1 Building Capacity in Knowledge Translation: Module 1 Building Capacity in Knowledge Translation: Why it’s important and how to do it Melanie Barwick, PhD, CPsych Senior Scientist Child Health Evaluative Sciences, Research Institute Head, Child and Youth Mental Health Research Unit, Department of Psychiatry The Hospital for Sick Children Associate Professor Department of Psychiatry Dalla Lana School of Public Health University of Toronto, Canada "Strategic Initiatives for KT in Rehabilitation” 1st National Knowledge Translation Conference in Rehabilitation School of Physical & Occupational Therapy, McGill University May 5, 2016 (c) SickKids Hospital 2014
2 Module 1 You want a what? In (2000), CIHR was created by an act of Parliament with an explicit mandate to excel in “the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian Health System. In the years that followed, CIHR changed its funding opportunities in a very significant way. They funded CRC’s in KT, and developed specific FOA to encourage KT research. But also around this time, they began requesting a knowledge translation plan alongside the research proposal. If it were possible, we would have heard a collective gasp of despair across the country as researchers lamented about what that actually was and how to do it. (c) SickKids Hospital 2014
3 Drivers of Change KT is of critical importance to health research, as it has become clear that the creation of new knowledge often does not, on its own, lead to widespread implementation or impacts on health. From CIHR's perspective, accountability from the federal and provincial governments, as well as the public, makes it increasingly important to demonstrate the benefits of the investment of taxpayer dollars in health research by moving research into policy, programs and practice. With KT as a focus for our federal and provincial funders, we are compelled to ensure that we have both the capacity and the competencies to jump out of our own fishbowl to share what we know with knowledge users who swim in other contexts. This is the NEW scientific paradigm. In many ways, developments in Canada have led the way in terms of the current prominence of knowledge translation internationally. It has its roots in the evidence based medicine (EBM) “paradigm shift” started at McMaster University in Hamilton Ontario in 1992 with the Evidence Based Medicine Working Group). 1997 saw the creation of the Canadian Health Services Research Foundation (CHSRF), an organization devoted entirely to bringing researchers and decision makers together “to create and apply knowledge to improve health services for Canadians” The CHSRF (now the Canadian Foundation for Healthcare Improvement, was a main driver of knowledge translation in Canada, focused on health services organizations and health professions (especially nursing) in funding research and research trainees, facilitating research-decision maker workshops, and providing a collection of toolkits, bulletins, and reports supporting KT.
4 Implementation Science Funding WorldwideModule 1 Implementation Science Funding Worldwide Source: Tetroe et al., (2008). The Milbank Quarterly, 86(1), If we cast our eyes globally, we can see the vast interest in KT amongst health funders worldwide. Internationally, KT Implementation Research is a recognized area of funding within healthcare systems. In countries where there is a named, dedicated, funding stream (e.g., Canada, Australia) the research area has a higher profile with both researchers and with clinicians. (c) SickKids Hospital 2014
5 Health Research Funders’ Support & Promotion of KT InternationallyModule 1 Health Research Funders’ Support & Promotion of KT Internationally Source: Tetroe et al., (2008). The Milbank Quarterly, 86(1), Major health research funders now require explanations of how research results will be applicable to decision makers (e.g., clinical, health policy) and/or the inclusion of decision makers as part of research teams(Bowen and Graham, 2013; Goering, Ross, Jacobson and Butterill, 2010; Tetroe, Graham, Foy et al., 2008) in order to facilitate and expedite research utilization in practice. (c) SickKids Hospital 2014
6 KT is a Requirement for Many Research FundersModule 1 KT is a Requirement for Many Research Funders Measuring the returns from research is of growing importance to research funding organizations: They need to demonstrate the benefits arising from their expenditure which (for government agencies) is directly funded by the taxpayer They also need to build an evidence base to inform strategic decisions on how to fund research The last decade has seen significant changes in how funders are addressing the research to practice gap. This is the age of accountability, and there is a need to demonstrate the benefits arising from research dollars. This fundamentally changes how we do science and practice in healthcare, whether it be rehabilitation sciences, genetics, health services, or other areas of clinical research. (c) SickKids Hospital 2014
7 KT Defined (CIHR) While KT has been given many different labels, CIHR defines it as "a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system." This is by no means a simple process and involves a range of "interactions between researchers and knowledge users that may vary in intensity, complexity and level of engagement depending on the nature of the research and the findings as well as the needs of the particular knowledge user."i READ SLIDE In simple terms, I define KT as ensuring that people understand the evidence.
8 KT Activities are Guided by KT GoalsGenerate awareness & interest Share knowledge Inform research Inform decision making Generate practice change Generate policy change Generate public action (behavior change) Technology Transfer / Commercialization KT activities are underpinned by what I call KT GOALS The KT goals determine your KT activities – their purpose, if you will. We often ‘do’ KT by rote, rushing through it for the sake of time, or acting blindly by subscribing to the typical KT activities of our organization. Effective KT requires us to pause and reflect on what we want to share, with whom, and FOR WHAT PURPOSE. This is the essence of good communication.
9 Terms Related To Knowledge TranslationTransfer Transfer & Exchange Mobilization Brokering Knowledge Management Implementation science Technology Transfer (Commercialization) Translational Research (bench to bedside) Knowledge management - Many large companies, public institutions, and non-profit organisations have resources dedicated to internal KM efforts, often as a part of their business strategy, information technology, or human resource management departments.[6] Knowledge management efforts typically focus on organisational objectives such as improved performance, competitive advantage, innovation, the sharing of lessons learned, integration, and continuous improvement of the organisation.[7] KT is all of these things
10 Objectives For This TalkWhy building organizational and scientist KT capacity is relevant & important Capacity building strategies Capacity building resources & tools In my time with you this afternoon I’d like to turn you on to the importance and relevance of knowledge translation – For your own career, as a researcher and/or clinician For your organization For your academic institution I will also highlight for you what we, at SickKids, and what other organizations have done to build internal capacity for KT And introduce some new thinking for changes in academic promotion, based on the model that has been taking shape at the University of Toronto.
11 Drivers of KT Capacity BuildingImplicit Drivers Explicit Drivers To improve impact To improve reach To justify organizational KT investments To advance science and practice Action results from planning Often required by research funder May be required by academic institution To improve impact by reaching a broader group of knowledge users and doing so in thoughtful ways that attend to what they want to know, their preferences for receiving evidence, and the manner in which they will use the evidence. Research evidence is not just for other researchers. We know this implicitly, however, our traditional processes for how we conduct science and how we acknowledge and reward discovery and academic contribution and productivity is not structured to support this notion. To improve reach. Results will remain inactive with no impact if they sit unread in a journal. Organizations are making investments in KT and need to demonstrate their own ROI To advance science and practice and include a wide variety of knowledge users, researchers, decision makers in the process in a collaborative manner. Action emerges from planning; If we don’t plan for it, it won’t happen because it won’t figure in our research vision of what we hope to accomplish and contribute, and we won’t have sufficient resources after the project has been funded unless there are funds to cover KT activities and outputs. It’s a requirement for many research funders (proposal, CCV, final report). It’s can be a requirement for academic promotion and I will share some of what this looks like at my own institution, the University of Toronto. Lets take a closer look at each of these.
12 To Improve Impact Impact indicators have to tell you or show you that people knew what to do with the knowledge you shared If you don’t plan for impact early on, you may or may not get there You will certainly have a difficult time capturing your impact retrospectively Explicitly: you will likely be asked to demonstrate your impact Consider where you wish to have an impact? Research Programs/services Policy Health outcomes, well being Shape your KT according to these aims
13 To Improve Reach “Only 12% of medicine articles are not cited, compared to 82% for humanities, 27% for natural sciences and 32% for social sciences” (Lariviere & Gingras, These numbers are high and say nothing about who is able to access and/or read your paper KT efforts enable you to expand your reach to many relevant knowledge users using complimentary strategies How many people do you think will read your research paper or report? There were an estimated 25,400 active scholarly peer-reviewed journals in early 2009, collectively publishing 1.5 million articles a year; this number has grown Expanding your reach means reaching more people, but doing so using a range of strategies that map on to how they wish to receive information. This means expanding our teams to include people with this skill set, and working with those in our organizations that have this expertise – social media, communications, media.
14 To Justify Organizational KT InvestmentsCanadian Centre for Substance Abuse Cancer Care Ontario SickKids Hospital Bloorview Children’s Rehabilitation Hospital Parachute Gambling Research Exchange of Ontario Centre for Addiction and Mental Health Centre of Excellence for Child & Youth Mental Health Ontario Brain Institute Lung Association Hospitals Universities Health Authorities, Governments Research Funders Voluntary Sector organizations Non Governmental organizations A range of organizations have been hiring KT practitioners over the last 7 years Investments are being made that need to provide indicators of effectiveness This list is just a sample of organizations working in KT, and they reflect a range of organization types: hospitals, universities, health authorities and governments, research funders, voluntary health sector organizations, advocacy and intermediary organizations, and non governmental organizations (global health)
15 To Advance Science and PracticePeople need to find your research in order to read it Your research has to be clearly communicated so people understand it They need to be interested enough to read it when they do find it The main messages and implications need to be evident, relevant and actionable And, you need to track your impacts so you can report on them For research to advance science or clinical practice, key people need to know it’s there, how to find it, and what to make of it
16 Action Emerges From PlanningIf you don’t plan for it, it won’t happen (no direction) If you don’t plan for it, it can’t happen (no money) This goes without saying but worth repeating – if that makes sense ?! All good things start with intent, with a plan, with a ‘postcard destination’ And that plan reaches beyond what used to be the end game in research; the end of the project, the publication, the conference talk. These strategies are essential for academic work, yes, but they accomplish little in and of themselves.
17 Research Funder RequirementsCommon CV Proposal Final Report
18 Promotion RequirementsCPA Criteria, Faculty of Medicine, University of Toronto Professional Innovation and Creative Excellence Inventions, patents and licenses Developing new techniques Conceptual innovations Educational programs outside the University e.g., continuing education Patient education Contributions to the Development of Professional Practices Development & dissemination of an invention, technique, conceptual innovation, educational program, etc. Illustrative to students & peers Recognized by peers, emulated by others or impacted practice. Exemplary Professional Practice Leadership in the profession, professional organizations, government or regulatory agencies that has influenced standards and/or enhanced the effectiveness of the discipline. Guidelines & health policy development Consensus conference statements Regulatory Committees and setting of standards Professional Innovation and Creative Excellence Contributions to the Development of Professional Practices Exemplary Professional Practice
19 Successful knowledge translation means informing a range of knowledge users about our science, and getting what we know works to improve health and well-being into the hands of people who can apply it.
20 How Organizations are Building and Evaluating KT Capacity
21 SickKids Hospital KT ProgramKelly Warmington MSc, KT Manager Melanie Barwick PhD CPsych, Course Director Research & Evaluation Mentorship KT Stories SKTT (researchers) KTPC (practitioners) Tools
22 Ontario Ministry of Aboriginal Affairs Julia Lalande, Senior Policy AdvisorStumbling blocks for knowledge brokers in large organizations: Uniqueness and/or newness of the role Role is not clear Expectations beyond capacity of role Value of role is not immediately clear Time is ‘soaked up’ by activities that do not advance the role Clarify role with manager Set clear expectations/goals/focus and build in room for growth Create a strategic plan Communicate (and have your manager communicate) your role & contribution “You are an explorer not a tourist” If your position is relatively new there is still a lot of unchartered territory, so you may have to draw the map and chart the course It helps to connect with others and continuously update and upgrade Attach yourself to large-scale initiatives that could use KT expertise
23 Pathways to Education Konrad Glogowski, Ph. DPathways to Education Konrad Glogowski, Ph.D. Director, Research and Knowledge Mobilization Find the voices in your system Listen to learn Identify opportunities to add value Define your work and build a strong (business) case for it Build, but do not build alone Ensure that what you’re building adds value Don’t‘ always seek to think ‘big’ – smaller projects can add value too Find powerful friends: researchers, subject-matter experts, non-profit leaders, KT professionals, like-minded organizations – they can open a lot of doors Capture your impact
24 EENet, CAMH Heather Bullock, MSC Director of Knowledge ExchangeDO: Remind people of your mandate or you face scope creep DO: Help (outside of your mandate) where possible DO: Become a resource for others DO: Use resources from other KT shops DO: Use KT community to help educate your colleagues – sometimes external voice has more weight DO: Take advantage of the fact that people want to have better knowledge – KT can UNITE (bring people together, internally and externally) DO: Make friends in your organization – engage your communication department and others who might feel their toes are being stepped on DO: Take opportunities to publish and evaluate your work
25 KTPC Casebook: Building KT Friendly Organizations
26 KT Tools and Resources
27 Scientist KT Training Workshop (SKTT)™
28 Knowledge Translation Practitioner Certificate (KTPC)™
29 Knowledge Translation Planning Template (KTPT) ™
30 Knowledge Translation Planning Template™Assistance in formulating a KT Plan. Available as free download: Barwick, M. (2008, 2013). Knowledge Translation Planning Template. Ontario: The Hospital for Sick Children © 2008, 2013 The Hospital for Sick Children
31 To order your own KT GameSKTT Module 2 The KT Game™ To order your own KT Game (c) SickKids Hospital 2014
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37 Melanie Barwick, PhD,CPsych Senior Scientist, Child Health Evaluative Sciences, Research Institute Head, Child and Youth Mental Health Research Unit, Psychiatry The Hospital for Sick Children Associate Professor, Department of Psychiatry Associate Professor, Dalla Lana School of Public Health University of Toronto Web: twitter.com/MelanieBarwick WordPress: melaniebarwick.wordpress.com PH: Scientist Knowledge Translation Training course (SKTT) Knowledge Translation Professional Certificate (KTPC) http://tinyurl.com/7zrvbq4