1. Applying Knowledge Transfer and Exchange Strategies to Promote Integrated Stroke Care Grace Warner, PhD Atlantic Health Promotion Research Centre

2. Funded by the Canadian Stroke Network Partners: Provincial Departments of Health and Heart and Stroke Foundations

3. Interdisciplinary/Collaborative project  Principal Investigator Renee Lyons  Lead: Steve Phillips, Division of Neurology Dalhousie University

5. “ Successful implementation of research to practice is a function of the interplay of the level and nature of evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated.” (Kitson, 1998)

6. Knowledge Brokering The Canadian Health Services Research Foundation defines knowledge brokering as the human force that makes knowledge transfer more effective by bringing people together to help build relationships, uncover needs, and share ideas and to help each other develop evidence-based solutions.

7. Health System Change for Integrated Stroke Care  Evidence-Integrated care for stroke, best practices on prevention to reintegration  Context- Departments of Health political climate, resources, available stroke care services, number of individuals who are hospitalized for stroke, population risk factors for stroke  Facilitation-Knowledge brokers

9. Description of the Project The Atlantic Canada Integrated Stroke Strategy project is examining how knowledge exchange strategies can facilitate health system change. The objectives 1) to increase policy makers knowledge on best practices research on integrated stroke care 2) to improve researchers understanding of the context that affects the provincial government’s uptake of this research.

10. Provincial Teams Provincial teams were formed between the Departments of Health and the Heart and Stroke Foundation. These teams worked with the researchers to hire knowledge brokers in each Atlantic Province (Nova Scotia, Newfoundland/Labrador, New Brunswick and Prince Edward Island).

11. Knowledge Exchange Each provincial team defined the goals they wanted to achieve by the end of the project (Sept 2003-March 2006) The research team supported knowledge exchange activities by  Atlantic-wide forums every 6 months  Monthly teleconferences/meetings with knowledge brokers

12. Measurement of Outcomes Process: Key informant interviews/focus groups with knowledge brokers and partners. Context: Hospital surveys on stroke services and CIHI stroke separations for each hospital in Atlantic Canada. Canadian Community Health Survey: Risk factors for stroke and post-stroke disability

13. Partnership Building It takes time to  Understand each other’s cultures  Create a common language  Build a foundation of trust Challenges  Time commitments  Changes in government leadership & structure  Limited resources for future changes  Confidentiality concerns

14. Researcher’s Challenges  Lack of understanding about the context  Difficulty introducing unsolicited evidence  Changing thinking from outcomes to process  Communicating collaborative outcomes to funders  Evaluating knowledge exchange effectiveness

15. The Process of Knowledge Exchange Increase decision makers’ knowledge on best practices research on integrated stroke care  Range in strength of best practices research  Integrated stroke care-difficult to explain  Lessons learned from Ontario-does it apply to Atlantic Canada?

16. The Process of Knowledge Exchange Improve researchers understanding of the context for this evidence  Understanding the responsibilities of the government health sectors  Province specific strategies to communicate best practices  Associating integrated stroke care with chronic disease management

17. Knowledge Broker Responsibilities  Communicating between partners  Creating a advisory group to develop a province-specific stroke strategy based on best practices  Communicating the strategy to stakeholders to build support for possible implementation  Travel commitments around the province

18. Knowledge Broker Challenges  Communicating with diverse audiences  Keeping people thinking about the overall goal rather than the details  Getting the right stakeholders around the table  Expectations about content expertise  The grunt work  Confidentiality concerns

19. A Success? Not finished yet but knowledge brokers-  Enhanced partner communication/collaboration  Identification of gaps in communication and training/educational needs to facilitate health system change  Evidence is being used in making changes in the health care system

20. The Broader Picture  Can knowledge brokers be sustained?  Who will finance the needed training/education?  Communication is discontinued when resources and time are limited.  The quality literature suggests we need to monitor interventions and make systems accountable rather than the individuals

21. Final Quote Q: Is there anything else about the project that you would like to share? A: …But I don’t think without having somebody dedicated to the cause, it [the integrated stroke strategy] necessarily would have gotten off the ground this year. I know from conversations I’ve had with certain people who have been fighting for this kind of change for a number of years, they were really feeling quite frustrated because they weren’t getting the support they needed…. And all indications are that everybody sees this as a very worthwhile project but that you really needed somebody in this position to help tie it together and to push it along.