Creating Knowledge Cultures

2. Creating Knowledge Cultures Our mission is to help health organizations make the best decisions through development of people, relationships and information.

4. SEARCH Goals 1996 • using evidence • to have health professionals in the RHAs use current, relevant and appropriate information to assist in identifying priority health issues and making decisions on these issues based on research results • creating evidence • to develop a collaborative network of expertise across Alberta to initiate and carry out health research on a local, regional or provincial basis • changing culture • to create a culture in which policy-responsive research is both valued and supported

5. Northwestern Northernlights Peace Keeweetinok Mistahia Lakeland Aspen Capital E.Central Crossroads AHW AMHB MDs HC Other D Thompson RHA 5 Calgary Headwaters Palliser Chinook Evolution • SEARCH I, 96-98 • 17/19 health authorities; AHW • 9 new ‘research’ positions • SEARCH II, 98-00 • 10 health authorities • + MDs, CHCs, Health Canada • ACHRN started; CREBA • SEARCH III, 01-03 • 14 health authorities • + continuing care sector • SEARCH IV, 03-05 • 7 / 9 health regions • + “others”: community, EMS, primary care; out of province,

6. Fifth Cohort Northwestern Northernlights • SEARCH I, 96-98 • SEARCH II, 98-00 • SEARCH III, 01-03 • SEARCH IV, 03-05 • SEARCH V, 05-07 • 9/9 health regions • + Cancer Board • + First Nations Branch Peace Keeweetinok Mistahia Lakeland Aspen Capital E.Central Crossroads D Thompson AHW AMHB MDs HC Other RHA 5 Calgary Headwaters Chinook Palliser

7. Organization Capacity

9. CHSRF Open Grant • The Taber Integrated Primary Care Project - Turning Vision into Reality • August 2003 • By Paul Hasselback, Duncan Saunders, Ali Dastmalchian, Robert Boudreau, Phil Jacobs, Janet Lapins, Robert Wedel, and Kathleen Oliver

10. 2 acute care program coordinators 3 PH program managers Emergency nurse CDC nurse Program analyst Mental health manager 2 Family physicians Medical Director, pediatrics Psychiatrist Provincial projects Attitudes to medical restraints Change management competencies Evaluation methodologies Community participation in primary care EHR data for population health SEARCH III-V

11. A Collaborative Network • “Through SEARCH I became part of a phenomenal broad network of high energy, like-minded health and human service professionals across Alberta who are leaders in their clinical practice or organizations, with faculty, researchers and advisors that are incredibly accomplished in their fields. This diverse multidisciplinary nature of the network makes it incredibly rich.” • Daria Wallsten, Keeweetinoks Lake Health Region

12. David Thompson Health Region

13. Academic Engagement

14. Program Strategies residential sessions; skills and knowledge; intensive team, network; province-wide Face to Face • local synthesis projects ; provincial primary research; • priority-driven; faculty mentoring; collaborative teams; project advice Projects virtual learning community; database access and other resources; on-line collaboration tools; curriculum material Virtual RDAs; ongoing advice; communication; SEARCHlight; managers ; conference Network Recruitment and selection; project priorities module ‘hosting’; collaborative exercises; capacity planning Organizations

15. Curriculum Framework • What do you want people to be able to do?

16. Foundational Competencies Curriculum Content Using Information Tools and Technologies Creating and Participating in Collaborative Networks Personal Development – Scholar Practitioner and Change Agent Navigating Context: personal, organisation, system, province

17. Network supports • SEARCH Desktop access • Research Development Advisors • “The SEARCHlight” weekly information • Network Committee • Biannual Forum and Conference • Recognition Awards • Site visit planning • Mentorship program • Connections Newsletter quarterly

18. Working with Organizations • Recruitment and selection • Support for participant managers • Working with champions • Provincial project priorities • Learning charter • Module activities • Site visits • Meet the CEO • Integrative exercise

19. Integrative Exercise Northern Lights Health Region “How can we reduce rates of sexually transmitted diseases and teenage pregnancy?”

20. Impact Assessment 01-04

21. Key messages • 1. Tremendous development of human and intellectual ‘capital’ – increased capacity and readiness for more. • “Strong vibrations”: capacity for change • Network potential: profile and contribution • Faculty development: commitment, identity, momentum, intellectual asset

22. Key messages • 2. There are many impacts, but not consistent: • Infrastructure and resources • Skill and knowledge • Recognition and utilization of expertise • Increased leadership • Management decisions influenced • Research and evaluation activity

23. Key messages • 3. Interface of organization and individual is critical: • Projects are major mechanism by which organizations engage • Characteristics of the individual are powerful • Optimal ‘fit’ and ‘synergy’ • Need to define ‘organization’ (‘subunit’ level?) • Organizations have varying definitions of ‘capacity’ and ability/intent to capitalize on investment

24. Key messages • 4. Issues of recognition are recurring • Outcomes of value to organizations are very different from assumptions of ‘value’ in academics • challenges notions of ‘standards’, ‘fairness’ for individuals • challenge notions of success and reward for researchers • Assessing human capital: • understanding ‘completion’; recognizing success

25. Key Messages • 5. “Out of the Box” frames needed • Skill application is continuous; permeable barrier of ‘SEARCH’ • Leadership development is a critical, unanticipated, highly valued outcome • Linked to network, profile, confidence • An alternative (to academic) reference frame is required for both program description and outcome definition

26. Leadership Development • An organizational strategy for enhancing leadership capacity • Career trajectories of increased responsibility • Recruitment and retention of key staff • Movement from research to management, and front-line to information/evaluation • “its not the skills we get, it’s the leadership”

27. Five-Year Plan

28. The SEARCH Resource • Culture • Context • Collaboration • Teams • Skills and knowledge • Technology • Dissemination • Synthesis • Information

29. Knowledge culture • Our most essential knowledge-era norms include creativity, individuality, self-expression, curiosity about self and others and world, self-reliance, social service, and enjoyment of – not just tolerance of – differences. Mark Satin: The Radical Middle

30. SEARCH’s contribution isgrowing a culture of trustin which a culture of knowledge can thrive. Above and beyond skills and information, evidence-based practice depends on the attitudes and values people have about themselves and their daily interactions. Using research is as much a matter of relationships as of information. It is dependent on a culture of openness, exchange, respect and confidence.

31. Five Year Strategy • An autonomous, focused and shared organization • Continue and strengthen SEARCH Classic program • Activate network, develop research responsiveness • Develop new programs, products, services • Enter partnerships and cost-recovery collaborations

32. Building on the Asset Keeping the whole Strengthening the parts

33. Programs and Services • SEARCH Classic • Two-year cohort development and network. • SEARCH Custom • Ongoing, locally available advice and support. • SEARCH Knowledge Services • Customized knowledge desktops; curriculum products; research opportunities • SEARCH Consultation • For replication and organization development.

34. Current collaborations • BC: Michael Smith Health Research Foundation • SK: Saskatchewan Health Research Foundation and Health Quality Council • Uganda: CIDA Tier 1 with UofA • Knowledge services pilots: Aspen, RNinfodesk, Peace.

35. Development Priorities • Understanding replication of social programs • Organizational learning • Curriculum management: learning objects • Academic sector engagement • Managing network capital • Impact assessment: system-level, networks, cases

36. SEARCH and EXTRA • Complementarity • Synergy • Program development, design, delivery • Organizational capacity • Collaboration • Partnership

37. Common National Strategy Contributions • Human resource development • Interdisciplinary education; Teaming; Leadership • Applied health research capacity • Decision-maker partnerships; non-tertiary; • Information management • Human infrastructure; knowledge focus

38. Beliefs • In health system workplaces, knowledge is generated, selected and used by all. • Quality research requires the engagement of the whole health system • Organizations know best how to build their capacity • Networks of diverse people create powerful learning and knowledge exchange

39. SEARCH Partnerships PARTNERS 3 Universities, 2 Community Colleges 9 RHAs, 2PHAs, Alberta Health, Rural Physician Action Plan Health Canada AHFMR PEOPLE managers, analysts, nurses, mental health workers, physicians, rehab professionals, community developers, epidemiologists, economists, policy analysts, informatics experts, health services researchers PROJECTS immunization, health indicators, early maternity discharge, mental health assessment, primary care models, medication access, community capacity, injury prevention, staff quality of life...

40. Impact: participants • Career development • Network use • Skill application • Relevant responsibility • Research and dissemination • Organizational support • Other outcomes

41. Career • Career development: • 83% positive or major positive influence • 50% undertake additional training, 10% enroll in graduate education • Remain in province: • > 80% remain in province; 2/3 in same organization

42. Use of the network • Currently use personal and professional networks established through SEARCH at 2-4 years: 89% • Contact fellow SEARCH participants (86%) • Obtain other regional contacts (56%) • Contact SEARCH faculty members (56%) • Contact previous/later SEARCH participants (30%) • Contact non-SEARCH university faculty (17%)

43. Application of skills 2 out of 3 apply ‘always/often’ at 2-4 years post program

44. Changes in responsibility • High job mobility into positions with increased responsibility: • 2/3 changed position • 2 out of 3 increased/substantially responsibility • research -> management; practice -> research

45. Other outcomes • Personal networks (94%) • Professional networks (92%) • Leadership skills (78%) • Job satisfaction (75%) • Ability to influence decision-making (75%) • Value to organization (75%) • Respect and recognition from employer (69%) • Other positive outcomes (62%) • Respect and recognition from colleagues(61%) • Adverse outcomes (8%)

46. Impact: Projects • 83% completed 1 or more individual projects • 78% completed 2 or more group projects • 72% of engaged in new research • 64 external and 15 peer-reviewed publications • 69% some form of publication of results • 75% some form of presentation • Organizational support for research • 80% agree/strongly ‘organization is supportive of research’ • 50% ‘currently receive support from direct supervisor to apply learning’

47. Examples of application, use, dissemination, and impact • She re-organized the journals and the docs realised how much she knew and used her differently. • She gave a workshop for the other clinical specialists, they wouldn’t have heard it from someone else. • Because she worked with the team on their questions, they supported her time. • It’s not the skills, we get problem-solvers. • I did apply skills learned through SEARCH ... but not applying results of “the project”. It was more of “a process”. • We used the model as a way of explaining health indicators to the general public, and to health professionals. • The results supported the ongoing funding and expansion of tele-psychiatry.

48. Services • At various levels: • Program/unit (travel clinic; classroom; consent procedures) • Department (PHN distribution; guideline implementation) • Organization (Staff development; business planning) • System (Primary care model; GAF measurement tools; rural physician recruitment, support)

49. Impact: Organizations • “Organizational Research Capacity (ORC) Model” • Improved ‘a great deal’ through SEARCH project: • Skill and knowledge of staff (90%) • Access to resources • Collaboration (individual, organizational) • Research and evaluation • Supportive attitudes and values • Ability to identify relevant information • Identification of priorities • Influence of research on decisions (40%)

50. Outcomes • Individual careers and contributions • Network, recognition, influence and satisfaction • Ability and responsibility to do and use research • “Organizational research capacity” • Resources, collaboration, research/evaluation, attitudes, information, priorities, influence of research • Research activity • New research, dissemination, support, funding • Project impacts • services and outcomes; system reform; human resources • Leadership development • Research infrastructure development; Management capacity *based on SI and SII cohorts at 2-4 years post-program