Applying Knowledge Transfer and Exchange Strategies to Promote Integrated Stroke Care
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Applying Knowledge Transfer and Exchange Strategies to Promote Integrated Stroke Care Grace Warner, PhD Atlantic Health Promotion Research Centre Funded by the Canadian Stroke Network Partners: Provincial Departments of Health and Heart and Stroke Foundations Interdisciplinary/Collaborative project Principal Investigator Renee Lyons Lead: Steve Phillips, Division of Neurology Dalhousie University Knowledge Brokering “ Successful implementation of research to practice is a function of the interplay of the level and nature of evidence, evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated.” facilitated.” (Kitson, Kitson, 1998) The Canadian Health Services Research Foundation defines knowledge brokering as the human force that makes knowledge transfer more effective by bringing people together to help build relationships, uncover needs, and share ideas and to help each other develop evidenceevidence-based solutions. 1 Health System Change for Integrated Stroke Care EvidenceEvidence-Integrated care for stroke, best A Systems Approach to Stroke Care Conceptual Framework practices on prevention to reintegration Surveillance ContextContext- Departments of Health political climate, resources, available stroke care services, number of individuals who are hospitalized for stroke, population risk factors for stroke FacilitationFacilitation-Knowledge brokers Description of the Project The Atlantic Canada Integrated Stroke Strategy project is examining how knowledge exchange strategies can facilitate health system change. The objectives 1) to increase policy makers knowledge on best practices research on integrated stroke care 2) to improve researchers understanding of the context that affects the provincial government’s uptake of this research. Prevention Pre-hospital and Emergency Care Hospital Care Rehabilitation & Community Re-integration Research Provincial Teams Provincial teams were formed between the Departments of Health and the Heart and Stroke Foundation. These teams worked with the researchers to hire knowledge brokers in each Atlantic Province (Nova Scotia, Newfoundland/Labrador, New Brunswick and Prince Edward Island). Knowledge Exchange Measurement of Outcomes Each provincial team defined the goals they wanted to achieve by the end of the project (Sept 20032003-March 2006) The research team supported knowledge exchange activities by AtlanticAtlantic-wide forums every 6 months Monthly teleconferences/meetings with knowledge brokers Process: Key informant interviews/focus groups with knowledge brokers and partners. Context: Hospital surveys on stroke services and CIHI stroke separations for each hospital in Atlantic Canada. Canadian Community Health Survey: Risk factors for stroke and postpost-stroke disability 2 Partnership Building It takes time to Understand each other’s cultures Create a common language Build a foundation of trust Challenges Time commitments Changes in government leadership & structure Limited resources for future changes Confidentiality concerns The Process of Knowledge Exchange Increase decision makers’ knowledge on best practices research on integrated stroke care Range in strength of best practices research Integrated stroke carecare-difficult to explain Lessons learned from OntarioOntario-does it apply to Atlantic Canada? Knowledge Broker Responsibilities Communicating between partners Creating a advisory group to develop a provinceprovince-specific stroke strategy based on best practices Communicating the strategy to stakeholders to build support for possible implementation Travel commitments around the province Researcher’s Challenges Lack of understanding about the context Difficulty introducing unsolicited evidence Changing thinking from outcomes to process Communicating collaborative outcomes to funders Evaluating knowledge exchange effectiveness The Process of Knowledge Exchange Improve researchers understanding of the context for this evidence Understanding the responsibilities of the government health sectors Province specific strategies to communicate best practices Associating integrated stroke care with chronic disease management Knowledge Broker Challenges Communicating with diverse audiences Keeping people thinking about the overall goal rather than the details Getting the right stakeholders around the table Expectations about content expertise The grunt work Confidentiality concerns 3 A Success? Not finished yet but knowledge brokersbrokers Enhanced partner communication/collaboration Identification of gaps in communication and training/educational needs to facilitate health system change Evidence is being used in making changes in the health care system The Broader Picture Can knowledge brokers be sustained? Who will finance the needed training/education? Communication is discontinued when resources and time are limited. The quality literature suggests we need to monitor interventions and make systems accountable rather than the individuals Final Quote Q: Is there anything else about the project that you would like to share? A: …But I don’t think without having somebody dedicated to the cause, it [the [the integrated stroke strategy] strategy] necessarily would have gotten off the ground this year. I know from conversations I’ve had with certain people who have been fighting for this kind of change for a number of years, they were really feeling quite frustrated because they weren’t getting the support they needed…. And all indications are that everybody sees this as a very worthwhile project but that you really needed somebody in this position to help tie it together and to push it along. 4
