Building Clinicians’ Capability in Translating Knowledge for Practice Improvement
By Sharon Mickan, Professor of Healthcare Innovation, Faculty of Health Sciences and Medicine, Bond University
Bond University is an Australian private university that has built a reputation for a personalised student experience. In 2020, a new suite of Healthcare Innovations Programs (1) was launched to develop post-graduates’ abilities to navigate research evidence, critically evaluate health systems and practices, and utilise data and technology to identify opportunities for sustainable innovations. Professor Sharon Mickan has developed a new core 12 week subject “Knowledge Translation and Quality in Healthcare” (2) in a blended learning format.
Guiding the Knowledge Translation Curriculum: The Knowledge to Action Framework
The Knowledge to Action framework (3) was used to underpin the whole subject. Ten self-directed online learning modules were developed to guide learners around the 7 phases of the Knowledge to Action framework, using a range of written, visual and video resources. Local research and project examples were used to illustrate each module alongside published examples from The MOVE Program (4) in Canada. Learners were facilitated to apply their learning concurrently using their own knowledge translation project. The 3 pieces of assessment encouraged this process and provided formative feedback towards the final assessment, a protocol to implement an evidence-informed intervention.
Applying knowledge translation theories, models, and frameworks in healthcare
The subject opened with a critical exploration of quality improvement in healthcare. Quality improvement processes were recognised as key monitoring and evaluation strategies, that together with external accreditation drivers, promoted high quality health systems and services. Their limitations in generating sustainable change were discussed in relation to inconsistent use of theory and sporadic use of research evidence. However, the outcome of safe and effective healthcare was highlighted as important for both quality improvement and knowledge translation projects. While both use a series of processes to investigate current practice and propose improvement, it was emphasised that knowledge translation utilises research evidence to frame the original problem and a theory of change (and research evidence) to guide every step of the problem solving process. Consequently, the Knowledge to Action framework was introduced as a research infused quality improvement cycle! Throughout this subject, it was acknowledged that additional theories and frameworks were required to complement the Knowledge to Action framework.
By week 3, learners were facilitated to identify a knowledge practice gap, where research evidence was not being consistently applied in their local practice. Instead of jumping to a problem solving conclusion, they were guided to summarise a research translation aim, to describe the research evidence they wanted to apply. In the 2nd phase of ‘adapting knowledge to local context’, learners were asked to analyse individuals’ behaviour change. This enabled them to refine a clinical improvement aim to describe what should be happening, by whom, how often and where. This clarification of who will benefit from the clinical improvement helped learners identify key stakeholders to work with.
Learners were prompted to engage with key stakeholders and analyse their comparative power and interest while also investigating the 3rd phase of ‘assessing barriers and facilitators to knowledge use’. To better understand behaviour, learners were directed to the dynamic work of the Centre for Behaviour Change (5); specifically the COM-B system (6) which explains the necessity of capability, opportunity and motivation, and the Theoretical Domains Framework (TDF) (7) which identifies 14 determinants of behaviour change. The local context shaped learners’ choice of these behavioural tools. While some used the TDF to analyse behavioural drivers underpinning local barriers and facilitators, others used the COM-B system to map and prioritise behavioural determinants.
For the 4th phase of ‘select, tailor, implement interventions’, learners continued their behavioural analysis to design implementation strategies that could address the key behavioural determinants. They were introduced to a range of contemporary implementation science frameworks, which were applied with key stakeholders, to evaluate local organisational readiness and tailor suitable implementation strategies. The Consolidated Framework for Implementation Research (CFIR) (8) and the Promoting Action on Research Implementation in Health Services Framework (PARiHS) (9) were commonly utilised to better understand implementation within complex, interacting and multi-level systems.
To prepare for the 5th ‘monitor knowledge use’ and 6th ‘evaluate outcomes’ phases, learners were encouraged to collaboratively build a logic model to identify suitable measurement tools and strategies for key stakeholders to monitor their implementation strategies. This helped to distinguish implementation outcomes from treatment effectiveness and facilitated the inclusion of user/client and service outcomes (10) across short, medium and long term time frames. Both the monitoring plan and the evaluation of the original evidence-based intervention were integrated together to guide progress towards the final phase ‘sustain knowledge use’.
During this 12 week subject, busy clinicians were facilitated to use knowledge translation theories and frameworks to better understand their local context and stakeholders. From the identification of a knowledge practice gap, they designed implementation strategies to support an evidence-based intervention in their own workplace. Ultimately, this practice improvement was explained and situated in relation to existing research, and it can further progress knowledge and understanding of innovative clinical improvements.
References
https://bond.edu.au/subject/hper71-112-knowledge-translation-and-quality-healthcare
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0605-9
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0398-2
https://link.springer.com/content/pdf/10.1007/s10488-010-0319-7.pdf
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