Susan de Jersey, Senior Dietitian QUT
The recent Knowledge Translation course presented by AusHSI hosted 50 clinicians and academics who are passionate about implementing evidence based practice into front line health services. The wide range of disciplines included nursing, midwifery, occupational therapy, dietetics, pharmacy, and consumer representatives.
This background diversity provided a rich fabric for cross fertilisation of ideas, opportunities for flexibility in thinking and brought a true picture of the diversity in views that need to be considered when hoping to translate evidence- based change to a service area.
It is true that even a very small change can affect many and often in ways it was not intended.
I am an early career clinician researcher with what I consider a fairly sound understanding of implementation science, the dominant frameworks and theories and at least some implementation experience. I was hoping for some pearls of wisdom about how to evaluate the process of implementing innovation into practice rather than evaluating innovation itself. While this area was touched on in the formal program, the ample opportunity for networking and discussing ideas at breaks and at the course dinner I was able discuss this aspect of implementation science deeply with presenters.
The course program over two and a half days integrated seminar presentations with opportunities for discussion and group activities.
Take home messages included:
- Knowledge translation is an active process that is based on facilitation of innovation.
- It is important to actually define what successful implementation looks like. I know I have high expectations and often want perfection when it comes to introducing change into practice. However, tailoring the innovation to the local context may be more realistic in a ’real world’ setting and still represent an improvement to care.
- Successful implementation requires consideration not only of the characteristics of the innovation or practice change but a thorough understanding of the local and wider context in which the change is to occur and examination and engagement with the people who will be involved in or impacted by the change.
- The art of facilitation is central to successful implementation and not everyone has the skills to be a good facilitator.
- Engaging stakeholders and shared decision making through skilled facilitation is essential to successful implementation
- Implementation Failure is not necessarily failure if we can identify why it did not work and learn from this.
Course discussion often focussed on finding solutions to the everyday challenges we face when implementing change. However there was a common theme of frustration in often not having sufficient funding to plan the implementation, facilitate change and evaluate outcomes when implementing complex interventions as this process is not well understood or valued by decision makers.
The final session on day three brought out the sharks.
The culmination of the course was an opportunity to present 6 projects to three Sharks; Queensland Clinical Senate Chair David Rosengren, RBWH Executive Director Dr Amanda Dines, and Queensland Health’s Deputy Director General of Clinical Excellence Dr John Wakefield.
Robust and honest discussion ensued for what were hotly contested imaginary dollars.
I initially walked away with a sense of frustration at the realisation that evidence and cost effectiveness are often not the top consideration in funding decisions but rather personal bias and other agendas are highly influential. However, these characteristics are ever present in the workplaces that we seek to implement change.
While we would ideally wish for bias to be left at the door, the role of facilitation is to seek to understand these biases and agendas, work towards a shared understanding and find a beneficial solution that allows passage of evidence to informed service delivery. And thus is the subtle (or not so) art of knowledge translation.
As more and more clinicians and management are armed with the skills in knowledge translation we can advocate for the importance and value of appropriate facilitation and demand decisions about health care are evidence based.