IDRC-PAHO Round Table on Use of Research Results Knowledge Translation: The Difficult Road from Theory to Policy and Practice in the Americas Patricia Pittman IDRC-PAHO Round Table on Use of Research Results in Policy Decision-making, Formulation and Implementation 11th World Congress on Public Health August 22, 2006

Four parts: Brief review of KT theories What do we know about what works? List some of the models currently being applied in the Americas Describe one: AHRQ –AcademyHealth Learning Networks

A Succession (or Accumulation?) of Theoretical Paradigms: Discrete Event: Linear problems solving- rationale model-sales. Diffusion of Innovation (Rogers): Framed as process of social change, learning from peers with early adopters leading. Decision making as a continuum as reduction of uncertainty. Still assumes linear sequence of innovation, dissemination and implementation Interaction and linkages: Closer look at epistemology and situates research as part of social process Influence of Complex Adaptive Theory (knowledge is not a thing, but an active process of relating- shared learning).

If all three co-exist…. What do we know about what works? Landry, Lamari & Amara, 2000 (over 800 Canadian gov DMs): Engineering: Scholarly as likely to be used as applied research! Theoretical and quali less, quanti more likely. Organizational factors: Structure, size, policy domain not important, relevance to work was. Individual factors: Education yes, position no. Two communities: Yes, tailor results for users (push.), build capacity for use (pull) Linkage: Yes, opportunities for interaction, trust.

Implications for policy Clearly not a problem of individuals’ attitudes, and it can not be prescribed. So policies should focus on processes and mechanisms for interaction. From an organizational (funder) viewpoint, therefore, the issue becomes one of MANAGING KNOWLEDGE ASSETS – or the conversion of individuals’ knowledge into forms that can be “transferred” to a larger group.

Current models in the Americas include: Collaboratives: IHI Berwick, Wagner’s Chronic Care (www.ihi.org) Knowledge Brokers (“gardeners”): CHSRF Push: IDRC Policy briefs Pull: CHSRF EXTRA Allied Research: Research for Social Protection in Health Program (PAHO IDRC) ARHQ/AcademyHealth: Learning Networks and communities of practice

Why did we choose Learning Networks? Create a fertile breeding ground that researchers can visit. How? By fostering new dynamics among individuals and organizations that share daily challenges and interests, but would not otherwise have the opportunity to come together to learn…. Go beyond the two-way interaction, tap into shared learning among peers.

TYPES OF LNs PRACTICE BASED associated with a job function and related knowledge domain, less structured. TASK/PROBLEM BASED implementation focused, temporary, but highly structured and some hierarchy. RESEARCH KNOWLEDGE BASED, with credentials and research contributions defining identity, long term. Not a KT strategy.

AHRQ- AcademyHealth Examples Practice: Medicaid Medical Directors Task: Quality Based Purchasing Quick lessons: Bring together people that have a natural affinity - similarly situated in their organizations and are seeking to expand/increase their role. Avoid having two identities- in this case public and private sectors.

What markers of success are we looking for? Competed: get beyond partisan and bureaucratic networks of relationships. Captured knowledge “assets” as they are produced, and further share them. Moved beyond face to face communication, with formal web-based (blog) and off-line communication. Spin-off relationships and activities arisen Self-sustained??

Final thought: Who convenes matters Legitimate neutral convener: “science partner” Funding : two staff to nurture the process, organize meetings, create web-based resources, formalize timeline, lead formative evaluations.