Session 2 – Knowledge utilization and transfer and the organization

1. Session 2 – Knowledge utilization and transfer and the organization Discussants: Cheryl B. Stetler & Shannon Scott-Findlay

2. Unpack issues relevant to development of the science • Highlight important contextual factors in knowledgeutilizationandtransfer(KU/T) • Research utilization (RU) • Evidence-based practice(EBP) • Explore commonalties & differences of presented approaches. • Enhance dialogue

3. Observations re: KU/T within Health Care Organizations • What we (seem to) know about “making it happen” B. What we don’t (seem to) know about “making it happen”

4. A. What we (seem to) know …(albeit) • There is no one “inductive” or “deductive” approach that has been substantiated: • There is some evidence re: individual strategies & the need to use multiple strategies • Often per Rogers’ work on innovations (but largely re: individuals) • Mostly per research re: physicians, whose “organizational” links vary

5. 1. …no one…approach… • There is a growing body of funded RU/EBP/translation research • Interventional: Often, “medical” or “interdisciplinary” focus; in few cases, with a KU framework; usually project- or condition-focused. • Descriptive: In many cases, nursing focused, exploratory, and barrier focused. • Effective approaches may be an adaptation/“mix” & relate to: • Definition of evidence & its strength • Nature of evidence-based practice

6. A. What we (seem to) know …(albeit) • There is increasing recognition in research of the potential influence of “context,”including leadership and culture, in transfer/utilization: • Interventional studies: Often within the perspective of an isolated project, as a correlate/barrier • Descriptive studies: Just beginning to be explored in-depth beyond barrier perceptions

7. B. What we don’t (seem to) know about … • Approaches to implementation • Association of QI & EBP/KU-T • Impact on tailoring/adaptation • “Facilitation” of implementation efforts • Context of implementation • Meaning/measurement • “RU/EBP”exemplar organizations

8. 1. Approaches to implementation • What is the association between Quality Improvement Models & KU-T/RU/EBP? • Meaning of “EBQI” models? • Degree/importance of QI function involvement with KU/T/EBP research or projects?

9. What is the impact of alternative approaches on the tailoring/adaptation of “evidence”? • Relation to strength of evidence or nature of evidence/innovation? • “Intelligently adapt evidence-based (clinical) interventions” (rather than “tailor”) (Goldberg & Horowitz)

10. What is the extent, nature, or influence of “facilitation” or “researcher change agentry”needed for implementation efforts? • Within individual (“research”/implementation) projects • Internal facilitation (content champion or QI role?) • External facilitation (researcher role?) • Within an EBP organization • Role of service-based nurse researcher? • A generic facilitation mechanism?

11. 2. OrganizationalContext • What is the meaning of context & culture? • Variable meanings/variable measures • Inconsistent terminology used to describe the context • Organizational context of nursing practice • Powerful determinant which influences the work in the organization (Hall, 1991). • Organizational culture • Multitude of definitions • Trends in the definition: 1) SHARED; 2) UNIQUE

12. “Organizational”research issues • Measurement • Approaches • Who forms the sample • Unitofanalysis • Impact of multiple use of translation solutions

13. Nature of “RU/EBP exemplar” organizations or “naturally occurring experiments”? • Identifiable Nursing departments (&…?) • Use an RU/EBP Model • Focus on both project and departmental level • There is a lack of organizational-level research about such departments/organizations: • Descriptive or interventional • Issue in terms of cost-effective implementation • Issue in terms of role of a researcher/facilitator

14. Organizational Context & KU/T (EBP) at the Macro Level • There is knowledge on organizational change potentially applicable to “routine, cost-effective, sustained, and integrated KU/T” • There are frameworks that could be evaluated/tested.

15. (Sample Framework) EBP Organizational Implementation Framework: • Leadership Support for an EBP Culture • Capacity Building • RU Model • Infrastructure to Support and Maintain Handout

16. Managing Change in the NHS: Organizational Change(Iles & Sutherland: ) “…time is ripe for investigation of… alternative models of organization and management … emerging in service settings” • Integration of KU/T & EBP

17. Recommendations: • Multi-site research at the organizational/ departmental level re: KU & Transfer in, at least, Nursing • Naturally occurring experiments • Interventional

18. Collaboration across research projects to refine/create/use standard measurements, at a minimum, for: • Culture, as Relevant to EBP • Organizational culture • Professional practice culture • Propensity to innovate (Iles & Sutherland) • Organizational (and Project) Capacity • Facilitation, internal and external (Kitson et al.; Harvey et al.) • Self-audit tool (Lomas) • Organizational readiness (Sales et al)

19. Critical Infrastructures: • Formal goals/priorities • Information systems • Roles/expectations • “Adaptation,” relative to: • Strength of evidence • Nature of evidence/innovation • “Intensity” of implementation • Character/format of the clinical innovation

20. Innovative “research”/evaluative designs with service-based EBP projects • Beyond case studies • Multi-site, networking

21. Knowledge utilization and transfer and the organization: How to Make It Happen (Routinely)?