Graham October 4 2007 Ig4

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 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

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

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 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

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

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

“ 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

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.

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.

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

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

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

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)

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)

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)

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

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

Third- need to focus on moving research into action
shift attention from individual adopters to the organizational and environmental context for 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)

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)

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

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]

Polar bears often are seen walking down the streets of Ottawa

Graham October 4 2007 Ig4

by ShawnHoke on Oct 06, 2007

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Graham October 4 2007 Ig4 — Presentation Transcript