified service priorities Disseminate successful initiatives across CLAHRC partnership Develop the capacity of health care professionals to engage in KT implementation & KT research Establish collaborations between NHS and academic partners to facilitate knowledge translation Contribute to the field of implementation science TK2A objectives

7. Contribute new knowledge to the field of KT Understanding the trajectory of complex innovation in healthcare settings Test and further refine existing theoretical frameworks for KT Knowledge to Action - Graham et al 2005 Consolidated framework for implementation research - Damschroeder 2009 Contribute to the further development of key concepts in KT Knowledge brokering Boundary spanning Undertake KT evaluation Knowledge translation case book Evaluation of After Action Review methodology

8. KT is a dynamic, iterative process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge within a complex system of interactions among researchers and users with the intention to improve the health of (Canadians), provide more effective health services and products, and strengthen the health care system CIHR 2006

9. Monitor Knowledge Use Sustain Knowledge Use Evaluate Outcomes Adapt Knowledge to Local Context to Local Context Assess Barriers/ Assess Barriers/ Supports to Supports to Knowledge Use Knowledge Use Select, Tailor, Select, Tailor, Implement Interventions Identify Problem Identify Problem Identify, Review, Identify, Review, Select Knowledge Select Knowledge Products/Tools Synthesis Knowledge Inquiry Tailoring Knowledge KNOWLEDGE CREATION ACTION CYCLE APPLICATION Graham et al 2006

10.  Meta-theoretical and overarching typology derived from 19 theories about change / innovation / implementation  Composed of 5 domains with 39 constructs  Dynamic interaction between each of the 5 domains 1 Intervention characteristics: core & adaptable periphery 2 Outer setting: economic, political, social context 3 Inner setting: structural, political, cultural context 4 Characteristics of individuals: agency, choice & power 5 Process of implementation: change process Damschroeder et al 2009

11. Management of patients with dysphagia Oral nutrition support for patients at risk of malnutrition Reducing the risk of hospital acquired VTE

12. Focus NHS Priorities Partnership working Evidence- based approaches Capacity building

13. Priorities identified by health care partners - links to national policy initiatives Quality Innovation, Productivity, Prevention, (QIPP) Commissioning for Quality & Innovation (CQIN). NICE guidelines, national guidance Local health priorities Health needs Identified shortfalls in care Focus on complex issues rather than quick fixes

14. Projects embedded within the NHSShared ownership & responsibility for successFocus on multi-disciplinary teams to change practiceWorking at different levels across the organisationParticipatory ways of working to achieve changeBoundary spanning and knowledge brokering roles

15. Utilise knowledge from implementation science CIHR ‘Knowledge to Action’ framework to guide implementation, informed by CFIR Evidence-based approaches to implement change, adapted to local context Embedded evaluation

16. Individuals Knowledge translation facilitator secondments from NHS partners Knowledge translation research secondments from HEI partners PhD, post doctoral fellowships NIHR MSc Clinical Research, ACF medicine, CATP for nurses, AHPs Clinical teams KT skills development – evidence appraisal, change management, evaluation etc. Managers KT engagement / culture – evidence informed local policy and practice, evaluative culture

17. Aim To enhance the quality of oral nutrition support provided by the multi-disciplinary team to adult patients with long-term conditions through the implementation of a malnutrition screening tool (MUST+) and associated care guidelines Objectives To trial and evaluate two interventions designed to facilitate the uptake of MUST+ and care guidelines Ward-based nutrition champions Facilitation of the multi- disciplinary team by a dietitian

18. Knowledge Inquiry Knowledge synthesis Knowledge tools / products Tailoring knowledge Systematic reviews oral nutrition support NICE guidance Joanna Briggs best practice Nutrition screening tools Care guidelines Professional expertise

19. Identify problem Select knowledge Adapt knowledge to local context Assess barriers to knowledge use Select, tailor implement interventions Monitor knowledge use Evaluate outcomes Sustain knowledge use Review guidelines using AGREE Appraise MUST Develop MUST+ Action research approach Multi-level problem identification Understand macro, meso, micro context Ensure ownership of need for change at different levels of the organisation Collect baseline data observation, audit Survey knowledge, attitudes, barriers to ONS Feedback baseline data to ward teams Develop interventions and tailor to local context. Facilitate implementation of interventions in collaboration with front-line staff Modify interventions in response to changes in local context Repeat audit of oral nutrition support and patient records Feedback from facilitators, clinical staff and patient representatives via Project Advisory Group Measure patient & staff outcomes Evaluate intervention strategies Phased withdrawal of facilitati on Ongoing audit to monitor sustainability Roll out of interventions and disseminate learning

20. Time and tide waiteth for no man Geoffrey Chaucer 14 th Century poet Swampy lowlands of practice rather than hard ground of theory Donald Schon 1983

21. Political and economic context Productivity and efficiency in climate of spending restrictions Health organisation performance Alignment with organisational priorities Within and across organisation Transformational leadership Multiple levels: managers / practitioners Opinion leaders, champions – expert credible sources System change mechanisms Shared ownership Contextualising, Risk taking Supporting / reinforcing structures Standards / regulations Communications infrastructures

22. Establishing effective engagement Symbiotic partnerships Reconciling different agendas and time frames Immediacy of the NHS agenda HEI research agenda Organisational capacity for change lack of organisational slack Environmental instability Whole systems to clinical micro-systems change Sustainability of change and scaling up

23. Implementation in the real world is complex and messy We need to be prepared to deal with unpredictability, be able to adapt and cope with complexity

24. Understanding the context at macro, meso and micro levelThe rapidly changing context requires different ways of workingEmbedding implementation projects within the organisation Board to bedside ownership Identifying champions at different levels Partnership working at all levels of the organisation(s) Drawing upon existing systems and processes Boundary spanners Understanding different cultures and contexts Speaking different languages to different audiences / stakeholders Managing different and at times competing agendas Operating at different levels of the organisation

25. Expertise in implementation science, change management, evaluation methodologies Extra resources to support healthcare providers to meet objectives linked to quality, safety, effectiveness agenda Use evidence-based approaches to implement change adapted to the local context Focus on complex issues rather than quick fixes Participatory ways of working with on-going feedback to enhance quality Focus on sustainability and spread of innovation Positive impact on meeting NHS priorities – e.g. CQUINS, CQC, QIPP Sharing learning and resources across CLAHRC SY Added value to NHS

26. Collaboration with healthcare providers to support research Enhanced grant capture Mechanisms to facilitate greater impact of research Expertise in implementation science Capacity building Added value to HEI

27. The CLAHRC partnership model provides a means of harnessing the capacity of higher education and the NHS to facilitate knowledge translation