Skepticism about Knowledge-Translation Models
While I don’t claim to speak for everyone, in my experience, nothing makes a front-line-nurse’s eyes roll more than the implementation of yet another model that will make her care better, her life easier, and the flow of resources more efficient. The “LEAN” model comes to mind; a several year obsession of cadres of managers at Vancouver Coastal Health. In theory, the model provides guidance to improve efficiency in many different sectors (www.lean.org). In my experience, it creates a jargon and a rubric for the slow but steady march of pre-existing goals, like cost cutting.
Tabak, Khoong, Chambers, Ross & Brownson champion models in implementation and dissemination research, explaining that research projects tend to be more successful if they are involved. While the measures of success are not provided, the success seems to refer to the research itself, rather than actual implementation or dissemination.
If we were to look to specifically recommended approaches, we could first look toward Glasgow, Gree, Taylor, & Stange for their Evidence Integration Triangle. Aside for not providing any clear evidence of its efficacy, there’s also very little discussion about how this model might look operationalized. Most interesting is that the authors deplore standardized, decontextualized approaches. They then deliver a conspicuously standardized, decontextualized model.
Similarly, Hanlon, Carlisle, Hannah, Lyon and Reilly’s proposition of “Learning our way into the future of public health” effectively discusses the philosophical components of knowledge translation, however the “know-do” gap between the knowledge presented in their article and a practical application could be described as a gulf.
Peschl & Fundneider present an approach that addresses measures which are implementable, however even these could be described as somewhat vague. It’s interesting to note that while the authors of these papers and chapters are writing about innovative methods of translating knowledge into practice, they are all using a particularly traditional medium for their message: the academic journal and book.
Gawande’s musings in the New Yorker about his involvement in the Better Birth Project in India provide a demonstration of true efficacy in the field, on the other hand. While he doesn’t propose a firm rubric or model to guide action, he implores health workers engaged in knowledge translation work to talk to the people they are working with. He draws lessons from Bangladeshi programs that showed just how effective personal interactions with target populations are.
I don’t believe that firm models are the route of all evil, and I suspect that they serve to organized an endeavor in this field as well as in any other. I remain skeptical, however, about how much they lend to the potential efficacy of a given project. I wonder if it isn’t in fact the determination, skill, and genuine care of workers involved that isn’t the best predictor for the success of knowledge translation.
Glasgow, RE., et al. (2012). Evidence integration triangle for aligning science with policy and practice. American Journal of Preventive Medicine, 42(6), 646-654.
Gwande, Atul. Slow ideas: why innvations don’t always catch on. New Yorker, July 29, 2013.
Hanlon, P., et al. (2011). Learning our way into the future public health: a proposition. Journal of Public Health, 33(3), 335-342.
Pechl MF, Fundneider T (2008). Emergent Innovation and Sustainable Knowledge Co-Creation. A Socio-Epsitemological Approach to “Innovation from Within.” In Lytras MD, Carroll JM, Damiani E, et al (Eds), The Open Knowledge Society: A Computer Science and Information Systems Manifesto, pp101-108. New York, Berlin, Heidelber: Springer.
Tabak RG, Khoong EC, Chambers DA, Brownson RC. (2012). Bridging research and practice: models for dissemination and implementation research. American Journal of Preventive Medicine, 43(3), 337-350.