Knowledge translation is about putting evidence into practice, but what about putting practices into place that support evidence creation and the people who are in charge of this? Until this missing link is addressed, our knowledge-practice gap will not shrink anytime soon.
Knowing is not enough; we must apply. Willing is not enough; we must do – Goethe
There is a widely held, mistaken belief that knowledge translation (KT) is all about knowledge. During my post doctoral work on KT and systems science I came to know just how strongly this view is held and how faulty it is in terms of practice. Spend time observing how people actually generate, share and take in knowledge and you’ll see that the actual content is a small part of the equation. Quality relationships, networks of people working together, and the right systems and environments in place to facilitate interaction of those people and ideas is what moves knowledge into action.
I was part of a review team that looked at the evidence for knowledge translation and how it fit within cancer communications and we found that much of what has been published focuses on content, not context. While good, appropriate and timely content is a necessary factor in KT, it is hardly sufficient if there are no people or environments where that knowledge can be appropriately contemplated, learned and applied. This is knowledge integration and it requires people and systems working together.
The systems part is tricky enough and has received growing attention over the past decade (see the linked paper above for a short history of knowledge-to-action research), but it is the human side that remains neglected. To make matters worse, it is our future leaders who are bearing the brunt of this lack of attention.
Consider three examples that presented themselves to me over the past week:
1. A young, bold, charismatic and clear communicator with all the skills, knowledge and enthusiasm and desire to be a knowledge broker who is working on the latest of a string of one-year contracts for different organizations. How is this person supposed to be effective at building relationships when she has to start over in a new role in a new organizational every 12 months?
2. A knowledge mobilizer who speaks highly of his team and role on an enthusiastic, dynamic project aimed at transforming academic knowledge into useful, usable, and accessible forms for policy makers and how he is going to miss it as his contract is up (because his part of the project was funded for just one year). What is going to happen to his knowledge when he leaves?
3. A knowledge generator and health promoter who brings a talent for engaging the community and building networks between disparate voices and groups contemplates what it means to be told in one breath that her work (and that of her team and their projects) is so highly valued and impactful and with the next breath that the project will not be funded again, because it is only a one-year initiative. Are those networks she helped create going to grow without someone paying attention to the whole and not just the parts?
These are not content issues, they are human resource issues and systems ones. All the wonderful research scientists do and the amazing innovations that clinicians introduce are not going to amount to anything lasting without someone to carry the torch and to pay attention to getting that knowledge into practice. The knowledge-to-action system is too complex, too fast moving, and attentional resources are too thin to expect that all this can be done on its own without some forethought and committed focus on KT.
And KT and the relationships necessary for true knowledge integration are not things that can be compartmentalized and squished into one year contracts.
What Allan Best, Bob Hiatt and the panel we worked with found (as have others) is that the content itself needs systems in place to do support its integration into practice. These are human systems and those are built on relationships, and relationships are contiguous, not arbitrary or episodic. Yet that is how we view these activities given the way we structure projects and roles for people working in KT.
We are starting to pay more attention to the way in which content is created now it is time to pay as much attention to how it is translated in real human terms and create the same kinds of supports for people that we try to do for content. Otherwise, the young leaders I profiled above will leave the system and take with them their enthusiasm, energy and, ironically, their knowledge leaving us with little more than a name (KT).
*** Photo “Thinker” by dirvish used under a Creative Commons License from Flickr