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Structure and Process for KTE: Growing Canada ’ s capacity for embedded research

Structure and Process for KTE: Growing Canada ’ s capacity for embedded research. allan.best@ubc.ca. HSR IN THE 21ST CENTURY. Interdisciplinary Intersectoral Nationally Representative, Locally Connected Researchers & Decision-Makers. GUIDING PRINCIPLES. Networking

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Structure and Process for KTE: Growing Canada ’ s capacity for embedded research

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  1. Structure and Process for KTE:Growing Canada’s capacity for embedded research allan.best@ubc.ca

  2. HSR IN THE 21ST CENTURY • Interdisciplinary • Intersectoral • Nationally Representative, Locally Connected • Researchers & Decision-Makers

  3. GUIDING PRINCIPLES • Networking • Linkage between researchers and decision makers • Knowledge transfer, exchange and integration • Training and capacity • Advocacy for research and its more effective use in planning, practice, and policy-making

  4. CO-AUTHORS Allan Best, Ph.D.Vancouver Coastal Health Research Institute Enette PauzéUniversity of Toronto Jennifer L. Terpstra, MPHUniversity of British Columbia Gregg MoorInSource

  5. OVERVIEW • Core concepts • Knowledge to Action models • Mandate for embedded research • Tools for local agencies • Summary and discussion

  6. MODE I Focus is knowledge generation Basic to applied research Scientist as expert Clear standards of knowledge MODE II Focus is problem solving Learn by doing Knowledge is co created and context dependent Flexible methods & general guidelines for quality COMPARISON OF KNOWLEDGE TYPES Denis JL et al. In Lemieux-Charles L & Champagne F. Using Knowledge and Evidence in Health Care, U of T Press, 2005

  7. SYSTEMS THINKING ~ ZONES OF COMPLEXITY Source: Stacey, 1996. As in Crossing the Quality Chasm

  8. Build teams Think through problems Integrate perspectives Foster systems change “For every complex problem, there is a solution that is simple, neat, and wrong”H.L.Mencken PROBLEM-BASED RESEARCH

  9. Generations of Knowledge Thinking1: Linear Models (1960s-mid 90s)

  10. Generations of Knowledge Thinking2: Relationship Models (Mid-90s to present)

  11. Generations of Knowledge Thinking3: Systems Models

  12. SEMINAL ARTICLES CHANGE THEORY Grol, Richard, et al. Planning and studying improvement in patient care.Milbank Quarterly 2007; 85:93-138. KNOWLEDGE TO ACTION MODELS Van de Ven, Andrew, & Johnson, Paul. Knowledge for theory and practice.Academy of Management Review 2006; 31:802-821. Van de Ven, A. Engaged Scholarship. Oxford, 2007

  13. VAN DE VEN’STHREE LENSES • Knowledge transfer problem • Problem is different theory and practice knowledge • Knowledge production problem  “Engaged Scholarship”

  14. LINKING CHANGE THEORY TO KTA

  15. FROM KTA THEORYTO MENTAL MODELS

  16. Linear Models ~ Two Stage Translational Research Crowley WF et al. JAMA 2004;291:1120-1126.

  17. Circular Models ~Planned Action Graham ID et al. J Cont Ed in the Health Professions 2006; 26:13-24.

  18. Circular Models 2 ~ NHS Systems Change Kelly MP, Speller V, & Meyrick J (2004). London: Health Development Agency, http://www.nice.org.uk/page.aspx?o=502709

  19. SYSTEM ANTECEDENTS FOR INNOVATION Structure Size/maturity Formalisation Differentiation Decentralisation Slack resources Absorptive capacity for new knowledge Pre-existing knowledge/skills base Ability to find, interpret, re-codify and integrate new knowledge Enablement of knowledge sharing via internal and external networks Receptive context for change Leadership and vision Good managerial relations Risk-taking climate Clear goals and priorities High quality data capture COMMUNICATION AND INFLUENCE DIFFUSION (Informal, unplanned) Social networks Homophily Peer opinion Marketing Expert opinion Champions Boundary spanners Change agents DISSEMINATION (formal, planned) Change agency SYSTEM READINESS FOR INNOVATION Tension for change Innovation-system fit Power balances (supporters vs opponents) Assessment of implications Dedicated time / resources Monitoring and feedback THE INNOVATION Relative advantage Compatibility Low complexity Trialability Observability Potential for reinvention Risk Task issues Nature of knowledge required (tacit/explicit) Technical support User system LINKAGE System antecedents Resource system THE ADOPTER Needs Motivation Values and goals Skills Learning style Social networks The innovation Knowledge purveyors System readiness Diffusion ASSIMILATION Complex, non-linear process ‘Soft periphery’ elements Dissemination Adoption / assimilation LINKAGE Implementation THE IMPLEMENTATION PROCESS Decision-making devolved to front line teams Hands-on approach by leaders and managers Human resource issues, especially training Dedicated resources Internal communication External collaboration Reinvention/development Feedback on progress Consequences Outer context THE OUTER CONTEXT Socio-political climate Incentives and mandates Inter-organisational norm-setting & networks Environmental stability LINKAGE Design stage Implementation stage Shared meanings and mission Communication and information Effective knowledge transfer User orientation User involvement in specification Product augmentation e.g. technical help Capture of user-led innovation Project management support

  20. Systems Model ~ Estabrooks and Glasgow AJPM 2006; 31:S45-56 Delivery Sites Team-building PA Interventions Organization Prevention Department Tested in Clinic Multiple Settings Approval of PIC & MOA Critical Elements Fit Peer Sharing Group feedback Sense of Distinction Group goal setting Group Roles Health Educators Space Limits Primary Care Research Staff Delivery Frequent Contact Electronic Medical Record Limited Staff Time MOVE MORE Re-invention of intervention retaining critical elements but reducing contact Clinic Staff Engagement Diverse Samples Appropriate For Question Scheduling, Cost, & Co-pay Partnerships across organizational structure defined necessary results for decision to deliver broadly across multiple clinics Broader Health Policy and Cultural Context 1. National Organizational Campaign To Promote Healthy Lifestyles 2. Prevention Department Desire to Provide PA Program Practical Controlled Trial Note: PIC=Physician in Charge; MOA=Medical Office Administrator

  21. OVERVIEW • Core concepts • Knowledge to Action models • Mandate for embedded research • Interorganizational partnerships • Embedded structures • Tools for local agencies • Summary and discussion

  22. OBSSR/CHSRF RAPID REVIEW OF PARTNERSHIPS • Clear common aims • Trust • Collaborative leadership • Sensitivity to power issues • Membership structure • Action learning

  23. EMBEDDED RESEARCH Intersectoral collaboration for problem-based research • Primacy of Mode II • Blended funding ~ grants, contracts, platform • Close collaboration between producers and users • Shared governance and accountability

  24. VANCOUVER“DIALOGUE ON HEALTH SYSTEMS RESEARCH” • “Explore how research can be better realized in BC to support decision makers” • 15 senior decision makers, 15 research leaders • 2 extended breakfasts - define the gap, seek solutions • Provocateurs - Steven Lewis, Hugh MacLeod, Jeanette Ward, Penny Hawe RESULTS • Shared understand is a complex adaptive system • Infrastructure and policies don’t support linkage • Measurement and evaluation need to be built in • Must build the business case

  25. CAHSPR COMMUNITY OF PRACTICE FOR EMBEDDED RESEARCH • Supported by CAHSPR ~ member association with some 200 student members • Linked to national health services and policy research training programs • Demand from next generation • Web-based, student driven • Directors from 14 centres and training programs in six countries • Priority on ways to involve students early

  26. OVERVIEW • Core concepts • Knowledge to Action models • Mandate for embedded research • Tools for local agencies • Summary and discussion

  27. ACTION RESEARCH REFINING METHODS WHOLE SYSTEMS METHODS AdministrativeDatabases KnowledgeIntegration SystemDynamics NetworkAnalysis ConceptMapping Surveillance, Info Systems, Report Cards Systematic reviews Better Practices Toolbox STRATEGIC CHANGE Rapid Learning Systems* *Etheredge L, Health Affairs 2007 26(2): w107-w118

  28. Implement Innovative Professional Training Learning Infrastructure Data and Accountability Systems Promote Evidence Based Practice Share Findings in the Context of Practice Enhance Data Systems and Capacity Change Organizational Culture and Structure Provide Incentives to Apply Research Findings Ensure Quality and Accountability Organizational Culture and Structure Fund and Facilitate Integration Activities Respond to Stakeholder Priorities Incentives and Funding Develop Participatory/Action Research Strategies Stakeholder Collaboration CONCEPT MAPPING

  29. Learning Infrastructure Data and Accountability Systems Organizational Culture and Structure Incentives and Funding Stakeholder Collaboration ANOTHER KTA MENTAL MODEL

  30. SYSTEM DYNAMIC EXAMPLE FROM ISIS

  31. SYSTEM DYNAMIC EXAMPLE FROM ISIS ~ 2

  32. SOCIAL NETWORK ANALYSIS

  33. RAPID REVIEW METHODOLOGY • Realist review methodology (Pawson, et al. 2005) • Targeted literature review • Virtual expert panel • Scheduled modified e-Delphi process over 3 months • Report providing practical understanding of theoretical frameworks and/or evidence-based interventions • Sense making process to tailor results to local context

  34. EVIDENCE IN CONTEXT Context-sensitive X DeliberativeProcess USEFULNESS X Context-free SystematicReview RIGOUR

  35. RAPID REVIEWS TO DATE • Person-centred care • Healthy Weights • Population-based chronic disease self management support • Interorganizational partnerships • Evidence-informed public health policy • Telehealth services for regional chronic disease management strategy

  36. ANOTHER KTAMENTAL MODEL Adapted from Barr et al, HospitalQuarterly 2003; 7:73-82

  37. OVERVIEW • Knowledge to Action models • Implications for partnerships • Tools for local agencies • Summary and discussion

  38. 1. REVOLUTION IN ACADEMIA • Van de Ven’s “engaged scholarship” • Gabriele Bammer’s “integration and implementation science” ~ Bammer G.Ecology and Society 2005; 10(2):6www.ecologyandsociety.org/vol10/iss2/art6/ • Systems thinking and complexity science • Participatory methods • Knowledge management, exchange and implementation  Implications for early training? Career paths?

  39. 2. REVOLUTION IN SERVICE • Research a line item competing with patient service • Transformative versus incremental strategy  Implications for incorporating training? Career paths?

  40. 3. REVOLUTION IN SCIENCE • Generalizable versus contextual knowledge • Behaviour change AND system dynamics • Clinical versus public health evidence  Implications for funding Type II and embedded research? Career paths?

  41. NEEDS YOU!

  42. www.cahspr.ca

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