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Graham October 4 2007 Ig4

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Information about Graham October 4 2007 Ig4

Published on October 6, 2007

Author: ShawnHoke

Source: slideshare.net

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Can Knowledge Translation be a Strategy for Transformative Change?
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Can Knowledge Translation be a Strategy for Transformative Change? 10 th Biennial Regenstrief Conference Turkey Run State Park Indiana October 2 nd - 4 th , 2007 Ian D Graham PhD Vice President, Knowledge Translation Portfolio Canadian Institutes of Health Research

Presentation Outline Context- biases A case study- an early IT innovation A bit about CIHR What is transformative change? What is Knowledge Translation (KT)? How can KT be a strategy for transformative change? Reflections

Context- biases

A case study- an early IT innovation

A bit about CIHR

What is transformative change?

What is Knowledge Translation (KT)?

How can KT be a strategy for transformative change?

Reflections

Context or Biases Trained as a health sociologist socio-historical analysis of use of episiotomy in the US and UK ~1850-1995 Interdisciplinary post-doc training in clinical epidemiology unit patient and physician perceptions and response to decision aids HSR and KT/implementation researcher applied, pragmatic, multi-method conceptual frameworks (OMRU, PGEAC, ADAPTE process) decision support tools development, appraisal, implementation VP- Knowledge Translation, CIHR

Trained as a health sociologist

socio-historical analysis of use of episiotomy in the US and UK ~1850-1995

Interdisciplinary post-doc training in clinical epidemiology unit

patient and physician perceptions and response to decision aids

HSR and KT/implementation researcher

applied, pragmatic, multi-method

conceptual frameworks (OMRU, PGEAC, ADAPTE process)

decision support tools development, appraisal, implementation

VP- Knowledge Translation, CIHR

http://www.youtube.com/watch?v=4pyjRj3UMRM&mode=related&search = http:// www.youtube.com/watch?v =xFAWR6hzZek

http://www.youtube.com/watch?v=4pyjRj3UMRM&mode=related&search =

http:// www.youtube.com/watch?v =xFAWR6hzZek

IT Case Study: Key messages Even great innovations don’t implement themselves Attributes of innovations Relative advantage, Complexity, Compatibility, Observability, Trialability Characteristics of potential adopter important Knowledge, attitudes and skills Context is important Printed educational material many not be sufficient Change agents/outreach facilitation are potentially useful implementation interventions

Even great innovations don’t implement themselves

Attributes of innovations

Relative advantage, Complexity, Compatibility,

Observability, Trialability

Characteristics of potential adopter important

Knowledge, attitudes and skills

Context is important

Printed educational material many not be sufficient

Change agents/outreach facilitation are potentially useful implementation interventions

Population 32.8 million

CIHR: is Government of Canada’s health research funding agency supports 10,000 researchers and trainees funds research that improves Canadians’ health, health care system and quality of life fosters commercialization, moving research discoveries from academic setting to the marketplace allocates 94 cents of every dollar to fund Canadian health researchers CIHR: Overview CIHR Mandate “ To excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system…”

CIHR:

is Government of Canada’s health research funding agency

supports 10,000 researchers and trainees

funds research that improves Canadians’ health, health care system and quality of life

fosters commercialization, moving research discoveries from academic setting to the marketplace

allocates 94 cents of every dollar to fund Canadian health researchers

CIHR Approach 13 Research Institutes Population and Public Health Gender and Health Aboriginal Peoples’ Health Health Services and Policy Research Genetics Infection and Immunity Nutrition, Metabolism and Diabetes Cancer Research Neurosciences, Mental Health and Addiction Aging Musculoskeletal Health and Arthritis Circulatory and Respiratory Health Human Development, Child and Youth Health

CIHR Approach -13 Research Institutes Institutes become a meeting ground for Canada’s health research community each Institute -- with its partners -- has developed a strategic plan to guide its research initiatives these plans build on existing knowledge, fill gaps, and help to fully realize Canadians' investment in health research by maximizing cooperation and minimizing duplication

Institutes become a meeting ground for Canada’s health research community

each Institute -- with its partners -- has developed a strategic plan to guide its research initiatives

these plans build on existing knowledge, fill gaps, and help to fully realize Canadians' investment in health research by maximizing cooperation and minimizing duplication

CIHR Approach Problem-based and Multidisciplinary CIHR takes a problem-based multidisciplinary approach to health issues encompasses research in four theme areas: Biomedical Clinical Health systems and services Population and public health

CIHR takes a problem-based multidisciplinary approach to health issues

encompasses research in four theme areas:

Biomedical

Clinical

Health systems and services

Population and public health

What does “transformation” mean? A marked change, as in appearance or character, usually for the better. A qualitative change (now rare: a woman’s wig) Example: Some fresh paint soon transformed the room Mathematics a. Replacement of the variables in an algebraic expression by their values in terms of another set of variables. b. A mapping of one space onto another or onto itself. Thesaurus: change, change over, alter, metamorphose, transmogrify, redo, reconstruct, renew, remodel; Antonym: preserve. http://www.thefreedictionary.com/transformation

Transformational change Paradigm shift Revolution Thinking outside the box

Paradigm shift

Revolution

Thinking outside the box

“ Never, ever, think outside the box.” (From The New Yorker , November 30, 1998.)

What does CIHR mean by ”Knowledge Translation”? Knowledge translation (implementation) is about : Making users aware of knowledge/innovations and facilitating their use of it to improve health and health care systems Closing the gap between what we know and what we do (reducing the know-do gap) Moving knowledge into action Knowledge translation research (KT/implementation Science) is about : Studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge

Knowledge translation (implementation) is about :

Making users aware of knowledge/innovations and facilitating their use of it to improve health and health care systems

Closing the gap between what we know and what we do (reducing the know-do gap)

Moving knowledge into action

Knowledge translation research (KT/implementation Science) is about :

Studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge

What is ”Knowledge Translation”? CIHR’s working definition : Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

CIHR’s working definition :

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.

This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

Knowledge Translation at CIHR The revised working definition : Knowledge translation is a dynamic and iterative process that includes synthesis , dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

The revised working definition :

Knowledge translation is a dynamic and iterative process that includes synthesis , dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.

This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

Knowledge Translation at CIHR The revised working definition : Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination , exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

The revised working definition :

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination , exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.

This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

Knowledge Translation at CIHR The revised working definition : Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

The revised working definition :

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.

This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

Knowledge Translation at CIHR The revised working definition : Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

The revised working definition :

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.

This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

Knowledge Translation at CIHR The revised working definition : Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. given that the purpose is ultimately to improve the health of Canadians and the health care system - monitoring and evaluation of KT outcomes and impact is essential

The revised working definition :

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.



given that the purpose is ultimately to improve the health of Canadians and the health care system - monitoring and evaluation of KT outcomes and impact is essential

End of Grant and Integrated KT Two broad categories of KT at CIHR End of grant KT (which could be simple diffusion , dissemination or a more intensive application of research findings) Integrated KT- KT woven into the research process

Two broad categories of KT at CIHR

End of grant KT (which could be simple diffusion , dissemination or a more intensive application of research findings)

Integrated KT- KT woven into the research process

What is integrated KT? a way of doing research solutions-based action-oriented research, collaborative research, co-production of knowledge, applied research involves engaging and integrating stakeholders into the research process Study stakeholders can be: Policy makers, decision makers, research funders, the public, clinicians, the media Investigators from different disciplines, teams, countries

a way of doing research

solutions-based

action-oriented research, collaborative research, co-production of knowledge, applied research

involves engaging and integrating stakeholders into the research process

Study stakeholders can be:

Policy makers, decision makers, research funders, the public, clinicians, the media

Investigators from different disciplines, teams, countries

Stakeholders can be involved in: defining and shaping the research questions deciding on the methodology helping with data collection and tools development interpreting the study findings crafting the message and disseminating the research results moving the results into their practice promoting widespread dissemination and application What is integrated KT? It is about the importance of stakeholders

Stakeholders can be involved in:

defining and shaping the research questions

deciding on the methodology

helping with data collection and tools development

interpreting the study findings

crafting the message and disseminating the research results

moving the results into their practice

promoting widespread dissemination and application

What is your dangerous idea? (John Brockman, editor) “ We have in hand most of the information we need to facilitate a new golden age of medicine. And what we don’t have in hand we can get fairly readily by wise investment in targeted research and intervention.” Paul Ewald (evolutionary biologist)

“ We have in hand most of the information we need to facilitate a new golden age of medicine. And what we don’t have in hand we can get fairly readily by wise investment in targeted research and intervention.”

Paul Ewald (evolutionary biologist)

And now the provocative part- knowledge translation as transformative change First, researchers need to conduct the right research need syntheses to determine what we already know (or should know) in many areas we need to use the research we already have- synthesis should determine these areas 30-40% patients do not get treatments of proven effectiveness 20–25% patients get care that is not needed or potentially harmful (Schuster, McGlynn, Brook, 1998; Grol R, (2001) Cancer outcomes could be improved by 30% with optimum application of what is currently known 10% reduction in cancer mortality with widespread use of available therapies (CSCC 2001; Ford et al, 1990)

First, researchers need to conduct the right research

need syntheses to determine what we already know (or should know)

in many areas we need to use the research we already have- synthesis should determine these areas

30-40% patients do not get treatments of proven effectiveness

20–25% patients get care that is not needed or potentially harmful (Schuster, McGlynn, Brook, 1998; Grol R, (2001)

Cancer outcomes could be improved by 30% with optimum application of what is currently known

10% reduction in cancer mortality with widespread use of available therapies (CSCC 2001; Ford et al, 1990)

When research gaps exist Get the right people involved from the beginning Need applied, collaborative, interdisciplinary research AKA INTEGRATED KT Today’s health problems are complex and interdisciplinary and require mixed methods to solve Research users need to be setting the research agenda and defining the research questions to ensure relevance and greater likelihood of uptake (70-30)

Get the right people involved from the beginning

Need applied, collaborative, interdisciplinary research AKA INTEGRATED KT

Today’s health problems are complex and interdisciplinary and require mixed methods to solve

Research users need to be setting the research agenda and defining the research questions to ensure relevance and greater likelihood of uptake (70-30)

And now the provocative part Knowledge Translation as Transformative Change Second- end-users need to make the research right for them Research not used like a can opener Users need to adapt and take ownership of knowledge for local use

Second- end-users need to make the research right for them

Research not used like a can opener

Users need to adapt and take ownership of knowledge for local use

The Knowledge to Action Cycle From : Graham et al: Lost in Knowledge Translation. Time for a Map? A useful tool/schematic for describing the many components of the KT process

And now the provocative part Knowledge Translation as Transformative Change Third- need to focus on moving research into action shift attention from individual adopters to the organizational and environmental context for change

Third- need to focus on moving research into action

shift attention from individual adopters to the organizational and environmental context for change

And now the provocative part Knowledge Translation as Transformative Change Lastly- Set targets for change monitor uptake of the research and evaluate the health and system outcomes/impact Keep it simple (a few important targets, practical indicators)

Lastly- Set targets for change

monitor uptake of the research and evaluate the health and system outcomes/impact

Keep it simple (a few important targets, practical indicators)

Reflections on transformational change When transforming the ‘health care system’ what is included in the system? Informal health care system, patients, public, complementary and alternative medicine Organizations/systems are organic NOT mechanistic and linear (complex, dynamic, adaptive, flexible, responsive) Need to meaningfully engage end user throughout process (integrated KT)

When transforming the ‘health care system’ what is included in the system? Informal health care system, patients, public, complementary and alternative medicine

Organizations/systems are organic NOT mechanistic and linear

(complex, dynamic, adaptive, flexible, responsive)

Need to meaningfully engage end user throughout process (integrated KT)

Reflections on transformational change Opportunity costs of implementation- avoid the KT imperative Importance of performance measurement- measure the right things at the right time Can start small and build

Opportunity costs of implementation- avoid the KT imperative

Importance of performance measurement- measure the right things at the right time

Can start small and build

Reflections on transformational change Distinction between implementation research (studying) vs practice (doing) Implementation research needs to be interdisciplinary and use mixed methods – strive to be rigorous Need much more research on intervention design, implementation/administration, evaluation

Distinction between implementation research (studying) vs practice (doing)

Implementation research needs to be interdisciplinary and use mixed methods – strive to be rigorous

Need much more research on intervention design, implementation/administration, evaluation

Thank you Questions? [email_address]

Thank you

Questions?

[email_address]

Polar bears often are seen walking down the streets of Ottawa

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