Knowledge Utilisation and Transfer and the Organisation

1. Knowledge Utilisation and Transfer and the Organisation Professor Brendan McCormack, Director of Nursing Research & Practice Development

2. Presentation Focus • Background Influences • Cultural Perspectives • A Strategic Focus

3. Influence 1 - Health & Social Care Policy • Centralisation and standardisation • Integrated care delivery models • Focus on outcomes and effectiveness • Customer driven

4. Influence 2 - Professionals • Clinical governance and accountability • Regulation of the professions • Competence and performance • Development of ‘new’ roles • Multidisciplinary developments • Outcomes and Effectiveness

5. Influence 3 - Ideologies • Person-centredness • Partnership • Collaboration • Evidence-based • Community involvement

6. Challenges of working with these influences • The pace of change • Rhetoric of effectiveness versus reality of practice cultures • Changing political [P & p] climates • Fear of the public • Confidence in competence • Debunking of old norms and stereotypes!

7. Hierarchical management Research done by academics Evidence is unimportant to practice Knowing the evidence versus the realities of practice Poor research and PD infrastructure Significant recruitment and retention problems No facilities to support reflective practitioner inquiry Research and Knowledge Utilisation in a Segmented Culture

8. Developing Critical Inquiry • Practice is messy, complex & enmeshed in ethical conflict (Schon, 1991). • Practice is embedded in multiple cultures – “work-place culture” (Manley, 2000). • Accessing work-place cultures enables the release of practice knowledge that is embedded in experience (Titchen & Higgs, 2001). • Deductive & inductive knowledge equally valued (Kitson et al, 1998) • The primary intention of becoming critical is ‘increased effectiveness in patient-centred care’ (Garbett & McCormack, 2002) • Getting research into an organisation requires individual, organisational and strategic directions (McCormack et al, 1998)

9. Research in an Inquiring Culture • Shared governance approach to management • Quality is everybody’s business • Patient-centred approach to practice • Reflective feedback from patients • Practitioner participation in evidence generation and utilisation • Ward leader as practice developer • Supported reflective processes • Systematic evaluation of achievements

10. Strong and Effective Cultures have ……….. • People values • Emphasis on internal communication and respect for all employees at all levels • Shared values and practices • A shared common purpose and the means of achieving it

11. High levels of employee motivation through participation and reward • Learning from the past • Adapt to change • Are strategically appropriate • Value large stakeholders (especially employees) • Value effective leadership at all levels (transformational leadership)

12. How is it Achieved? • Every aspect of nursing and its organisation is practice focused. • Central focus on the development of expertise. • Organisational support to enable practitioner inquiry – “no wing clipping”. • Criticism is not suppressed – “not a harmonious team”. • Encouragement for “self-evaluation”. • Development of transformational leaders. • Focus on processes rather than on changing structures. • External knowledge is welcomed and valued

13. “We have to shift the centre of gravity in our philosophical tradition, and to alter our established mode of thinking. To propose this is easy; to accomplish it is so difficult that complete success at the first attempt is inconceivable. We are largely creatures of habit; not least in our reflective activities. To change our standpoint is to transform our habits of thought. It is not to exchange one theory for another, but to change the basis of all theory” (McMurray, 1991; 85 – The Self as Agent)

14. Developing practices and the context to support an expert person-centred inquiring culture Knowledge Generation Knowledge Generation Practice Development Develop Research and Practice Development Knowledge and Expertise. Undertake and Utilise Research in Key Clinical Themes identified by practitioners Patient-centred Practices Research Clinical Education Org. Development Develop the research and practice development infrastructure Knowledge Generation Knowledge Generation

15. Knowledge for Practice • Professional Knowledge as: • Scientific knowledge • Competence • Public knowledge • Craft knowledge

16. Frameworks embedded in the Royal Hospitals Approach to knowledge generation, implementation and utilisation • Practitioner Research • Practice Development • The PARiHS Framework • Creating a Learning Environment

17. 1. Practitioner Research “practitioner research is a formal and systematic attempt made by practitioners alone, or in collaboration with others, to understand practitioners work, with the intended purpose of transforming self, colleagues and work contexts and the development of new understandings of practitioners’ work” [adapted from Brooker & MacPherson, 1999) • Level 1: Practitioner Led • Level 2: Practitioner Collaborative • Level 3: Practitioner Focused

18. 2. Practice Development Practice development is a continuous process of improvement towards increased effectiveness in patient centred care. This is brought about by enabling health care teams to develop their knowledge and skills and to transform the culture and context of care. It is enabled and supported by facilitators committed to systematic, rigorous continuous processes of emancipatory change that reflect the perspectives of service users and service providers (Garbett & McCormack, 2002)

19. Pre-post evaluation; discussion groups; cultures workshop Values clarification; visioning workshop; fantasy writing transforming individuals and contexts of care Improving patient care Learning in and from practice Systematic approaches Action Planning and Review of Progress; integral data collection Action learning; work-based learning; reflective practice Values and beliefs (Garbett & McCormack, 2002)

20. 3. The PARiHS Framework • Successful implementation of evidence is a function of the relation between: • the nature of the evidence • the context or environment in which the proposed change is to be implemented and, • the way or method by which the change is facilitated SI = f(E,C,F) [Kitson et al, 1998; 2002]

21. Understanding the importance of the development of the practice and organisational context (McCormack et al, 2002) • Development of facilitation roles and relationships (Harvey et al, 2002) • Embracing a variety of forms of evidence and integrating them into practice development, practitioner research and quality improvement agendas (Kitson et al, 1998)

22. 4. Creating a learning environment Improve the knowledge base among staff at all levels in terms of: • Identifying appropriate questions for ‘new’ research and distinguishing between the need for new research versus the implementation of existing knowledge. • Research methodologies. • Practice development frameworks and processes. • Data collection, analysis and dissemination processes. • The use of systematic approaches to audit and evaluation in order to transfer knowledge into practice. • Reading research critically and understanding how to make judicious use of research in practice.

23. Develop staff knowledge in approaches to developing a culture of ‘critical inquiry’ in practice settings: • Increase awareness of approaches to reflective practice. • Develop an understanding of the way knowledge can be generated from practice as a legitimate research activity in itself. • Expose staff to models of critical inquiry. • Help clinical leaders identify the readiness of their practice context for critical inquiry.

24. "The reasonable man adapts himself to the world; the unreasonable man persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man” [George Bernard Shaw, 1856-1950]