Ian Graham Regenstrief Conference Slides October 4 2007

Can Knowledge Translation be a Strategy for Transformative Change?

10th Biennial Regenstrief ConferenceTurkey Run State Park

IndianaOctober 2nd- 4th, 2007

Ian D Graham PhDVice President, Knowledge Translation Portfolio

Canadian Institutes of Health Research

Presentation Outline

• Context- biases• A case study- an early IT innovation• A bit about CIHR• What is transformative change?• What is Knowledge Translation (KT)?• How can KT be a strategy for

transformative change?• Reflections

Context or Biases

• Trained as a health sociologist• socio-historical analysis of use of episiotomy in the US and UK ~1850-1995

• Interdisciplinary post-doc training in clinical epidemiology unit• patient and physician perceptions and response to decision aids

• HSR and KT/implementation researcher

• applied, pragmatic, multi-method

• conceptual frameworks (OMRU, PGEAC, ADAPTE process)

• decision support tools development, appraisal, implementation

• VP- Knowledge Translation, CIHR

http://www.youtube.com/watch?v=4pyjRj3UMRM&mode=related&search

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http://www.youtube.com/watch?v=xFAWR6hzZek






IT Case Study: Key messages

• Even great innovations don’t implement themselves

• Attributes of innovations• Relative advantage, Complexity, Compatibility, • Observability, Trialability

• Characteristics of potential adopter important• Knowledge, attitudes and skills

• Context is important

• Printed educational material many not be sufficient• Change agents/outreach facilitation are potentially useful

implementation interventions

Population

32.8 million

CIHR: is Government of Canada’s health research funding agency supports 10,000 researchers and trainees funds research that improves Canadians’ health, health care system

and quality of life fosters commercialization, moving research discoveries from

academic setting to the marketplace allocates 94 cents of every dollar to fund Canadian health researchers

CIHR: Overview

CIHR Mandate“To excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system…”

CIHR Approach13 Research Institutes

Population and Public

Health

Genderand

Health

Aboriginal Peoples’Health

Health Servicesand PolicyResearch

Genetics

Infectionand Immunity

Nutrition,Metabolism and Diabetes

Cancer Research

Neurosciences,Mental Healthand Addiction

Aging

MusculoskeletalHealth and

Arthritis

Circulatoryand

RespiratoryHealth

HumanDevelopment,

Child and Youth Health

CIHR Approach -13 Research Institutes

Institutes become a meeting ground for Canada’s health research community

each Institute -- with its partners -- has developed a strategic plan to guide its research initiatives

these plans build on existing knowledge, fill gaps, and help to fully realize Canadians' investment in health research by maximizing cooperation and minimizing duplication

CIHR Approach

Problem-based and Multidisciplinary

CIHR takes a problem-based multidisciplinary approach to health issues

encompasses research in four theme areas:

1. Biomedical

2. Clinical

3. Health systems and services

4. Population and public health

What does “transformation” mean?

A marked change, as in appearance or character, usually for the better. A qualitative change (now rare: a woman’s wig)

Example: Some fresh paint soon transformed the room

Mathematics

a. Replacement of the variables in an algebraic expression by their values in terms of another set of variables.

b. A mapping of one space onto another or onto itself.

Thesaurus: change, change over, alter, metamorphose, transmogrify, redo, reconstruct, renew, remodel;

Antonym: preserve.

http://www.thefreedictionary.com/transformation

Transformational change

• Paradigm shift

• Revolution

• Thinking outside the box

“Never, ever, think outside the box.” (From The New Yorker, November 30, 1998.)

What does CIHR mean by ”Knowledge Translation”?

Knowledge translation (implementation) is about:• Making users aware of knowledge/innovations and

facilitating their use of it to improve health and health care systems

• Closing the gap between what we know and what we do (reducing the know-do gap)

• Moving knowledge into action

• Knowledge translation research (KT/implementation

Science) is about:• Studying the determinants of knowledge use and effective

methods of promoting the uptake of knowledge

What is ”Knowledge Translation”?

CIHR’s working definitionworking definition:

Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care

system. This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.

Knowledge Translation at CIHR

The revised working definitionrevised working definition:

Knowledge translation is a dynamic and iterative process

that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care














Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and

ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health

care system. This process takes place within a complex system of interactions between researches and knowledge users which may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user.



Knowledge translation is a dynamic and iterative process that includes synthesis, dissemination, exchange and

ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system.

given that the purpose is ultimately to improve the health of Canadians and the health care system - monitoring and evaluation of KT outcomes and impact is essential

End of Grant and Integrated KT

Two broad categories of KT at CIHR

• End of grant KT (which could be simple diffusion, dissemination or a more intensive application of research findings)

• Integrated KT- KT woven into the research process

What is integrated KT?

• a way of doing research• solutions-based• action-oriented research, collaborative research, co-

production of knowledge, applied research • involves engaging and integrating stakeholders into the

research process

Study stakeholders can be:• Policy makers, decision makers, research funders, the

public, clinicians, the media • Investigators from different disciplines, teams, countries

Stakeholders can be involved in:

• defining and shaping the research questions• deciding on the methodology• helping with data collection and tools development• interpreting the study findings• crafting the message and disseminating the research

results• moving the results into their practice• promoting widespread dissemination and application

What is integrated KT? It is about the importance of stakeholders

What is your dangerous idea? (John Brockman, editor)

“We have in hand most of the information we need to facilitate a new golden age of medicine. And what we don’t have in hand we can get fairly readily by wise investment in targeted research and intervention.”

Paul Ewald (evolutionary biologist)

And now the provocative part-knowledge translation as transformative

change

First, researchers need to conduct the right research• need syntheses to determine what we already know (or should

know)

• in many areas we need to use the research we already have- synthesis should determine these areas

• 30-40% patients do not get treatments of proven effectiveness• 20–25% patients get care that is not needed or potentially harmful

(Schuster, McGlynn, Brook, 1998; Grol R, (2001)

• Cancer outcomes could be improved by 30% with optimum application of what is currently known

• 10% reduction in cancer mortality with widespread use of available therapies (CSCC 2001; Ford et al, 1990)

When research gaps exist

Get the right people involved from the beginning

Need applied, collaborative, interdisciplinary research AKA INTEGRATED KT

Today’s health problems are complex and interdisciplinary and require mixed methods to solve

Research users need to be setting the research agenda and defining the research questions to ensure relevance and greater likelihood of uptake (70-30)

And now the provocative partKnowledge Translation as Transformative Change

Second- end-users need to make the research right for them

• Research not used like a can opener

• Users need to adapt and take ownership of knowledge for local use

The Knowledge to Action CycleFrom :

Graham et al: Lost in Knowledge Translation. Time for a Map?

A useful tool/schematic for describing the many components of the KT process


Third- need to focus on moving research into action

• shift attention from individual adopters to the organizational and environmental context for change


Lastly- Set targets for change

• monitor uptake of the research and evaluate the health and system outcomes/impact• Keep it simple (a few important targets,

practical indicators)

Reflections on transformational change

When transforming the ‘health care system’ what is included in the system? Informal health care system, patients, public, complementary and alternative medicine

Organizations/systems are organic NOT mechanistic and linear

(complex, dynamic, adaptive, flexible, responsive)

Need to meaningfully engage end user throughout process (integrated KT)


Opportunity costs of implementation- avoid the KT imperative

Importance of performance measurement- measure the right things at the right time

Can start small and build


Distinction between implementation research (studying) vs practice (doing)

Implementation research needs to be interdisciplinary and use mixed methods – strive to be rigorous

Need much more research on intervention design, implementation/administration, evaluation

Thank you

Questions?

[email protected]

Polar bears often are seen walking down the streets of

Ottawa

Health & Medicine

Ian Graham Regenstrief Conference Slides October 4 2007