Promoting partnership in knowledge translation: the NIHR CLAHRC approach

1. NIHR CLAHRC for South Yorkshire Promoting partnership in knowledge translation: the NIHR CLAHRC approach • Kate Gerrish, PhD, RN • Professor of Nursing Research • University of Sheffield/Sheffield Teaching Hospitals NHS Foundation Trust

2. Doncaster Barnsley Sheffield Rotherham NIHR Collaboration for Leadership in Applied Research and Care for South Yorkshire (CLAHRC) 5 year NIHR funded programme of applied research and implementation of research focusing on self management and self care for long-term conditions

3. CLAHRC – key features

4. Obesity Stroke Diabetes COPD User-centredHealthcare Design Translating knowledge intoaction Intelligentcommissioning Inequalitiesinhealth - NIHR CLAHRC for South Yorkshire Achieving translation Tele-health and Tele-care Application of technologies Chronic conditions Self-management and self-care of long term conditions Genetics Mental Health

5. Translating knowledge into action (TK2A)

6. TK2A objectives

7. Contribution to implementation science

8. Knowledge translation CIHR 2006

9. Knowledge Inquiry Tailoring Knowledge Synthesis Products/ Tools Monitor Knowledge Use Select, Tailor, Implement Interventions Evaluate Outcomes KNOWLEDGE CREATION Assess Barriers/ Supports to Knowledge Use Sustain Knowledge Use Adapt Knowledge to Local Context Identify Problem Identify, Review, Select Knowledge ACTION CYCLE APPLICATION Graham et al 2006

10. Consolidated Framework for Implementation Research • Meta-theoretical and overarching typology derived from 19 theories about change / innovation / implementation • Composed of 5 domains with 39 constructs • Dynamic interaction between each of the 5 domains • Intervention characteristics: core & adaptable periphery • Outer setting: economic, political, social context • Inner setting: structural, political, cultural context • Characteristics of individuals: agency, choice & power • Process of implementation: change process Damschroeder et al 2009

11. Clinically focused KT projects

12. TK2A - approach

13. Focus on healthcare (NHS) priorities

14. Partnership working

15. Evidence-based approach

16. Capacity building for KT

17. Enhancing the quality of oral nutrition support: EQONS

18. Knowledge creation Knowledge Inquiry Knowledge synthesis Systematic reviews oral nutrition support Tailoring knowledge Knowledge tools / products NICE guidance Joanna Briggs best practice Nutrition screening tools Care guidelines Professional expertise

19. Multi-level problem identification Understand macro, meso, micro context Ensure ownership of need for change at different levels of the organisation Ongoing audit to monitor sustainability Roll out of interventions and disseminate learning Appraise MUST Develop MUST+ Review guidelines using AGREE Phased withdrawal of facilitation Collect baseline data observation, audit Action research approach Measure patient & staff outcomes Evaluate intervention strategies Survey knowledge, attitudes, barriers to ONS Feedback baseline data to ward teams Repeat audit of oral nutrition support and patient records Feedback from facilitators, clinical staff and patient representatives via Project Advisory Group Develop interventions and tailor to local context. Facilitate implementation of interventions in collaboration with front-line staff Modify interventions in response to changes in local context

20. Implementation in the real world

21. Benefit levers

22. Challenges

23. Challenges Implementation in the real world is complex and messy We need to be prepared to deal with unpredictability, be able to adapt and cope with complexity

24. Lessons learnt

27. Conclusions The CLAHRC partnership model provides a means of harnessing the capacity of higher education and the NHS to facilitate knowledge translation