Knowledge Translation & the Systems Problem

Serendipity is a funny thing. Finding two or three themes that coalesce suggests to me that a blog post is necessary to bring them together.

This week the Canadian Public Health Association conference wrapped up in Toronto. Between the pre-conference workshops and the post-conference catch-up on email, Tweets and other media posts it was a week filled with concurrent themes:

1. Time Crunch: Too much to do and not enough time to do it for most people
2. Information Management: How to manage all the different media messages as a prosumer (a creator and consumer of content)
3. Knowledge translation: How to get the message to ‘stick’ and take our best knowledge and put it into action.

These are all different facets of a larger problem besetting those of us in the health professions and knowledge work trying to engage the public and peers using new media. In nearly all of the conversations and presentations I was a part of or witnesses, the question came down to this:

“How can we make it all work?”

The first point, which was discussed in a previous post, seems to be a growing issue that has been a continuation of a theme my entire adult life: people are busier than ever and the demands keep growing. What makes the current context different isn’t that the changes in technology are making this worse (because that’s always been the case), but rather that the rate of change is so fast.

My grandparents lived through the introduction of radio, TV and then the VCR as the major information technologies they had to deal with (computers existed, but they never used them or cared to). My parents have lived through those plus the computer, mobile phones, GPS systems, DVDs, and now PVR added to HD TV. They use email and surf webpages and My Mom recently got a Kobo ereader and loves it, but that might be the most high-tech entree that they engage in for the next while (unless someone can come up with a really good Sodoku system for my Dad).

Me? Add all of these and Skype, Twitter, Facebook, Blackberries/iPhones/Smartphones, Foursquare and the myriad cloud computing tools out there to my list. On a daily basis I probably read 100 blog posts, get more than 500 Twitter updates, see about 50 Facebook posts, receive 100 emails, and receive a myriad other number of Skype, GChat, Buzz, and BBM messages and voice mails. And that’s just correspondence and ‘keeping in touch’. I also have about a dozen books on my ‘about to read’ list and usually keep a pile of research articles I need to keep up with. At some point, this system of mine is about to break.

And then there is the physical world. My wife, my neighbors, my research team and other colleagues in addition to the people I meet on the street, in meetings, and who serve me at the local Starbucks.

I wish I was unique in this, but the truth is that a lot of people in academia, knowledge work, or the health system are in the same boat. Yet, we expect to reach these people so that they become better at what they do.

The conditions in which knowledge is shared is only part of the equation.

I recall a conversation with a colleague responsible for continuing education at a local hospital who told me about her challenge of keeping things interesting for the staff she trains. She does most of her training at 7am when there is a shift overlap. This means her audience is either exhausted from a 12 or 24 hour shift or half-asleep because they just woke up and have a shift ahead. As we talked, she laughed about how ludicrous the whole thing was. No matter how compelling the information is or how dynamic the presenter is, little will overcome this system design and its influence on learning. Yet, we accept it for what it is and try to envision clever ways to overcome these ‘inconvenient’ structural issues.

Same goes with social media. We expect to translate knowledge to busy people through tweets, Facebook posts, reports, and ads and yet fail to consider the context in which these messages are viewed. If there is too much going in, not much is really being translated.

It is with some irony that if the community we wish to reach is too busy or their information ecology too grand, then the effort required to translate anything will be far greater, putting more stress on those with the knowledge and adding to their ‘to do’ list. Take this further and you can see that we are in a race to the bottom.

And yet, that is what many seem prepared to do because no one – no one – I spoke with about these matters was prepared to do anything with the elephant in the room (that being the current information/work context). There was some begrudging acknowledgment, but otherwise a passive acceptance that workloads are high and the information landscape is vast, but that these factors can be overcome with the “right” strategy.

Too many cling to is this idea that if we just get the message right, time it perfectly, get buy-in from the end users (and maybe create a message with them), and use the appropriate medium, we’ll achieve knowledge translation. To that, I am reminded of Russell Ackoff’s statement about doing the “wrong things righter” . In this case, these are ‘right’ things, but without a system that supports integration capacity, it is just an exercise in looking good.

Knowledge translation scholars and practitioners have made enormous strides in acknowledging the power of integrated activities, marketing theory and practice, and getting beyond simply pushing content at people, but working with people in exchange relationships. The next critical skill they need to master is systems thinking and related action if any of those other great skills are to have meaning.

3 thoughts on “Knowledge Translation & the Systems Problem”

  1. Humans. We are so predictable. It is second nature for many of us to leave things in our daily lives to the last minute then wonder why the world has such huge economical, environmental and health catastrophes looming.

    I once had a friend who was chronically late for everything (she was fired from 9 jobs). She was also a strong advocate for extreme, bordering on militant, regulations to reduce global warming. One day I said to her, “You can’t manage to meet me on time for a coffee give minutes away from where you live yet you expect everyone to change behaviour and habits they have engaged in their entire lives”. This gave her pause. She was, however, still late the next time we met, which was the last 😉

  2. Cameron:

    In one of our podcasts, Bill Novelli talks about his experience with starting up the Campaign for Tobacco-Free Kids. With his savvy, contacts, and organizing skills, it quickly became a major player in anti-tobacco education, and it will far outlive his departure for academia. But, he pointed out that for any seemingly intractable public health problem, like tobacco use, the key is sustainability. CFTFK is 15 years old, and they’ve barely started making a dent.

    You talk above about the power of integrated activities, marketing theory and practice, getting beyond simply pushing content at people, working with people in exchange relationships. It sounds like if we work hard and smart enough, we’ll refine these activities down to the fabled silver bullet. Still won’t be enough if you don’t have the energy, personnel and budget to fire the silver bullet over and over and over at the target. Whether your opponent is Big Tobacco, or just human nature, the single silver bullet is never enough.

    1. Rick,

      Thanks as always for your comments. The point about energy and the size of your opponent are critical to note. Big Tobacco (or any of the well-funded ‘Bigs’) will have an obvious advantage of being able to do what they want in a manner that brings a weight of resources that simply can’t be matched pound-for-pound by a decentralized band of poorly financed and supported health promoters.

      That said, the economies of scale that the ‘Bigs’ have is also a weakness in that it brings an inherent bias towards strategies that use their size to their advantage and this takes them away from the kind of relationship-based strategies that fit social media.

      There are some examples of where the Bigs can do both, but they are rare. Big Pharma’s use of local reps who visit doctors, take them for lunch, and invite them to the odd golf game (where permitted) works because it builds on relationships. And because it works, companies invest money into it.

      In healthcare and public health, there is greater reluctance to invest the kind of resources into this kind of person-to-person, relationship based strategies that link people outside of ‘problems’ to where they are in their daily lives. Primary care is perhaps the only place where this is considered standard practice, which is why it is not surprising that they, as a group, are great at sharing knowledge. But even they aren’t funded to do that.

      In my mind, it comes down to a real shift in Mindset and transformation in the way we understand the system(s) we work in otherwise we risk doing what business scholar Russell Ackoff called “doing the wrong things righter” . I think NOT investing in these kind of strategies is this kind of thing.

      Big Pharma gets it. Big Tobacco gets it too if you look at past practices and what they are doing abroad (but no longer allowed to do it). It’s true they have the capital to do it easily, but building relationships around a topic that is inherently of interest to people (health) is a lot easier and cheaper than selling a commercial product.

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