Graeme on knowledge mobilisation

Graeme Currie: I’m Graeme Currie, a Professor of Public Management from Warwick Business School. My research expertise lies with healthcare organisation and management. Issues such as strategy, leadership innovation, knowledge mobilisation and workforce development. Today I’m going to talk to you about knowledge mobilisation. I’m particularly interested in translating evidence into practice. In the healthcare system we spend billions of pounds, billions of dollars upon generating knowledge about what works clinically. But it’s slow to translate into practice. So it seems to be a poor investment.

However what we’ve seen in countries such as the UK where I’m from and other countries such as Canada, the US and Netherlands, is increasing investment to support the translation of evidence into practice to address what’s called the translational health research problem. In essence, what we’re doing here is trying to move from what we know, the evidence, to what we do i.e. clinical and other type of evidence into clinical practice. Now from a business school point of view, I work in a business school, that’s a problem of knowledge mobilisation. Now that’s an interesting word knowledge mobilisation.

You may be more familiar with terms such as: knowledge transfer or knowledge exchange. The idea behind knowledge mobilisation, it’s a deliberate change in the use of the term. Because it’s a very dynamic process. It’s not just transferring from person A, the academic, to Person B, the clinical practitioner. It’s a very complex process. And clinical practice and academia need to work together to help translate evidence into practice. Hence the term knowledge mobilisation. Now one of the things we’ve done in the UK is report hundreds of millions of pounds investment into something called translational health research interventions, such as academic health science centres and something I’m going to talk about today called CLAHRCs. C.L.A.H.R.C.s, the acronym,

and it does what it says on the tin: the Collaborations for Leadership in Applied Health Research and Care. Collaborations between academic institutions and healthcare and social care practice, to build up leadership capacity to get evidence into practice and it’s applied health research, so it’s not blue skies research it’s applied to the case of long term conditions. And it’s care, the last letter of the acronym, care, so very much emphasising that it’s not just doing the research, but it needs to have a care outcome. Now CLAHRCs have been funded for two periods of five years in the United Kingdom by a body called the National Institute for Health Research. And recently they’ve enjoyed a third wave of funding but being..

they’ve been renamed as ARCs. Why the name change? Because in the UK as in many other countries we recognise that healthcare has an interdependence with other domains of care, particularly social care and public health. Hence the renaming. Now CLAHRCs, most CLAHRCs were predicated on what we call a knowledge brokering model. So what happened with the CLAHRCs I’ve been involved with, in the East Midlands and the West Midlands of England, is we’ve drawn clinical practitioners into the research as knowledge brokers. They work into our research to co-produce the research, help us analyse the findings and then help but push the research out into practice.

Now knowledge broker is a very specific conceptual term, a knowledge broker gets the right knowledge to the right people, in the right place at the right time. It very much reflects a push model of knowledge mobilisation where we’re doing the research together and then we’re pushing it into practice. Now in CLAHRC West Midlands we had around 30 or 40 knowledge brokers for a population let’s say of around 6 or 7 million in the region that we covered. You can imagine that 30 knowledge brokers in that size system are a mere ripple in the pond. They have an effect but it tends to be a local effect.

And one of the big problems we face with evidence based innovation is moving from local implementation to scaling it up regionally and nationally where we’ve assessed that it’s effective. So knowledge brokers we might see as necessary and helpful but they’re insufficient. What we need to do is not just push knowledge out through knowledge brokers but enhance the capacity of the system to pull knowledge in to the system to inform clinical and social care practice. Now from my point of view as an academic in a business school as an organisation scientist, that’s about the absorptive capacity of the health and social care system and the constituent organisations within that system.

An absorptive capacity is what it says on the tin, it’s the capacity of a system and its constituent organisations to absorb knowledge to inform practice. And then scale up that practice. And what that relies on, the enhancement of it relies on, is developing co-ordination capabilities in the system and in its constituent organisations. By coordination capabilities, what we mean are distribution of leadership, patient and public involvement so that this participation in decision making, more integrated knowledge management systems to bring data and other evidence together, workforce development where there’s boundary spanning roles for example, collaborative strategies so that we develop an integrated care system.

And if we develop our coordination capabilities, the system and its constituent organisation will enhance their absorptive capacity and not only will we implement evidence based innovation locally, but will scale it up. That’s a model upon which CLAHRCs and their successor ARCs rely. Have they been successful? Yes. We’ve addressed long term conditions in many domains. And accelerated, broadened and deepened the translation of evidence into practice. Of course we’ve learnt a lot. Personally as an organisational scientist in a business school I’m bringing something novel to a clinical science audience that they perhaps don’t understand. And we’ve had to work through our different perspectives. The more theoretical stance an organisational scientist tends to take and a preference for methods.

You know RCTs c are very rare in my world, whereas qualitative case study research is very prevalent and valued. Let’s hope we can work together; Australia, the UK, other countries for example. I’m involved in India doing this sort of thing.

And let’s get the effect that we all want: which is to improve our healthcare system. Enhance its capacity to draw down evidence to clinical and other practice, such as social care practice and make a difference to patient and other outcomes.