Meeting the Challenge of the "Know-Do" Gap Comment on "CIHR Health System Impact Fellows: Reflections on ‘Driving Change’ Within the Health System"

Abstract

Bridging the ‘know-do’ gap is not new but considerably greater attention is being focused on the issue as governments and research funders seek to demonstrate value for money and impact on policy and practice. Initiatives like the Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship are therefore both timely and welcome. However, they confront major obstacles which, unless addressed, will result in such schemes remaining the exception and having limited impact. Context is everything and as long as universities and research funders privilege peer-reviewed journal papers and traditional measures of academic performance and success, novel schemes seeking to break down barriers between researchers and end users are likely to have limited appeal. Indeed, for some academics they risk being career limiting. The onus should be on universities to welcome greater diversity and nurture and value a range of academic researchers with different skills matched to the needs of applied health system research. One size does not fit all and adopting a horses for courses approach would go a long way to solving the conundrum facing higher education institutions. At the same time, researchers need to show greater humility and acknowledge that scientific evidence is only one factor shaping policy and practice. To help overcome a risk of ideology and opinion triumphing over evidence, attention should be devoted to encouraging citizens to get actively involved in research. Research funders also need to give higher priority to how policy can be made to stick if the ‘know-do’ gap is to be closed.

Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme

“…Some are also in the process of being addressed, while others may demand urgent attention, especially at national policy and political levels. Health system transformation is difficult work and takes time 11 12. Attention to the key messages cannot guarantee success but is likely to strengthen the chances of transformation being achieved.…”

Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships

“…Given the diversity of organizations involved in the HSI Fellowship program and differences in these organizations' previous experience with and capacity for research, additional guidance regarding research processes and outputs, strategies for dual health system and academic mentorship and models of successful partnerships with universities could be beneficial. It has been recognized in both Canada and the US that the work environments in health system organizations differ from the university settings in which doctoral students are currently trained and that the skill set required to contribute to and lead transformative change within these organizations differs from those emphasized in most doctoral programs (Bornstein et al 2018;Hamelin and Paradis 2018;Kanani et al 2017;Paradis et al 2017;Reid 2016;Tamblyn et al 2016b) and from those currently prioritized and rewarded within academic institutions (Hunter 2019;Marshall et al 2016). Many PhD graduates have extensive academic training but lack experience working in other settings.…”

The Embedded Health Management Academic: A Boundary Spanning Role for Enabling Knowledge Translation Comment on "CIHR Health System Impact Fellows: Reflections on ‘Driving Change’ Within the Health System"

“…The benefits of the intertwined role are numerous, including: co-construction of knowledge and close engagement between industry and academia 32 ; impactful research for the end-user 33 ; and, an allocation of resources based on evidence. 16 Conversely, the challenges for the AIHSM and EHMA include: time constraints; securing and retaining funding 21 ; managing different, competing demands 21,34 ; appropriate performance measures 35 ; and, identifying potential staff with motivation, mindset and capacity to take on the role. The barriers, enablers and challenges related to the EMHA role are very likely to reflect those of other similar roles, such as clinical academics and embedded researchers.…”

“…20 However, aligning university and organisational outcome metrics together continues to pose difficulties. 21 Nevertheless, there is recognition of the need to create environments and organisations that can "occupy the middle ground, interpreting and translating messages that should flow both ways between researchers and policymakers and practitioners. " 22 In this space, three integrated knowledge translation components are promoted through partnership relationship management, allocating time for applied research, and outlining the value for both university and health organisations.…”