KT Knowledge Transfer

Collection of articles on KT is available here.

Enabling visibility of the clinician-scientists’ knowledge broker role: a participatory design research in the Dutch nursing-home sector
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Barry M, Kuijer W, Persoon A, Nieuwenhuis L, Scherpbier N.
Health Res Policy Syst 2021 Apr 7;19(1):61-021-00715-z.
BACKGROUND: A group of clinician-scientists and managers working within a Dutch academic network, experienced difficulties in clearly defining the knowledge broker role of the clinician-scientists. They found no role clarity in literature, nor did they find tools or methods suitable for clinician-scientists. Clarifying role expectations and providing accountability for funding these knowledge broker positions was difficult. The aim of this research was to design a theory-informed tool that allowed clinician-scientists to make their knowledge broker role visible. METHODS: A participatory design research was conducted in three phases, over a 21-month period, with a design group consisting of an external independent researcher, clinician-scientists and their managers from within the academic network. Phase 1 constituted a literature review, a context analysis and a needs analysis. Phase 2 constituted the design and development of a suitable tool and phase 3 was an evaluation of the tool’s perceived usefulness. Throughout the research process, the researcher logged the theoretic basis for all design decisions. RESULTS: The clinician-scientist’s knowledge broker role is a knowledge-intensive role and work-tasks associated with this role are not automatically visible (phase 1). A tool (the SP-tool) was developed in Microsoft Excel. This allowed clinician-scientists to log their knowledge broker activities as distinct from their clinical work and research related activities (phase 2). The SP-tool contributed to the clinician-scientists’ ability to make their knowledge broker role visible to themselves and their stakeholders (phase 3). The theoretic contribution of the design research is a conceptual model of professionalisation of the clinician-scientist’s knowledge broker role. This model presents the relationship between work visibility and the clarification of functions of the knowledge broker role. In the professionalisation of knowledge-intensive work, visibility contributes to the definition of clinician-scientists broker functions, which is an element necessary for the professionalisation of an occupation. CONCLUSIONS: The SP-tool that was developed in this research, contributes to creating work visibility of the clinician-scientists’ knowledge broker role. Further research using the SP-tool could establish a clearer description of the knowledge broker role at the day-to-day professional level and improved ability to support this role within organisations.

Using organization theory to position middle-level managers as agents of evidence-based practice implementation
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Birken SA, Currie G.
Implement Sci 2021 Apr 9;16(1):37-021-01106-2.
Middle-level managers (MLMs; i.e., healthcare professionals who may fill roles including obtaining and diffusing information, adapting information and the intervention, mediating between strategy and day-to-day activities, and selling intervention implementation) have been identified as having significant influence on evidence-based practice (EBP) implementation. We argue that understanding whether and how MLMs influence EBP implementation is aided by drawing upon organization theory. Organization theories propose strategies for increasing MLMs’ opportunities to facilitate implementation by optimizing their appreciation of constructs which we argue have heretofore been treated separately to the detriment of understanding and facilitating implementation: EBPs, context, and implementation strategies. Specifically, organization theory encourages us to delineate different types of MLMs and consider how generalist and hybrid MLMs make different contributions to EBP implementation. Organization theories also suggest that MLMs’ understanding of context allows them to adapt EBPs to promote implementation and effectiveness; MLMs’ potential vertical linking pin role may be supported by increasing MLMs’ interactions with external environment, helping them to understand strategic pressures and opportunities; and how lateral connections among MLMs have the potential to optimize their contribution to EBP implementation as a collective force. We end with recommendations for practice and future research.

Registered nurses’ self-rated research utilization in relation to their work climate: Using cluster analysis to search for patterns
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Karlberg Traav M, Forsman H, Eriksson M.
Int J Nurs Pract 2021 Apr 10:e12944.
AIM: To describe and study the association between registered nurses’ self-rated research utilization and their perception of their work climate. BACKGROUND: Research utilization is an important part of evidence-based nursing, and registered nurses value a work climate that supports the possibility to work evidence-based. METHOD: This cross-sectional study was conducted using the Creative Climate Questionnaire together with three questions measuring instrumental, conceptual and persuasive research utilization. The analysis was done using variable- and pattern-oriented approaches. RESULTS: An association was found between research utilization and experience of dynamism/liveliness. Women reported higher use of conceptual research utilization. Regarding work climate, younger registered nurses and registered nurses with less work experience gave higher scores for playfulness/humour and conflicts. The results showed an association between having a Bachelor’s or Master’s degree and higher instrumental research utilization. DISCUSSION: Research utilization was higher in registered nurses with higher academic education. Low users of research tended to experience a lack of dynamism and liveliness, which indicates the importance of improving the work climate by creating a climate that allows opinions and initiate discussions. CONCLUSION: The findings support the importance of creating a work climate that encourages reflection and discussion among registered nurses, and to promote academic education for nurses plus an optimal work-place staffing-mix. SUMMARY STATEMENT: What is already known about this topic? Research utilization is an important part of evidence-based nursing. Registered nurses value a work climate that supports the possibility to work evidence-based. Little is known about the association between how nurses use research in clinical work and how they perceive their work climate. What this paper adds? Low research users tended to experience low dynamism and liveliness in their work climate, showing the importance of improving the work climate in health care organizations to support clinical nurses’ ability to express opinions and initiate discussions. The association between work climate and the use of research among nurses needs further investigation. Our findings support previous research showing that a higher academic level is associated with increased research among registered nurses working clinically, and therefore benefits patient outcomes. The implications of this paper: The association between low research utilization and experience of low dynamism and liveliness indicates the importance of improving the work climate by creating an atmosphere where nurses can express their opinions and initiate discussions. There is a need to support clinical registered nurses to maintain their research utilization throughout their working career. The health care sector and the individual workplace should support registered nurses in furthering their academic level.

Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions
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Laur C, Corrado AM, Grimshaw JM, Ivers N.
Implement Sci Commun 2021 Apr 1;2(1):35-021-00137-6.
BACKGROUND: Quality improvement (QI) evaluations rarely consider how a successful intervention can be sustained long term, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained. This study explores why and how the effective interventions were sustained, spread, or scaled. METHODS: A qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for telephone interviews. Authors were eligible if they had completed the author survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed “effective.” Snowball sampling was used if the participant identified someone who could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify barriers and facilitators to sustainability, spread, and/or scale of the QI program, using case examples to show trajectories across projects and people. RESULTS: Eleven of 44 eligible trialists participated in an interview. Four reported that the intervention was “sustained” and nine were “spread,” however, interviews highlighted that these terms were interpreted differently over time and between participants. Participant stories highlighted the varied trajectories of how projects evolved and how some research careers adapted to increase impact. Three interacting themes, termed the “3C’s,” helped explain the variation in sustainability, spread, and scale: (i) understanding the concepts of implementation, sustainability, sustainment, spread, and scale; (ii) having the appropriate competencies; and (iii) the need for individual, organizational, and system capacity. CONCLUSIONS: Challenges in defining sustainability, spread and scale make it difficult to fully understand impact. However, it is clear that from the beginning of intervention design, trialists need to understand the concepts and have the competency and capacity to plan for feasible and sustainable interventions that have potential to be sustained, spread and/or scaled if found to be effective.

Knowledge Translation in Physical Medicine and Rehabilitation: A Citation Analysis of the Knowledge-to-Action Literature
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Moore JL, Mbalilaki JA, Graham ID.
Arch Phys Med Rehabil 2021 Feb 6.
OBJECTIVES: To (1) provide an overview of the use of the Knowledge-to-Action Cycle (KTA) to guide a clinical implementation project; (2) identify activities performed in each phase of the KTA; and (3) provide suggestions to improve KTA activities in physical medicine and rehabilitation. DATA SOURCES: Google Scholar and PubMed were searched through December 31, 2019. STUDY SELECTION: Two reviewers screened titles, abstracts, and full-text articles to identify published studies that used the KTA to implement a project. DATA EXTRACTION: Two reviewers examined full-text articles. Data extraction included activities performed in each phase of the KTA, including measurements used to evaluate the project’s effectiveness. DATA SYNTHESIS: Commonly performed KTA activities were identified and country of study, area of rehabilitation, and other factors related to the use of the KTA in rehabilitation were described. A total of 46 articles that met the study’s inclusion criteria provided an overview of the use of the KTA in rehabilitation. Strengths and weaknesses of the articles are discussed and recommendations for improved KTA use are provided. CONCLUSIONS: Implementation of evidence-based practice requires focused engineering and efforts. This review provides an overview of the knowledge translation activities occurring in physical medicine and rehabilitation and considerations to improve knowledge translation research and practice.

From novice to expert: methods for transferring implementation facilitation skills to improve healthcare delivery
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Ritchie MJ, Parker LE, Kirchner JE.
Implement Sci Commun 2021 Apr 8;2(1):39-021-00138-5.
BACKGROUND: There is substantial evidence that facilitation can address the challenges of implementing evidence-based innovations. However, facilitators need a wide variety of complex skills; lack of these can have a negative effect on implementation outcomes. Literature suggests that novice and less experienced facilitators need ongoing support from experts to develop these skills. Yet, no studies have investigated the transfer process. During a test of a facilitation strategy applied at 8 VA primary care clinics, we explored the techniques and processes an expert external facilitator utilized to transfer her skills to two initially novice internal facilitators who became experts. METHODS: In this qualitative descriptive study, we conducted monthly debriefings with three facilitators over a 30-month period and documented these in detailed notes. Debriefings with the expert facilitator focused on how she trained and mentored facilitation trainees. We also conducted, recorded, and transcribed two semi-structured qualitative interviews with each facilitator and queried them about training content and process. We used a mix of inductive and deductive approaches to analyze data; our analysis was informed by a review of mentoring, coaching, and cognitive apprenticeship literature. We also used a case comparison approach to explore how the expert tailored her efforts. RESULTS: The expert utilized 21 techniques to transfer implementation facilitation skills. Techniques included both active (providing information, modeling, and coaching) and participatory ones. She also used techniques to support learning, i.e., cognitive supports (making thinking visible, using heuristics, sharing experiences), psychosocial supports, strategies to promote self-learning, and structural supports. Additionally, she transferred responsibility for facilitation through a dynamic process of interaction with trainees and site stakeholders. Finally, the expert varied the level of focus on particular skills to tailor her efforts to trainee and local context. CONCLUSIONS: This study viewed the journey from novice to expert facilitator through the lens of the expert who transferred facilitation skills to support implementation of an evidence-based program. It identified techniques and processes that may foster transfer of these skills and build organizational capacity for future implementation efforts. As the first study to document the implementation facilitation skills transfer process, findings have research and practical implications.

A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies
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Springer MV, Sales AE, Islam N, McBride AC, Landis-Lewis Z, Tupper M, et al.
Implement Sci 2021 Apr 1;16(1):35-021-01102-6.
BACKGROUND: Audit and feedback (A&F) is a widely used implementation strategy. Understanding mechanisms of action of A&F increases the likelihood that the strategy will lead to implementation of an evidence-based practice. We therefore sought to understand one hospital’s experience selecting and implementing an A&F intervention, to determine the implementation strategies that were used by staff and to specify the mechanism of action of those implementation strategies using causal pathway models, with the ultimate goal of improving acute stroke treatment practices. METHODS: We selected an A&F strategy in a hospital, initially based on implementation determinants and staff consideration of their performance on acute stroke treatment measures. After 7 months of A&F, we conducted semi-structured interviews of hospital providers and administrative staff to understand how it contributed to implementing guideline-concordant acute stroke treatment (medication named tissue plasminogen activator). We coded the interviews to identify the implementation strategies that staff used following A&F and to assess their mechanisms of action. RESULTS: We identified five implementation strategies that staff used following the feedback intervention. These included (1) creating folders containing the acute stroke treatment protocol for the emergency department, (2) educating providers about the protocol for acute stroke, (3) obtaining computed tomography imaging of stroke patients immediately upon emergency department arrival, (4) increasing access to acute stroke medical treatment in the emergency department, and (5) providing additional staff support for implementation of the protocol in the emergency department. We identified enablement, training, and environmental restructuring as mechanisms of action through which the implementation strategies acted to improve guideline-concordant and timely acute stroke treatment. CONCLUSIONS: A&F of a hospital’s acute stroke treatment practices generated additional implementation strategies that acted through various mechanisms of action. Future studies should focus on how initial implementation strategies can be amplified through internal mechanisms.