Category: knowledge translation

knowledge translationpublic healthresearchsystems thinking

Innovation and Academic Science

 

Innovation grants are a misnomer, signifying one of the greatest problems with academic science and the quest to create novel solutions to important problems. 

Yesterday the Canadian Cancer Society Research Institute (the research arm of the largest charitable agency that supports cancer programming in Canada) announced its new, revamped lineup of grant funded programs to be launched within the coming months. Among the first of these new programs is one called Innovation Grants (PDF)while another is called Impact Grants (PDF). In fact, both of these new program announcements include the definition of each of the key terms in their program call:

Innovation: The action of innovating; the introduction of novelties; the alteration of what is 
established by the introduction of new elements or forms.
-Oxford English Dictionary

and

Impact: the action of one object coming forcibly into contact with another; a marked effect or 
influence
-Oxford English Dictionary

This is impressive in how they can clearly and distinctly linked the definition of the word to the program call. Why? Because too often grant program calls and their expression in reality are too often separate. I once served on a grant panel that was looking at grants aimed at ensuring quality knowledge translation only to find that most reviewers were comfortable with things like “prepare academic manuscript based on research” and “present findings at major conference” to be acceptable knowledge translation goals by themselves. I was appalled.

Yet, I can’t help but think, despite the good intentions here, that these new programs are going to follow in similar footsteps. The problem is not the funder, but rather the way that funding is granted and the reliance on the system to change itself.

The innovation grants are designed to :

support unconventional concepts, approaches or methodologies to address problems in cancer research. Innovation projects will include elements of creativity, curiosity, 
investigation, exploration and opportunity. Successful projects may involve higher risk ideas, but will 
have the potential for “high reward”, i.e. to significantly impact our understanding of cancer and 
generate new possibilities to combat the disease by introducing novel ideas into use or practice

The mechanism by which these grants are to be decided are, as much as I can tell, by peer review. It is for that reason alone that we can feel some level of confidence that these grants will fail outright. Peer review is designed to judge the quality of content by what is and has been, not by what could be. “Innovation” is about doing things differently, often markedly so. Scientific panels are about supporting incrementalism, particularly in the social and behavioural sciences.

Innovation is also about risk and the potential for failure. These are two words that are highly problematic in present day academic science. Firstly, if you’re a junior scientist, you may be working desperately to fund yourself and your research (and research team). The price of failure is high. If you’re not able to publish meaningfully off your research, you will have a hard time getting your next grant and keeping yourself afloat. In public health sciences for example, CLTA (contract limited-term appointments) are dominant.

I should know as that’s the position I hold.

But the tenured faculty don’t have it much better. While they are more secure, their research teams, graduate student trainees who rely on projects to develop their skills, and the ability to develop coherent programs of research are at risk every time there is an unsuccessful grant. There are real opportunity costs to pursuing risky ventures so many don’t do it

As one who has tried to be innovative with his work and having the privilige (or curse, depending on the perspective) of having interests that have fallen into the innovation category (or “trendy” category to the cynic), I’ve seen how innovation is treated and it’s not good. Innovation programs tend to split committees. I’ve had too many comments returned to me that have some variant on “this is amazing, potentially leading edge research!” alongside “the use of non-conventional methods makes this suspect” or “I don’t understand what this is supposed to do“. As one who had to endure years of questions like “I don’t see how this Internet thing has anything to do with health” in the early days of the eHealth this kind of line of questioning is familiar to me.

I point this out not to gripe, but to illustrate how innovation can get treated in academia. When you get feedback like I described it is very hard to critically assess the true merits of the proposal for improvement. Did people not understand an idea because it could have been written more clearly or did they just not “get” the innovation? Were those who were excited just caught up in the “newness” or were they really in sync with my vision? As a scientist, I don’t know the answer and can’t improve because the feedback is so contradictory.

And because innovators often create, develop or define fields of inquiry or practice that does not exist or is in development there are few if any adequate and available reviewers with the appropriate background on the topic.

In academia, we rely on tradition, on evidence (which is part of tradition, what has been done before), not on strategic foresight and innovation to guide us. That is a problem in itself. Universities haven’t survived hundreds of years by being risky, they have because they were safe (in spite of the occasional radical shift here and there). With complex social problems and the challenges posed by things like cancer, something risky is needed because the traditional ways of doing things have either been exhausted or are no longer producing the necessary health gains. Academics just aren’t positioned to embrace this risk unless the system changes — with them helping drive that change — to support innovation and not just talk about it.

Until that happens, the opportunities to live up to the definition of innovation posed about to create the impact described above will be limited indeed.

 

complexityenvironmentinnovationknowledge translation

Creating Campires For Innovation and Knowledge Translation

Gather round

A campire has been a beacon for human life for centuries and may provide the ideal analogy and literal tool to engaging people in creating new things. The opportunities for it to shape our thinking and actions is enormous.

The campfire is a place where we go for warmth, intimacy, safety, light, food and inspiration. As camping season comes upon us in the Northern part of the Americas, it seems fitting to consider the ways that the campfire might be used to stoke the sparks of imagination and flames of passion (pun firmly intended).

Metaphors and analogies are commonly used in systems thinking and complexity science to illustrate concepts that are, on their own, relatively complex and awkward to describe literally. A campfire provides both a metaphor for bringing people together, but also a literal tool that could be used more effectively in work with groups struggling to innovate, collaborate and contemplate together. From a design perspective, campfires and the social system that they create around them provide an opportunity to enhance intimacy quickly, allowing for the potential to explore issues in ways that are more difficult to do in other settings.

Consider some of the following properties of the campfire.

Lighting has been found to have a strong environmental effect on many behaviours and moods, and the type of inconsistent light that is thrown by a campfire is similar to that which induces relaxation and intimacy (PDF).

It can be argued that storytelling has been our most powerful vehicle for sharing what we know throughout human history. Research on narrative effectiveness has found that emulating the environments created by a campfire (PDF), the close-in, small-group, open dialogue sharing kinds of spaces, leads to more effective communication in business contexts.

The sensory richness of a campfire — the smell of wood and smoke, the crackle, the sight of sparks and flame, the feeling of heat — all create an environment that differs from much of what we are used to, provoking psychophysiological stimulation that has been associated with learning outcomes. Research linking environmental design and architecture has explored the phenomenon of sensory richness and how modern designed environments reduce this and (potentially) limit learning.  (See program example here).

Another quality of a campfire is that it creates space for meditative inquiry. Anthropologists and psychologists have speculated that it was the campfire and the meditative rituals that it created that led modern humans to separate from Neanderthals. The  focus on something like a fire draws attention away from the chaos of the world and channels into a circle that is generated through the campfire.

One of the benefits of a campfire is the circle that it creates. Leadership scholar Meg Wheatley, Christina Baldwin and Ann Linnea reflected on their use of the circle and how it has been used historically as a means of creating a common space where participants are on more equal footing with one another as a means of leadership promotion. In a circle, everyone can (usually) see everyone else and no position is held as more important than others, which privileges all participants and not just some.

Lastly, the campfire creates not just internal peace, but social intimacy as well. Indeed,modern social media has been compared to the campfire (PDF) in its ability to potentially replicate the focused, shared space that a campfire occupied for much of human life. For the reasons listed above, the social media effect is likely limited, but nonetheless the metaphor may partly hold in light of a lack of alternatives.

In practice, lighting a chord of wood in the middle of an urban setting might be problematic, but it is worth considering for those of us looking to create those social spaces where people can gather. Taking a break and leaving town might be worth doing as well. Failing that, what are the campfire-like spaces that we can create with what we have.

Designers, health promoters or anyone seeking to bring together ideas while working in complex spaces may wish to give this more thought — or meditate on it, which might (as it has done before) spark a new evolutionary shift attributed to the campfire.

knowledge translationpublic health

Translating From Ideal Practice to Real Practice

It’s exciting to see what can be done for health when you run a study under ideal conditions, but rarely are those conditions present in everyday life. These ideal condition studies only work when they can inform practice in less-than-ideal conditions.

There is something exciting about seeing what happens when you have a study executed under nearly ideal conditions. When the staff are well-trained, the participants are compensated and looked after, and there is plenty of resources free to do the proper follow-ups. It is wonderful to see what can happen.

But I find this to be frustrating and, in some ways, bordering on unethical if the results are not translated appropriately. There are studies that clearly do not have the ability to be translated well. If you gave every student their own personal 24/7 tutor to help them through secondary school they might do amazingly well, but there is no school board anywhere that could adopt that model.

We still do the equivalent of that in health sciences. We load up projects that operate in a bubble to show what can be done with a lot of resources and then give recommendations like the need for “adequate resources” at the end of the written study.

Are we really advancing science when we do this or just creating a larger gap between evidence and practice?

 

knowledge translation

What If We Treated Knowledge Like We Did Wine?

Knowledge: Drink it up.

The similarities between good wine and good knowledge might be worth considering as one imagines the type, quantity and pairing issues in parallel with practice.

Imagine if we treated knowledge like wine in our work?

Consider the role of the sommelier in picking the right knowledge to go with the right circumstance (a pairing).

Recall what it is like to have something that was well-crafted and fits the mood (knowledge appropriateness).

Consider the consequences of having too much wine (information overload).

What about aging? Does the wine (or knowledge) need to be “fresh” and used quickly or does its value increase over a certain span of time?

When is the right time and how long should we wait to consume it?

Does this analogy fit and, if so, what does it mean for the way we approach generating knowledge and related products?

** Photo wine*empty glass by Naomi Ibuki used under Creative Commons License from Flickr

art & designinnovationknowledge translationpublic healthsocial systems

Trying to Innovate? Try Empathy

Let's imagine what its like to be each other

Designers often point to empathy and collaboration as two essential activities in their creation process with clients. It now appears that these two are more linked than it first appears.  
Collaboration is increasingly becoming among the most “essential” of terms for those working in public health or any other field related to wellbeing. This is for good reason given that much of the environment is which this field operates in involves complex problem solving. And complex problems, those with multiple causes and consequences that are highly dependent on context, require multiple perspectives to adequately address.
Collaboration is a means of engaging the necessary diversity to problem-solve effectively. Adam Richardson from Frog Design recently compared collaborative activity to being a “team sport”. I find the analogy fitting, because a team sport is something that is highly engaging when you’re playing it. When you are on the field of play in a game like football (soccer) or hockey, the focus is on the ball/puck and attractor patterns that build around it. When control of the ball (or puck) is yours, the decision to move alone with it or share it with your teammates is strategic, but in the moment, with the aim of achieving (and scoring) a goal.
Team members don’t contemplate their relationship with others as “collaboration” while playing the game, they simply play the game. Although most of us have played some type of team sport, few of us are really skilled at collaboration and fewer are prepared for it when it comes about. Why is that?
Richardson’s HBR post provides some points to jump off on. He suggests the following key points to consider:
1. Collaboration is a process not an event. We need to be more attuned to the rhythms and pace of others if we are going to be successful at working together. Syncing these and understanding when they are not working together is important and this means paying attention.
2. Helping people warm up to collaboration. Socializing is natural, but many of the contexts we do this in terms of collaboration are not by themselves natural. It is important to get people in the right frame of mind and sometimes this means mixing things up.
3. What is good for collaboration is also good for innovation. What makes someone a good innovator is a willingness to take risks and to build trust. The former is something that comes from personality, experience and support. The latter adds empathy.
Getting these ducks in a row is a problem of design, not just a practice of design. Not only are we not designing spaces for collaboration (both social and physical), we are not designing the intellectual space for it. A study reported through Science Daily and presented at the annual meeting the American Psychological Society in Washington  suggests that students are nowhere near as empathic as their counterparts were in the latter part of the 20th century.
“We found the biggest drop in empathy after the year 2000,” said Sara Konrath, a researcher at the U-M Institute for Social Research. “College kids today are about 40 percent lower in empathy than their counterparts of 20 or 30 years ago, as measured by standard tests of this personality trait.”
The report goes on to show how perspective-taking, a key component in empathy (and in good design practice) is becoming less familiar or practiced by students today compared to the 1970’s:
Compared to college students of the late 1970s, the study found, college students today are less likely to agree with statements such as “I sometimes try to understand my friends better by imagining how things look from their perspective” and “I often have tender, concerned feelings for people less fortunate than me.”
It is perhaps not surprising that another recently posted article on innovation suggests that large corporate structures where impersonal relations are formed are not conducive to innovation.
Perhaps this all comes down to the relationship qualities that we’ve used since we were kinds. Find and build a tribe of people who you trust and like and spend time with them, get to know them, and invite new people in whenever possible to mix things up. If that is the case, then the way we work in the health and wellness sector is surely in trouble where we don’t curate information and customize our knowledge for others, and we don’t support the kind of relationship building that equates to robust knowledge translation.
I can sympathize with my colleagues who face this problem. But the key is whether or not I can empathize with them.
complexityknowledge translation

Branded Knowledge: Does This Make Sense for Health?

Commercial products relying heavily on branding to entice their purchase and use in a crowded marketplace. Is this something that the health sector should consider and, if so, what might it look like?

I’ve just spent a rare free weekend in Chicago walking around, taking in the sights, and doing what a lot of other people do when they travel to another country or city: shop. It is hard to avoid some shopping when down in the Loop on Saturday or Sunday as that is what much of Chicago’s core is made for. The same can be true of most major centers, if you exclude the office buildings that are often semi-vacant on weekends.

A brief tour of many of the shops, from the discounters (Filene’s Basement, TJ Maxx, and Nordstrom Rack) to the mid-range stores (Macy’s) to the higher end department stores (Nordstrom) and the many boutiques, one is easily amazed by the abundance of goods on sale. But what intrigued me as I stood and watched what was around me was that many of the branded goods available at all of these places (including many of the boutiques) were the same. Big names in fashion were at all of them. And the products themselves were virtually indistinguishable from one another except for 1) price and 2) seasonality.

The first is perhaps the most obvious, but as one who is not as attuned to the seasons in fashion beyond the warm-weather/cold weather distinction as many, it the second part that I find most interesting. What makes last year’s $150 pair of Lacoste sunglasses worth $25 this year is nothing other than its seasonality. In other words, they are last year’s model and no longer as coveted.

It struck me that we do this in the health sciences all the time. If your reference list isn’t up to date, people question the sources and the validity of the findings. While probably appropriate for work in basic and clinical sciences, it seems less true for health promotion. It also seems less appropriate for areas where there is great complexity.

Brands also matter with regards to where something is published. A premium is placed on scholarly work that is published in journals with high impact factors over those that are in lesser-known journals. The underlying assumption here is that the more people cite something and the more we believe a source to be high quality the higher the quality the knowledge. The strength of the brand of sources like JAMA, Science, the New England Journal of Medicine and the Lancet exceed the rest of the health field.

While this respect for such “brands” sounds reasonable, there are many problems associated with it. Most notable among these is that they publish a certain type of knowledge in a particular format that adheres to particular models of discovery and rewards particular ways of expressing information. This has advantages, but it also creates path dependencies that shape knowledge itself and restrict the sharing of other forms of knowledge. In doing so, there is some assumption that the “best” knowledge (i.e., that which fits with the brand) looks a certain way and fits a certain way.

An alternative is to create different brands, just as we see in the marketplace for clothing and other retail goods. Apple, once a brand favored by a small, but fervent group of supporters in the early 80’s, is now the world’s most valued brand. It was the small, scruffy underdog and now is the leader. The same might be said for other forms of knowledge. If we were to package health promotion into a form that had the same appeal as other sources, could we create a demand and cache for it in a manner that drew people to it? And would this be a good thing?

I’m not sure. But I do believe it is possible. A colleague of mine once did a study looking at factors that predicted uptake and citation of research knowledge in a particular domain by looking at study qualities across a number of dimensions including design, home institution, discipline and others. After all was considered only one factor predicted uptake: the study used an acronym. Yep, if you branded your study it was more likely to achieve uptake than if you didn’t. To my knowledge this data was never published, presumably because it was so embarrassing to us scientists as it provided evidence that evidence isn’t just what drives our work. Whether it holds over time is worth considering, but it does suggest that brands might matter.

Marketers and companies work hard to distinguish themselves in a crowded marketplace. In a world where there are literally tens of thousands of venues for publishing our findings that are chosen every week, the market is filled. And do we want to rely only on the big brands to fill our knowledge? If so, we run into the same scenario as I did shopping by seeing the same brand everywhere and, because of that, seeing its value discounted because there is so much of it and it expires quickly.

The comparison is not perfect, but neither is it outrageous. Could branding knowledge and knowledge translation be coming to an inbox, book, or library near you?

knowledge translationresearchsocial systemssystems thinking

The Know-Do Gap in Knowledge Translation Human Resources

Lots of thinking, not as much doing

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