Mike Walsh

Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review

AIM This paper presents the results of a review of literature relating to knowledge transfer and exchange in healthcare. BACKGROUND Treatment, planning and policy decisions in contemporary nursing and healthcare should be based on sound evidence wherever possible, but research knowledge remains generally underused. Knowledge transfer and exchange initiatives aim to facilitate the accessibility, application and production of evidence and may provide solutions to this challenge. This review was conducted to help inform the design and implementation of knowledge transfer and exchange activities for a large healthcare organization. DATA SOURCES Databases: ASSIA, Business Source Premier, CINAHL, PsychInfo, Medline and the Cochrane Database of Systematic Reviews. REVIEW METHODS An integrative literature review was carried out including an extensive literature search. English language systematic reviews, literature reviews, primary quantitative and qualitative papers and grey literature of high relevance evaluating, describing or discussing knowledge transfer or exchange activities in healthcare were included for review (January 1990-September 2009). FINDINGS Thirty-three papers were reviewed (four systematic reviews, nine literature reviews, one environmental scan, nine empirical studies and ten case studies). CONCLUSION Robust research into knowledge transfer and exchange in healthcare is limited. Analysis of a wide range of evidence indicates a number of commonly featured characteristics but further evaluation of these activities would benefit their application in facilitating evidence-based practice in nursing.

Systemic evaluation: a participative, multi-method approach

This paper presents some new ideas on systemic evaluation developed in the context of a project to support capacity building for the evaluation of community health services. Emphases are placed on the need for stakeholder participation; dialogue on the boundaries of evaluations; considering multiple values; and ensuring that marginalized people and issues are properly accounted for. Further developing the work of previous authors, three different approaches to evaluation are outlined, each of which can be applied participatively: goal-based (where goals are set and their achievement is measured); stakeholder (where there are no pre-set goals, and different peoples experiences and stories are surveyed to reveal significant issues); and organizational (where organizational processes are compared with models of good practice). There is a logical relationship between these: a stakeholder evaluation can lead to the setting of community-sensitive goals, the achievement of which can be measured through goal-based evaluation, and pursuit of the goals can be enhanced by organizational evaluation. A participative, flexible and responsive evaluation practice will often need to draw upon aspects of all three approaches. Initial feedback from health practitioners suggests that this way of thinking about systemic evaluation may prove useful in a range of situations faced by people in the statutory, voluntary and community sectors.

Improving health care through community OR

Two examples of Community OR (COR) applied to public and patient involvement in improving health services in the UK are described—the Hull and East Riding Impact project and Trailblazers. These projects are consumer controlled but professionally facilitated. The team members have or have had mental illnesses but are committed to improving mental health services by applying COR methods. These projects illustrate how COR can contribute to the improvement of health services by enabling service users to take the lead in facilitating multi-stakeholder planning and problem solving. The Impact team produced a tool based around Ulrichs critical heuristics and have used this in several successful consultations in the NHS. The Trailblazer project used an idealized planning approach in a novel way to produce a distance method of consultation aimed at enabling stakeholders to negotiate commitments to action. Longer-term evaluation of these approaches is planned.

Action Research—a Necessary Complement to Traditional Health Science?

There is continuing interest in action research in health care. This is despite action researchers facing major problems getting support for their projects from mainstream sources of R&D funds partly because its validity is disputed and partly because it is difficult to predict or evaluate and is therefore seen as risky. In contrast traditional health science dominates and relies on compliance with strictly defined scientific method and rules of accountability. Critics of scientific health care have highlighted many problems including a perpetual quality gap between what is publicly expected and what is deliverable in the face of rising costs and the cultural variability of scientific medicine. Political demand to close the quality gap led to what can be seen as an elitist reform of policy on UK health research by concentrating more resources on better fewer centres and this may also have reduced support for action research. However, incompetent, unethical or criminal clinical practice in the UK has shifted policy towards greater patient and public involvement in health care and research. This highlights complementarity between health science and action research because action research can, as UK health policy requires, involve patients and public in priority setting, defining research outcomes, selecting research methodology, patient recruitment, and interpretation of findings and dissemination of results. However action research will remain marginalised unless either scientific research is transformed generally into a more reflective cycle or there is increased representation of action research enthusiasts within the establishment of health R&D or current peer review and public accountability arrangements are modified. None of these seem likely at this time. The case for complementarity is illustrated with two case studies.

Enabling integrated knowledge acquisition and management in health care teams

Basing treatment, policy and planning decisions on the best available research knowledge remains a central principle in modern health care around the world, yet many health professionals find acquiring and managing published research knowledge challenging. In this paper, we report on a Soft Systems Methodology-based collaborative action research initiative with a specialist mental health service from the United Kingdoms National Health Service. Our objective was to design and implement improvements to their knowledge acquisition and management activities in order to facilitate sustained and effective evidence-based practices. We report on both the factors found to impede effective research knowledge acquisition and management and the development of more integrated knowledge management processes designed to improve the situation.

Services for children with developmental co-ordination disorder: an evaluation against best practice principles

Abstract Purpose: The National Health Service in Scotland published a best practice framework to support occupational therapists and physiotherapists to deliver effective services for children with developmental co-ordination disorder (DCD); however, adherence is variable. To highlight areas for development, this study compared the care pathway within a paediatric DCD service against the NHS Scotland framework. Methods: A partnership of researchers and clinicians based in the United Kingdom conducted a qualitative study with 37 participants (N = 13 interview participants, N = 24 workshop participants). In-depth interviews and/or workshops were used to map the DCD service against the NHS framework. Identified gaps were aligned with four key stages of the care pathway. Qualitative analysis software was used to analyse the data. Results: Core principles to guide future development were identified for each phase of the pathway. These core principles related to the NHS framework and focused on issues such as involving the family, defining clear pathways and enhancing children’s participation. Participants identified potential strategies for service improvement such as developing community-based interventions and information provision. Conclusion: Challenges when providing services for children with DCD include confusing service pathways and poor partnership working. It is, therefore, important that clinicians utilise collaborative working strategies that support children’s participation. Implications for Rehabilitation There are numerous challenges related to the implementation of best practice principles into the provision of therapy services for children with developmental coordination disorder (DCD). It is important that AHPs seek ways of engaging parents and educational professionals at all stages of the care pathway in order to ensure optimum service provision for the child. Addressing participation is an important aspect and community-based strategies may be particularly beneficial, both as a preventative activity and as an intervention approach.

Towards a new paradigm of healthcare: Addressing challenges to professional identities through Community Operational Research

Abstract Healthcare worldwide faces severe quality and cost issues, and the search for sustainability in healthcare establishes a grand challenge. Public interest is growing in a systemic re-conceptualising of healthcare, from primarily a consumerist problem of individual need for treatment to a need for communities themselves to become more effective in systemic prevention, coping and caring. In community led approaches, scarce resources are moved away from ever-increasing consumerist services to empower, develop and enable communities to plan their own health and community improvements in mutually interdependent patterns of care often seen as ‘co-production’. This approach is exemplified by the innovative NUKA system of community led healthcare which originated in Alaska and which was trialled in Scotland in 2012, where it did not achieve similar acclaim as in the United States. In the Scottish NUKA trial opposition from professionals meant the trial was ended early. Our research found that omitting to account for the strong professional identity of GPs and other practice staff was instrumental in the failure of the trial. Beyond deficiencies inadequately considering professional identities, the trial also failed to engage the community and its patients as owners and architects of the system. We argue that the root cause of these problems was a more general critical systemic failure to manage participatory boundaries and associated identities. Community Operational Research practitioners have developed relevant theories, methodologies and methods to address issues of participation and identity, so could make a significant contribution to opening up new solutions for community led healthcare.

Vocational rehabilitation: Facilitating evidence based practice through participatory action research

Background Improving vocational rehabilitation in line with the current evidence base is an area of considerable interest. Aims To describe the strategies used by a multidisciplinary team in the initial stages of a participatory action research (PAR) approach to improving a vocational rehabilitation service. Method A literature review and PAR process were completed. One hundred and fifteen participants engaged in multifaceted data collection and analysis, building consensus around key principles for a new vocational rehabilitation service. Results A synthesis of our literature review and PAR process was developed into a set of principles for practice which we plan to implement across the service. Conclusions We have developed methodologies in interdisciplinary collaborations spanning statutory and non-statutory services. We have developed a set of principles for practice and detailed plans for implementation are being drawn up to inform provision in the future.

Designing a recovery-orientated system of care: A community operational research perspective

Abstract Theory suggests health focused Community Operational Research (COR) projects and their participants can benefit from balancing a “glass half empty” concern for deficits, problems and weaknesses with a “glass half full” concern for identifying health assets and bringing them into use. We present a COR systemic intervention in the care of persons with addiction and substance use/ misuse problems in Clydeplace, Scotland (anonymised). Our research reveals how the Whole Person Recovery System is situated within a wider General Community Recovery System that offers a variety of health assets that can be mobilised to create and increase recovery capital. The project involved 20 semi-structured interviews, two asset mapping workshops, a certificated “health issues” course completed by seven “champions”, and action planning and implementation. In the interviews participants found gaps were more easily identified than assets. During the workshops participants identified 388 discrete assets and gaps, prioritised these using a simple voting system and developed a series of actions to mobilise health assets including bringing into use local facilities and amenities and involving a number of individuals and groups in local events and activities. Our study suggests that even in the impoverished system of Clydeplace, a “Community Catalyst” in the form of a Community Operational Researcher can act to stimulate the co-development of health assets, build relationships and enable the creation of social capital. It is not clear though when such systems become “self-catalysing.”

ACHIEVE - active in children's health: integrating evidence, valuing experience

The article discusses a study to develop a comprehensive procedure for continued assessment of children aged between of 0-18 years with attention deficit hyperactivity disorder (ADHD). The authors have designed a pathway incorporating 6 key performance indicators (KPIs) including a standardized classroom observation schedule, structured and equitable training opportunities and access to paediatric and Child and Adolescent Mental Health Services (CAMHS) occupational therapy where appropriate.