Complexity in healthcare systems presents knowledge translation (KT) challenges but also opportunities. Our Evidence & Policy article, ‘Connecting knowledge and action in complex health systems: examples from British Columbia, Canada’, illustrates ways we have harnessed complexity to narrow the gap between knowledge and action. We work across different health authorities and funding agencies building strong relationships with those who use research, fostering innovation, supporting evidence-based decision-making and helping people to de-implement obsolete practices. We share a commitment to building strong connections between knowledge and action, and our work is enhanced by embracing the inherent intricacies of the systems in which we work.
We share examples from our practice areas of how we navigate the demands of knowledge translation using responsive solutions and relationship building to support KT that promotes health. While many health systems leaders continue to perceive researchers and research as irrelevant and disconnected from their realities, we have found that when research is undertaken with people who use it, reciprocal and responsive relationships can overcome this barrier and lead to collaborations that support healthcare improvements. Embracing research as a public good requires reimagining the relationships and structures of both research and KT, and we are encouraged by the many ways we’ve seen this happen.
Examples of these collaborations include practice-based research programmes; opportunities to learn about and conduct patient-oriented research; an annual health system-led conference on rural health which focuses on exploring implications of research in local contexts; annual ‘research weeks’ that bring together people focused on health system and community priorities; and creation of a web-based learning and assessment tool called ‘KT Pathways’ that allows users to identify areas of KT strength and areas for further professional development. Additionally, we highlight the roles of knowledge brokers who enable linkage and exchange by providing KT guidance and training, and fostering impactful research partnerships.
We share the assertion that research needs to be fully integrated with structure and processes in health authorities. At a time when the relevance of research in health systems settings is questioned, we believe our examples of working as KT champions offer important insights. We highlight suggestions for co-development of research and KT in health systems, making visible the many ways that KT can be enabled in these complex settings. Connecting knowledge with action requires resources, tools, expertise and time, and invites us to reimagine how we monitor and evaluate impacts.
KT is critical in promoting the use of evidence to improve functioning in health systems, yet much of the KT literature highlights ‘successes’ in ways that render invisible the challenges of connecting knowledge and action. As people working within health systems around the world face exceedingly complex problems that require rapid solutions, our work has helped overcome fragmentation. Our examples assist health leaders to more successfully negotiate competing demands and respond to shifting, top-down priorities.
Change in complex health systems is emergent, unpredictable, uncertain and urgent; people across the system may be required to change at a moment’s notice, and change fatigue can accumulate, especially during shifts in political environment or crises. A health system’s capacity to respond to these shifts demonstrates that change is always possible, but never guaranteed.
Though the bureaucracy of health systems may move slowly at times, it can be extraordinarily nimble, and KT support must also be nimble to enable the uptake of evidence during these rapid turns. Each of our roles as KT champions demonstrates how health care and health research systems can enable and support the relational leadership needed to mobilise evidence into practice. The challenge of complexity thus presents an opportunity that, with appropriate responsiveness and the right mix of supports, can be harnessed to narrow the gap between knowledge and action.
You can read the original research in Evidence & Policy:
Plamondon, K. Battersby, L. Black, A. Creighton, G. Hoens, A.M. and Young, W. (2020). Connecting knowledge and action in complex health systems: examples from British Columbia, Canada. Evidence & Policy, DOI: 10.1332/174426420X15883549951570. [Open Access]
Agnes Black is the Director, Health Services & Clinical Research and Knowledge Translation at Providence Health Care in Vancouver, BC, Canada. Agnes completed her BSN at the University of Washington, Seattle, and her Master of Public Health at Simon Fraser University. She is an adjunct professor at the University of British Columbia School of Nursing; and Research Associate, Centre for Health Evaluation & Outcome Sciences.
Image credit: Connor Connolly-Moyls
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