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Graham October 4 2007 Ig4

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Can Knowledge Translation be a Strategy for Transformative Change?

Can Knowledge Translation be a Strategy for Transformative Change?

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Graham   October 4 2007 Ig4 Graham October 4 2007 Ig4 Presentation Transcript

  • 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.
    • 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.
  • 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.
  • 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.
  • 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
  • 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
  • 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
  • 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)
  • 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)
  • 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
  • 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
    • Thank you
    • Questions?
    • [email_address]
  • Polar bears often are seen walking down the streets of Ottawa