The need for systems change: reflections on knowledge translation and organizational change

Abstract

Title. The need for systems change: reflections on knowledge translation and organizational change. Background. Despite over 40 years’ work on general systems theory, informed by critical social science, there is a mismatch between the theories used to explain and influence clinical practice in nursing and the way in which transferring new knowledge into practice is articulated. Data sources. The analysis and emerging propositions were based on a critique of seminal texts published in English up to 2008 covering critical social science, action science, diffusion of innovations, practice development and the management of innovations. Discussion. There is an implicit adherence to the world view that healthcare systems operate like machines, and much of the science generated around knowledge translation research tends to be logico‐deductive. This is in direct contrast to the prevailing arguments of general systems theorists, who view the system more as an organism. Five propositions are posited: knowledge translation is a necessary but not sufficient mechanism to transform systems; the ‘system‐as‐machine’ metaphor is profoundly unhelpful to knowledge translation; the healthcare system is best viewed as a complex entity; successful innovation is a function of the level of local autonomy experienced by individuals, teams and the unit involved; innovation is most effective when it involves key stakeholders. Conclusion. The purposeful integration of systems theory with knowledge translation theories and models may enable the application of research and new knowledge to practice to be speeded up.

Exploring conceptualizations of knowledge translation, transfer and exchange across public health in one UK region: a qualitative mapping study

“…4,5 Furthermore, it is now recognised that getting evidence into, or indeed out of, policy and practice is not a straightforward or linear process and to view it as such may be misleading. [6][7][8][9] The Cooksey review 4 of publicly-funded health research in the UK highlighted two key gaps: in translating ideas from research into new products and approaches; and putting those products and approaches into practice. The term 'knowledge translation' (KT) is increasingly used to describe the work required to close or bridge these gaps.…”

“…16 These perspectives range from a linear bench-to-bedside view to a focus on co-creation and the organic complexity of systems. 8,14,17 A multitude of related terms exist and are often used interchangeably; for example, knowledge transfer, knowledge exchange, knowledge mobilisation and knowledge management. 18 While there is a growing body of literature exploring these concepts, using it to inform public health practice, strategy, research and education is often difficult given the range of sources, worldviews upon which they are based and need for local 'contextual fit'.…”

Perception Of Nursing Middle Managers About The Evidence-Based Management

“…The translation process is related to autonomous decisions about how knowledge can be used to improve results; how to negotiate relations in health system [individuals, team, internal and external relations] and how to conquer resources to sustain changes/improvements in practice [16]. It emphasizes that research is an essential activity for the advancement of health sciences and research results should contribute to improving the quality and efficiency of health organizations [17].…”

Health System-Level Factors Influence the Implementation of Complex Innovations in Cancer Care

“…Three theoretical perspectives largely informed the design of this study: the Promoting Action on Research Implementation in Health services (PARiHs) framework (Kitson et al 1998(Kitson et al , 2008, the organizational framework of innovation implementation (Helfrich et al 2007) and "systems" thinking/change (Kitson 2009). The PARiHs framework proposes that the successful implementation of research into practice is a function of the interaction between three core elements: the level and nature of the evidence; the context into which the research is implemented (where context is comprised of the sub-elements of culture, leadership and evaluation); and the method by which the process is facilitated.…”