KT Knowledge Transfer

Collection of articles on KT is available here.

Applying Agile Methodology to Reengineer the Delivery of Person-Centered Care in a Nursing Home: A Case Study.
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Abbott KM, Hulshult A, Eshraghi K, Heppner A, Crumbie V, Heid AR, et al.
Journal of the American Medical Directors Association. 2022 Jun.
Nursing home (NH) providers would benefit from adopting evidence-based measures for gathering and utilizing resident preference information in their daily care activities. However, providers face barriers when implementing assessment tools used to promote person-centered care (PCC). Although Agile methodology is not commonly used in NH settings, this case study shows how it can be used to achieve the goal of delivering preference-based, PCC, within a large NH. We present a road map for breaking down care processes, prioritizing, and implementing iterative plan, do, study, act cycles using Agile methodology to enhance group collaboration on quality improvement cycles, to achieve our goal of providing preference-based PCC. We first determined if care plans reflected each resident’s important preferences, developed a method for tracking whether residents attended activities that matched their preferences, and determined if residents were satisfied that their preferences were being met. These efforts had positive effects throughout the NH particularly when COVID-19 limited visitors and significantly modified staff workflow. Specifically, Agile processes helped staff to know how to honor preferences during quarantines which necessitated a shift to individualized (and not group) approaches for meeting preferences for social contact, comfort, and belonging. The ready availability of preference-based reporting was critical to quickly informing new staff on how to meet residents’ most important preferences. Based on lessons learned, we describe a developmental approach that other providers can consider for adoption. Implications of this work are discussed in terms of the need for provider training in Agile methodologies to support iterative improvements, the need for policies that reimburse providers for their efforts, and additional research around workflow processes.

Mechanisms to Bridge the Gap Between Science and Politics in Evidence-Informed Policymaking: Mapping the Landscape BT – Integrating Science and Politics for Public Health
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Cassola A, Fafard P, Palkovits M, Hoffman SJ.
Fafard P, Cassola A, de Leeuw E, editors. Cham: Springer International Publishing; 2022. p. 293–328.
Despite long-standing efforts to enhance evidence-informed decision-making in public health policy, tensions remain between the goal of basing decisions on the best available scientific evidence and the need to balance competing aims, interests, and evidentiary sources in representative democracies. In response, several strategies have been proposed both to democratize evidence production and evaluation, and to effectively integrate evidence into the decision-making processes of institutions of representative democracy. Drawing on a synthesis of the conceptual and empirical literature, this chapter describes and categorizes mechanisms that aim to reconcile political and scientific considerations in evidence-informed policymaking and develops an analytical typology that identifies salient dimensions of variation in their selection and design.

A practical ‘How-To’ Guide to plain language summaries (PLS) of peer-reviewed scientific publications: results of a multi-stakeholder initiative utilizing co-creation methodology.
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Dormer L, Schindler T, Williams LA, Lobban D, Khawaja S, Hunn A, et al.
Research involvement and engagement. 2022 Jun;8(1):23.
BACKGROUND: Peer-reviewed scientific publications and congress abstracts are typically written by scientists for specialist audiences; however, patients and other non-specialists are understandably interested in the potential implications of research and what they may mean for them. Plain language summaries (PLS)-summaries of scientific articles in easy-to-read language-are emerging as a valuable addition to traditional scientific publications. Co-creation of PLS with the intended audience is key to ensuring a successful outcome, but practical guidance on how to achieve this has been lacking. METHODS: Building on the Patient Engagement (PE) Quality Guidance previously developed by Patient Focused Medicines Development (PFMD), a multi-stakeholder working group (WG) of individuals with patient engagement experience and/or expertise in PLS was established to develop further activity-specific guidance. PLS guidance was developed through a stepwise approach that included several rounds of co-creation, public consultation (two rounds), internal review and a final external review. The iterative development process incorporated input from a wide variety of stakeholders (patient representatives, industry members, publishers, researchers, medical communications agencies, and public officials involved in research bodies). Feedback from each step was consolidated by the WG and used for refining the draft guidance. The final draft was then validated through external consultation. RESULTS: The WG comprised 14 stakeholders with relevant experience in PE and/or PLS. The WG developed a set of 15 ethical principles for PLS development. These include the necessity for objective reporting and the absence of any promotional intent, the need for balanced presentation, the importance of audience focus, the need to apply health literacy principles, and the importance of using inclusive and respectful language. The first public consultation yielded 29 responses comprising 478 comments or edits in the shared draft guidance. The second public consultation was an online survey of 14 questions which had 32 respondents. The final ‘How-To’ Guide reflects feedback received and provides a rational, stepwise breakdown of the development of PLS. CONCLUSIONS: The resulting ‘How-To’ Guide is a standalone, practical, ready-to-use tool to support multi-stakeholder co-creation of PLS.

The science-policy relationship in times of crisis: An urgent call for a pragmatist turn.
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Greenhalgh T, Engebretsen E.
Social science & medicine (1982). 2022 Jun;306:115140.
In this conceptual paper, we argue that at times of crisis, what is sometimes called “evidence-based” or “science-driven” policymaking-establishing scientific truths and then implementing them-must be tempered by a more agile, deliberative and inclusive approach which acknowledges and embraces uncertainty. We offer pragmatism as one potential option, using examples from the UK to illustrate how such an approach might have changed particular crisis decisions and led to better outcomes. We propose that to better prepare for the next public health crisis, five pragmatism-informed shifts are needed in the science-policy relationship: from scientism to science-informed narrative rationality that emerges from practice; from knowledge-then-action to acting judiciously under uncertainty; from hierarchies of evidence to pluralist inquiry; from polarized camps to frame-reflective dialogue; and from an “inside-track” science-policy dialogue to greater participatory democracy. We suggest an agenda for a pragmatist-informed program of applied research on crisis public health policymaking.

Barriers to Research Utilization in Nursing: A Systematic Review (2002-2021).
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Jabonete FGV, Roxas REO.
SAGE open nursing. 2022;8:23779608221091070.
INTRODUCTION: There is an existing gap between what people learned from theory and what they clinically practiced, as revealed in research studies in nursing. This gap is primarily due to identified barriers in utilizing the research findings in actual nursing practice. OBJECTIVE: To present a scientific mapping of the Scopus-indexed literature published from 2002 to 2021, which studied barriers to research utilization in nursing using the BARRIER scale. METHODS: This systematic review utilized bibliometric analysis. One hundred seventy-nine extracted literature from Scopus was manually reviewed, and the study included 53 documents for further analysis. RESULTS: Remarkably, almost three-fourths of the documents identified setting-related factors as the most common barrier to research utilization in nursing (n = 39, 73.58%). This is followed by presentation-related factors (n = 16.98%) and nurse-related factors (n = 5, 9.43%), respectively. Findings revealed that insufficient time at work in implementing new ideas was perceived as the top barrier in research utilization in nursing. CONCLUSION: It is crucial to determine the hindrances to the utilization of research findings. The results of this study establish the connection between research and evidence-based practice which stimulates in meeting the gap in the current nursing practice. Future studies must include research utilization studies that apply tools other than the BARRIER scale.

A knowledge implementation model in health system management based on the PARIHS model.
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Roohi G, Jahani MA, Farhadi Z, Mahmoudi G.
Health research policy and systems. 2022 Jun;20(1):66.
BACKGROUND: The gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran. METHODS: The present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software. RESULTS: The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model. CONCLUSION: The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

The Implementation of Evidence-Informed Family Nursing Practices: A Scoping Review of Strategies, Contextual Determinants, and Outcomes.
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Thürlimann E, Verweij L, Naef R.
Journal of family nursing. 2022 Jun;10748407221099656.
There is a lack of knowledge about the successful implementation of family nursing practices. This scoping review maps current knowledge about the implementation of evidence-informed family nursing practices across settings and populations. A systematic search (CINAHL, PubMed, Medline) identified 24 publications, published between 2010 and 2020. We found nurses’ implementation experience to be one of disruption, learning, and moving to new ways of practicing. The implementation resulted in benefits to families and self but was marked by fluctuation and partial integration of evidence-informed family nursing practices into care delivery. Uptake was shaped by various contextual determinants, with barriers mainly at the team and organizational levels. We identified low-quality, tentative evidence that capacity-building strategies coupled with dissemination-educational strategies may enable family nursing practice skills and increase the quality of family care. More rigorous research is needed to build further knowledge about effective implementation. Future implementation endeavors should utilize the evolving knowledge base in family nursing and tailor implementation strategies to contextual barriers.

A randomised fractional factorial screening experiment to predict effective features of audit and feedback.
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Wright-Hughes A, Willis TA, Wilson S, Weller A, Lorencatto F, Althaf M, et al.
Implementation science : IS. 2022 May;17(1):34.
BACKGROUND: Audit and feedback aims to improve patient care by comparing healthcare performance against explicit standards. It is used to monitor and improve patient care, including through National Clinical Audit (NCA) programmes in the UK. Variability in effectiveness of audit and feedback is attributed to intervention design; separate randomised trials to address multiple questions about how to optimise effectiveness would be inefficient. We evaluated different feedback modifications to identify leading candidates for further “real-world” evaluation. METHODS: Using an online fractional factorial screening experiment, we randomised recipients of feedback from five UK NCAs to different combinations of six feedback modifications applied within an audit report excerpt: use effective comparators, provide multimodal feedback, recommend specific actions, provide optional detail, incorporate the patient voice, and minimise cognitive load. Outcomes, assessed immediately after exposure to the online modifications, included intention to enact audit standards (primary outcome, ranked on a scale of -3 to +3, tailored to the NCA), comprehension, user experience, and engagement. RESULTS: We randomised 1241 participants (clinicians, managers, and audit staff) between April and October 2019. Inappropriate repeated participant completion occurred; we conservatively excluded participant entries during the relevant period, leaving a primary analysis population of 638 (51.4%) participants. None of the six feedback modifications had an independent effect on intention across the five NCAs. We observed both synergistic and antagonistic effects across outcomes when modifications were combined; the specific NCA and whether recipients had a clinical role had dominant influences on outcome, and there was an antagonistic interaction between multimodal feedback and optional detail. Among clinical participants, predicted intention ranged from 1.22 (95% confidence interval 0.72, 1.72) for the least effective combination in which multimodal feedback, optional detail, and reduced cognitive load were applied within the audit report, up to 2.40 (95% CI 1.88, 2.93) for the most effective combination including multimodal feedback, specific actions, patient voice, and reduced cognitive load. CONCLUSION: Potentially important synergistic and antagonistic effects were identified across combinations of feedback modifications, audit programmes, and recipients, suggesting that feedback designers must explicitly consider how different features of feedback may interact to achieve (or undermine) the desired effects. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: ISRCTN41584028.