Evidence in action, acting on evidence

CIHR Institute of Health Services and Policy Research
A casebook of health services and policy research knowledge translation stories

Canadian Institutes of Health Research
160 Elgin Street, 9th Floor
Address Locator 4809A
Ottawa, ON K1A 0W9 Canada

© Her Majesty the Queen in Right of Canada (2006)
Cat. No.: Mr21-71/2006
ISBN: 0-662-69591-7

Table of contents

Acknowledgements

The CIHR Institute of Health Services and Policy Research (IHSPR) would like to acknowledge the following individuals for their generous contribution of time and expertise to the inaugural IHSPR Knowledge Translation Casebook.

  • The core project implementation team, including Michelle Gagnon, for overseeing and leading the project; Heidi Matkovich, for working closely with the case authors, IHSPR Institute Advisory Board (IAB) members, and staff to edit the Casebook; Leanne Moussa, for strategic communications advice; Lori Greco and Liz Stirling, for knowledge translation expertise and support; and Kim Gaudreau, for assisting with the case abstract review process.
  • The Casebook review committee, including Irving Gold, Suzanne Lawson, Anne McFarlane, and Laurence Thompson (committee chair) from IHSPR's IAB Knowledge Translation Working Group; and Michèle O'Rouke and Heidi Matkovich, IHSPR staff, and Liz Stirling, CIHR Knowledge Translation Branch, for reviewing the case abstracts.
  • Morris Barer, Scientific Director, IHSPR, Diane Watson, Associate Director, IHSPR, and Laurence Thompson, member of the IHSPR Institute Advisory Board, for their advice and support.

The views expressed in this report do not necessarily represent the views of the Canadian Institutes of Health Research.

CIHR Mandate

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health care system. Composed of 13 Institutes, CIHR provides leadership and support to close to 10,000 health researchers and trainees across Canada.

IHSPR Mandate

The CIHR Institute of Health Services and Policy Research (IHSPR) is dedicated to supporting innovative research, capacity-building and knowledge translation initiatives designed to improve the way health care services are organized, regulated, managed, financed, paid for, used and delivered, in the interest of improving the health and quality of life of all Canadians.

Foreword

Knowledge translation (KT) is a broad concept, encompassing all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. Successful KT strategies can include linkage and exchange, communication and education, policy change, and program and practice improvement initiatives.

CIHR's vision of successful KT is the exchange, synthesis, and ethically-sound application of knowledge within a complex set of interactions among researchers and users—to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system. A core element of CIHR's knowledge translation strategy is to support and recognize KT excellence, and to act as a KT resource for Canada.

In early 2005, the CIHR Institute of Health Services and Policy Research issued a call for knowledge translation "stories" that illustrated both successful and less than successful examples of the collaborative development and practical use of health services and policy research. We wanted to encourage and recognize KT activity and provide a vehicle for publishing and sharing lessons from KT experiences.

We also wanted to highlight the potential impact of health services and policy research evidence in shaping policy and practice change. There is growing interest among health services organizations, individual researchers, and decision makers in learning more about KT experiences that lead to a greater understanding of KT in action and its better practices.

We invited individuals, teams, and organizations working in health care services and policy, particularly in the national priority areas for research and knowledge translation identified in Listening for Direction II,Footnote 1 to contribute to this KT Casebook.Footnote 2 Cases were selected based on review of the abstracts submitted.

The collection represents a broad cross-section of experiences—from the preliminary development of partnerships for future knowledge translation in Aboriginal communities, to the use of established knowledge translation networks to rapidly respond to a community in crisis. Widely-acclaimed KT models, like SEARCH Canada, PRISMA and Manitoba's The Need to Know Team, are showcased, but the Casebook also highlights efforts to develop new kinds of partnerships: between researchers and community-based organizations; between researchers and advocacy groups; and between multiple partners and dedicated KT brokers and champions.

The cases in this Casebook are first-hand, personal stories. We asked contributors to be frank about their successes and failures, and to report, from their own experiences, what worked, what didn't and the lessons they learned. This Casebook is not intended to be a replacement for insights gained from systematic reviews of the growing knowledge translation literature. But many of these stories echo common themes about conducting KT in the Canadian context.

Lessons learned

  • Effective KT requires long-term, sustained relationships. Such relationships are rarely well supported by current funding models and mechanisms. Some of the most successful examples of KT have leveraged existing relationships into funded programs with embedded KT aims. But in the initial stages of a KT initiative, competitive funding cycles can create unrealistic timelines for building trust, understanding, and common goals. This is particularly the case for activities with community partners, where a significant front-end investment in time may be required to establish mutual understanding of unfamiliar contexts, needs, and expectations.
  • KT activities are nourished by face-to-face interactions. In almost all of the cases profiled here, some form of in-person interaction between partners was crucial for success. Personal contact with practitioners is the most valuable form of KT, particularly in training and educational initiatives. Yet it is also one of the most costly and time-consuming elements of a KT strategy, and again, often not adequately supported through existing funding models.
  • KT is often conducted off the side of the desk. Frequently, KT is sustained by little more than a personal commitment to the research, to practice change, or to a community, and with full recognition that these activities are unlikely to be recognized by academic promotion and tenure committees. Without belittling the need for change in this area, it is also worth noting that one of the benefits of working in a partnership is the resulting synergy that can help fill resource gaps and provide less tangible "job satisfaction."
  • KT activities alone are often not enough to effect change. KT must take place within supportive organizational climates. Decision-making partners must have an interest in the research and the capacity to absorb evidence. They must understand its implications for the specific decision-making environment and be interested in engineering evidence-based change. Executive-level buy-in is crucial for KT designed to effect program and policy changes. Building individual capacity to develop and use research knowledge has far greater benefit within an organization that encourages individuals to use such knowledge to make practice and program improvements.
  • Peer-initiated change plays a major role. One important organizational element to consider, particularly for training and education initiatives, is the role of peer-initiated change. At least three cases in this Casebook focus on activities that utilize respected peers to promote the uptake and use of research knowledge to influence practice change. Outside of an individual organization, front-line practitioners can also independently pilot new, evidence-based practices and facilitate their uptake through peer networks and member associations.
  • KT activities can be too successful. It is encouraging, in one way, that the authors of two cases in this Casebook were compelled to note that KT activities can be too successful. Partner organizations can implement research findings prematurely, or respond wholeheartedly to identified problems before the necessary research is complete. These important lessons signal a welcome maturity in the current level of KT being conducted across the country.

We hope that this Casebook becomes a valuable resource for the diversity of health services and policy research communities in Canada. While we intend that this will be the first of many such efforts to illustrate health services and policy research-related knowledge translation in Canada, it is a pilot project, and will be evaluated for its usefulness as a source of information about KT in action. We therefore welcome your comments on content, presentation, distribution, or any other aspects of this project.

Morris Barer
Scientific Director
CIHR Institute of Health Services and Policy Research

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