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Getting knowledge into action. Professor Sue Dopson

Getting knowledge into action. Professor Sue Dopson. Approaches to Change. 1. Establish sense of urgency 2. Form guiding coalition 3. Create a vision 4. Communicate Vision 5. Empower people to act on vision 6. Create ‘short-term’ wins 7. Consolidate improvements to

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Getting knowledge into action. Professor Sue Dopson

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  1. Getting knowledge into action. Professor Sue Dopson

  2. Approaches to Change 1. Establish sense of urgency 2. Form guiding coalition 3. Create a vision 4. Communicate Vision 5. Empower people to act on vision 6. Create ‘short-term’ wins 7. Consolidate improvements to produce further change 8. Institutionalise new approaches Unfreeze Movement Refreeze Lewin 1951; Kotter 1995 Prof Sue Dopson

  3. Focus of Studies: ROGERS, E. (1995) “Diffusion of Innovations” 4th ed. New York, Free Press. “we should increase our understanding of the motivations for adopting an innovation. Strangely, such ‘why’ questions about adopting an innovation have rarely been probed by diffusion researchers...” (p. 109) Prof Sue Dopson

  4. The data base for reflection on EBM • Seven studies have been brought together, • These comprise 49 separate case studies. • In total, more than 1400 interviews with clinical professionals and managers in health care in the U.K. • Across the acute & primary care sectors Prof Sue Dopson

  5. Findings on Evidence….. • No such thing as ‘the evidence’, but competing bodies of evidence • Credibility of evidence is based on source • Hierarchies of evidence exist • Different professional groups have different views on scientific evidence • Limited data to show inter-professional sharing of evidence Prof Sue Dopson

  6. Findings on Evidence…. Social & cognitive professional boundaries : • The source of differences between professional groups lies in education and socialisation into the profession; • Cognitive boundaries have rarely been recognised; • Many decisions about innovations and adoption are taken in uni-professional ‘communities of practice’ Prof Sue Dopson

  7. The Influence of Context • History of prior relationships is critical • Diffusion is impeded when organizational structures are complex • Therefore • Only context sensitive diffusion processes will be effective; • Sound ideas always need customizing to local context; Prof Sue Dopson

  8. Rolesof Actors and Interactions Opinion Leaders as Accelerators and Facilitators of Change • similar pattern across contexts • opinion leaders account for differential speed of adoption • opinion leaders perform a range of roles e.g. technical champion • opinion leaders play a key role in translation to local level Prof Sue Dopson

  9. Case Study: The Genetic Knowledge Path Idea • “[The idea for GKPs] appeared very late in the drafting of the NHS plan, virtually just a sentence, just a throw away sentence that took everyone by surprise & when [the then Health Secretary] was questioned what it was, he said, ‘You tell me.’ We then had to develop some themes.” • Funded GKPs as a “reaction to lobbying” • Unclear specification of what GKPs should do Prof Sue Dopson

  10. Dept of Trade & Industry Dept of Health Health Secretary Science Medicine Social science Management / policy Senior civil servant Senior civil servant Civil servant Civil servant Other GKPs Old University Pathology Prof NHS Hospital Genetics Prof Medical Director Genetics Prof Genetics Prof Cardiology Prof Epidemiology Prof Social Science Institute Ethics Prof Genetics Prof NHS Science Labs Research Institute Lab Director Lab Director OGKP (Conception: 2001) Prof Sue Dopson

  11. Community Affiliations Prof Sue Dopson

  12. DTI DoH Commissioners (SHA) AGGR Civil Servant Primary Care Conflict Commissioner Misunder-standing Old University Network Director Other Labs Other GKPs Pathology Prof Genetics Prof Business School NHS Hospital Genetics Prof Medical Director Competitive pressure Genetics Prof (OGKP Chair) Consultant Geneticist Genetics Prof (PI WP2) Social Science Institute Prof Ethics Consultant Geneticist Cardiology Prof (PI WP1) Lawyer Economist Research Inst Scientist (New PI WP3) Scientist Sociologist Conflict NHS Science Labs Lab Director Lab Director Innovation Unit VCs GIG - Patients Genetics Prof (Old PI WP3) OtherUniversity Science Medicine Social science Management / policy Executive Committee in bold GKP Supervisory Board underlined OGKP (end 2007) Prof Sue Dopson

  13. Epistemic Clash Science vs. Social Science • Economist able to communicate with scientists (shared quantitative epistemology) & helped to prove SCD test as cost-effective (producing further funding) • Sociologist’s work weird & of no benefit • “Our world is very black & white so when a sociologist talks to me about barriers in networks it does not mean much to me.” Research Scientist • “These weird sort of sociology people… we were just providing material for them to write interesting papers.” NHS Scientist Prof Sue Dopson

  14. Why is knowledge ‘Sticky’ ? • SPATIAL BOUNDARIES • ORGANIZATIONAL BOUNDARIES • INTER-ORGANIZATIONAL BOUNDARIES • PROFESSIONAL BOUNDARIES • BOUNDARIES BETWEEN ‘COMMUNITIES OF PRACTICE’ • KNOWLEDGE TRANSPOSITION PROCESSES AND KNOWLEDGE LEADERSHIP Prof Sue Dopson

  15. Processes for sharing across boundaries • SHARING WILL NOT ‘JUST HAPPEN’ • ORGANIZATIONAL; INTER-ORGANIZATIONAL & PROFESSIONAL BOUNDARIES NEED PLANNED FACILITATION TO OVERCOME; • BRIDGING ROLES • RECOGNISE THE POWER DIFFERENCES Prof Sue Dopson

  16. The Challenge of Change • Do different kind of challenges require different kind of change? • Critical Challenges: Commander • Tame Challenges: Management • Wicked Challenges: Leadership Prof Sue Dopson

  17. The challenge of ‘engagement’ and the role of leadership ‘Technical Challenge’ Set goal and task Tell why Explain what and how Give instruction Motivate Measure and monitor • ‘Adaptive challenge’ • Set the context • ‘Get on the balcony’ • Describe a view of the future • ‘Give the work to the people’ • Manage conflict • Encourage, coach, challenge Prof Sue Dopson

  18. Sir Geoffrey Vickers • Background • Victoria Cross, Classics at Oxford, City Solicitor, Director of Economic Intelligence, Board of National Coal Board (800,000 employees) • Para-academic, prolific writer, Visiting Professor at Lancaster University, aged 85 • Approach • ‘I have spent my life in practising the law and helping to administer public and private affairs; and I have thus had opportunity to observe and take part in the making of policy. The more I have seen of this, the more insistent has been the challenge to understand it both as a mental activity and as a social process, for it seems strange and dangerous that something so familiar and apparently important should remain so obscure. My enquiry into it has led me further than I expected. I have had to question sciences in which I am not professionally qualified and sometimes to supply my own answers, when theirs seems so ambiguous, inconsistent or absent. I present the result with humility but without apology. Even the dogs may eat of the crumbs which fall from the rich man’s table; and in these days, when the rich in knowledge eat such specialized food at such separate tables, only the dogs have a chance of a balanced diet’. Prof Sue Dopson

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