SEARCH Canada: Building capacity in health organizations to create and use knowledge

Dr. Ann Casebeer, University of Calgary
Ms. Sarah Hayward, SEARCH Canada
Dr. Gail MacKean, University of Calgary
Ms. Sharon Matthias, SEARCH Canada
Dr. Rob Hayward, University of Alberta
(On behalf of the entire SEARCH Canada integrated faculty, staff, participants, and network).

Alberta's SEARCH Canada is dedicated to implementing a system-wide approach to knowledge translation (KT) and use. With a 24-month program to train community-based health professionals in applied health research, SEARCH develops individual and organizational capacity for the ongoing use and development of research evidence in decision making. Specific attention is paid to skill development in using information tools and technology, participating in collaborative networks, and sustaining ongoing personal development as a scholar-practitioner. SEARCH and its participants are now widely known in the Alberta health system, and the program has attracted both national and international acclaim.

Background

SEARCH (Swift Efficient Application of Research in Community Health) Canada* is an Alberta-based public service organization dedicated to knowledge access, creation, and use by health managers, health providers, and their organizations.

SEARCH was launched by the Alberta Heritage Foundation for Medical Research (AHFMR) in 1996 as a twenty-four-month program to train community-based health professionals in the "how-to's" of applied health research, including accessing and assessing high quality information, and applying it in decision making. In April 2005, SEARCH Canada began operating independently, governed and funded by member organizations, which include AHFMR, Alberta's nine health regions, and the University of Calgary. Support is also provided from Alberta Health and Wellness.

SEARCH develops capacities for, and communities of, practice-based learning and innovation, in practice and research sectors across the province. SEARCH supports a network of health professionals and researchers, and their respective organizations, all of which are dedicated to the creation of new knowledge and its translation into better quality health care decisions.1

The SEARCH story is about the experience of implementing a system-wide approach to KT and use. Through SEARCH, we are learning that evidence-based decision making across a health care system requires more than skills and information. It depends on people's attitudes, values, and their daily interactions; it is as much a matter of relationships as of information and is dependent on a culture of openness, exchange, respect, and confidence.

The KT initiative

The overall framework for learning and KT and exchange in SEARCH's activities links three overlapping areas of focus—choosing evidence, creating evidence, and using evidence—while always being mindful of the complex context in which it is to be used. SEARCH's philosophy embraces partnership and recognizes both service and academic organizations as part of the health system.

SEARCH's core activity is a cohort-based learning program that emphasizes the value of applied health research, KT and exchange of knowledge across diverse sectors. A combination of residential sessions, practice-based research projects and sophisticated web-based learning supports2 target long-term, sustainable capacity building of individuals and their organizations. Capacity in the academic sector is built through the core faculty team and additional experts, who are drawn from university faculties of medicine, nursing, and business, and the public and private sectors. Faculty are continuously involved in program design and delivery and develop enduring relationships with participants.

Participants are established health professionals from many health care areas, including nursing, social work, health promotion, mental health, family medicine, and health administration. They are selected by Alberta's health authorities and range from front line clinicians to senior managers. Participants continue in their employment and their salaries remain guaranteed by their sponsoring organizations. Approximately half of their time is allocated to learning and research-related activities.

SEARCH participants have ongoing access to a network of faculty and past participants through a web-based communications system designed to facilitate knowledge sharing. Learning is promoted as a lifelong endeavour, and support for using evidence to improve the quality of health care decisions continues well beyond the 24 -month program. The foundations for ongoing use of research evidence in decision making are developed by paying specific attention to skill development in using information tools and technologies, participating in collaborative networks and personal development as a change agent and scholar-practitioner.

Direct managers of SEARCH participants are involved in prioritizing provincial project topics, definition of local projects, and periodic meetings to discuss issues such as participant support and translation of individual to organizational capacity. Participating organizations are also connected to research development advisors based at colleges and universities across Alberta, for just-in-time advice and assistance.

Results of the KT experience

SEARCH program processes and outcomes are evaluated during and after each instructional module and at 12, 18, and 24 months using surveys and focus groups. To date, more than 125 health practitioners and 60 faculty members have participated in SEARCH's program. Seventy per cent of participants continue to be active in research after four years.

Over 100 practice-based research projects have addressed a variety of pressing issues in health services, health human resources, professional practice, health care management, and population health. These include program evaluations of community health programs, change management capacity assessments, analysis of the impact of the on-call burden on rural physicians and the value of telepsychiatry.

There are a number of levels—service delivery, academic, funding—and loci of change—individual, individual in an organization, health care organization, health care system, and trans-sectoral system—through which SEARCH activities can have an impact. Impacts of SEARCH for the individual, as perceived by managers and participants,3 include increased:

One small region has identified over $750,000 in grants attributable to the capacity introduced by SEARCH participants.

  • Skills in research and research application. One small region has identified over $750,000 in grants attributable to the capacity introduced by SEARCH participants. Another region has identified over $500,000 in successful grant applications.
  • Career development and responsibility for activities linked to evidence-based practice.
  • Personal and professional networks.
  • Leadership capacity and the ability to influence decision making.
  • Job satisfaction, recognition, and respect.
  • Research and evaluation activities.
  • Publication and dissemination of research results.

Organizational level impacts reported by managers4,5 include positive changes in:

  • Access to information resources and the ability to identify relevant information when needed.
  • Skills and knowledge among staff.
  • Leadership development.
  • Capacity for individual and organizational collaboration. Some regions and organizations have become active in province-wide and national initiatives due to expertise developed through SEARCH projects.
  • Health research and evaluation activities.
  • Supportive attitudes to research and evaluation.
  • Culture shift. Many organizations identify SEARCH participants as catalysts for change towards a more evaluative culture.

Lessons learned

Sustained learning opportunities, ongoing connection to knowledge sources, linkages across research and practice expertise, together with executive buy-in, are critical to successful engagement in the exchange and use of evidence.

SEARCH's approach is not a quick fix. Rather, sustained learning opportunities, ongoing connection to knowledge sources, linkages across research and practice expertise, together with executive buy-in, are critical to successful engagement in the exchange and use of evidence to make a lasting difference. Some of the key learnings throughout the early years of SEARCH include:

  • Health professionals are determined to improve practice and health outcomes through research, without academic credit as an incentive.
  • Managers are key to ensuring participants are supported in the program and are often the advocates for evidence-based decisions within an organization.
  • Senior executive engagement is critical for organizational-level impact and diffusion.
  • Experience of priority-setting and collaboration among decision makers and researchers fundamentally enhances evidence use and creation.
  • Learning and skill application takes time and needs to be seen as an investment.
  • The development of a flexible and distributed faculty with organizational support is crucial—commitment to practice-based learning and enjoyment in relationship-building are key.
  • Projects reflecting local and provincial planning priorities provide a powerful learning mode for individuals and an obvious benefit for organizations.
  • Viewing the participating organization (whether academic or service sector) as the client, rather than the individual health professional, transforms the potential for capacity development.

Projects reflecting local and provincial planning priorities provide a powerful learning mode for individuals and an obvious benefit for organizations.

We have also identified a number of characteristics of the SEARCH program that we believe have been crucial to its success:

  • The creation of a strong, supportive network of people across the province.
  • Exposure to and relationship-building with people from diverse settings and backgrounds.
  • The opportunity to learn intensively, with a broad perspective.
  • The opportunity to disengage from everyday work environments to focus on skill development and learning.
  • State-of-the-art communication and computerized networking to support collaboration and ongoing communication.
  • The emphasis on community-based issues, a population health perspective, and applied health services decisions.
  • The requirement to identify and complete projects relevant to the organizational setting.

Conclusions and implications

The result is a health system that is “research-savvy”, more likely to generate research questions from practice, more able to collaborate in research projects and more willing to use new knowledge to change policy and practice.

SEARCH has demonstrated the value of an integrated solution that builds bridges between research and practice, develops health organizations' research capabilities, invests in new expertise for mid-career professionals across all disciplines and supports academics with a passion for working with the service delivery system. The result is a health system that is "research-savvy", more likely to generate research questions from practice, more able to collaborate in research projects and more willing to use new knowledge to change policy and practice.

The program and its participants are now widely known in the Alberta health system. SEARCH has also attracted national and international attention, with jurisdictions in other Canadian provinces, the United Kingdom, Australia, and Uganda expressing interest in piloting SEARCH programs.

In conclusion, there is no better evidence that SEARCH is making a difference than hearing from participants themselves. Years after their participation in a SEARCH cohort, they continue to remain involved and to extend their learning in practice. We let one of the first "SEARCHers" have the last word:

"The concept of SEARCH has always been one of developing research capacity at the grass roots level, something that was never going to be accomplished overnight. But less than 10 years after it got off the ground, the program is reaching across the country; a fantastic accomplishment that reflects the efforts of…everyone who has dedicated their time to the vision of the program."

—Dan Richen, SEARCH I Participant
Manager, Environmental Public Health
David Thompson Health Region


* For more information about the SEARCH program.

References

1 Casebeer, A., S. Hayward, R. Hayward, and S. Matthias. 2003. SEARCH—A learning and communication network. In Collaboration in context, ed. C. M. Scott and W. E. Thurston, 183-94. Calgary, AB: University of Calgary.
2 Lau, F., and R. Hayward. 2000. Building a virtual network in a community health research training program. J Am Med Inform Assn 7 (4): 361-77.
3 McCaffrey Consulting. 2004. The Swift Efficient Application of Research in Community Health (SEARCH): Project Tracking Report. Developed for the Applied Health Research Programs, Alberta Heritage Foundation for Medical Research.
4 Birdsell, J. M. and P. O'Connell. 2003. The Impact of SEARCH on Participating Organizations: Evaluation Report. Developed for the Applied Health Research Programs, Alberta Heritage Foundation for Medical Research.
5 McCaffrey Consulting. 2003. Long Term Evaluation of the Swift Efficient Application of Research in Community Health (SEARCH) Program: Assessing Impact at the Individual Participant Level. Developed for the Applied Health Research Programs, Alberta Heritage Foundation for Medical Research.

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