Hello, this is Peter Levesque. Welcome to episode seven of the Knowledge Exchange Podcast. This podcast series is a product supported by the Canadian Council on Learning – Canada's leading organization committed to improving learning across Canada and in all walks of life. I want to thank the great staff at CCL for their efforts with this project to advance our understanding of effective knowledge exchange to improve the learning of Canadians. You can download this episode, as well as one of the thirteen future episodes in the series from my website at www.knowledgemobilization.net, from iTunes directly, just search for KM podcast. Alternatively go to knowledgeexchange.podomatic.com.
Dr. Scott's work is tied to action on knowledge exchange rather than just the use of jargon. Her discussion of the role of champions in creating an office to support evidence use is an important lesson for others trying to do similar work. She talks about creating learning opportunities in the workplace, including the effective use of existing infrastructure, such as libraries, to support emerging initiatives. The discussion about leadership and commitment, risk and innovation, and the challenges within large organizations all struck a cord with me. I learned much from the conversation about readiness for change and the benefits of sharing what we know to make better places to work and live. Enjoy.
Cathie: My name is Cathie Scott and I am currently working in a hybrid position on the cusp between the University and the Calgary Health Region. Within the Calgary Health Research portfolio, which is formed as a partnership between the University of Calgary and the Health Region. So many of the people in our portfolio have joined to point one sort or another. My position within the portfolio is as Director of the Knowledge Interaction Department. We shortened that to be K2A.
Peter: So how did you come up with that name of Knowledge to Action?
Cathie: I'll back up just a little bit. I started working with the Calgary Health Region about 2 years ago and was asked, because of my interest in knowledge exchange and transfer, asked to actually do an environmental scan of work that was being done in the Region to make better use of evidence and practice. So we, being myself and Nadine Gall, who is working with me, did this scan and as with some other scans that have been done in Canada recently – the Alberta Heritage for Medical Research and the Research Transfer Network of Alberta partnered to do a scan of the Western Canada - of knowledge transfer initiatives in people and research in the area. The Saskatchewan Health Research Foundation also did a scan of making better use of knowledge in practice.
Peter: So you had all this…..sets of activities and work that was going on?
Cathie: And with all those scans and with ours people said, quite clearly throughout the interviews that were done for them, that they were tired of the jargon in this field where people were talking about knowledge translation, knowledge transfer, knowledge transfer and exchange and you go up - the list goes on. And they just wanted people to talk about what knowledge was for.
So in the title of our department could quite easily have been the Knowledge Translation Department or the Knowledge Transfer Unit or the Knowledge Exchange, was one name that we came up with, but we thought that that was just doing again what people were saying they didn't want done, was using the jargon that is time-limited quite often. And so we started to talk about what we wanted to see happen as a result of our existence and that it was about putting knowledge to better use or knowledge to action. So that's where the name came from. Peter: Maybe talk a little bit about some of the actions that have come about because of this or in the process, because it's a fairly new unit. Cathie: It's still…it's only had a compliment of about 3 fulltime staff and a few contract people, for about 8 months now. So it's still very new, although the idea has been in place for a year now. Initially as a result of the scan, what people suggested would be a good way forward, was to a) trumpet better than we have in the past – all the good things that are happening in the region because there are a lot of people who want to use evidence better than they are and when I talk about evidence, I'm talking about a broad definition of evidence. So it's not just research evidence but it's evidence that's emerging from practice and it's evidence from patient experience and wanting to try and use that…those different sources of evidence to design better health systems. So there's a lot of good work happening but people even within the Region, didn't know that it was happening. Maybe we're too big for good communication around that but one of the things that we were told people wanted was to be just made more aware of the good things here. That was one of the things we set out to do was actually make more connections among people who have similar interests. So we're moving forward with people who are already going down this track but using communities of practice in a way that actually facilitates those connections. There are some naturally occurring ones that need support.
Another thing that was suggested was that we do a few pilot projects of these strategies that have worked well in one context and see if it actually works in another context….
Peter: …works in the Calgary context?
Cathie: Yes, yes exactly – in the Calgary context or other places within Calgary where they haven't been tried. So there is a push towards doing some pilot projects around again, communities at practice is one that I've already mentioned, but there are knowledge brokers. Canmore had that PEAK (Practice Enhancement Achieved through Knowledge) project, which was funded through CHSRF, as one of those test sites for knowledge brokering. And the PEAK project is a place where they've learned a lot of good lessons about how that position, of knowledge broker position, can work and maybe needs to be changed in order to work well. So piloting that in other places within the Region is something that we're hoping to do. Another thing that's happened within this region is the notion of time grants for people who have questions emerging from practice that they want to pursue in some way, to get more literature around it, to actually do a project that tests whether or not this would work well and with other people in other places. Peter: So if I understand correctly, in many ways you're providing the support for people to try things. Cathie: Yes, yes Peter: So and to try things based on evidence. One of the definitions that CCL promotes of knowledge exchange, they talk about knowledge exchange as bringing people and evidence together to influence behavior. And so does that seem to…does that fit with you? I mean is that how you see the knowledge exchange that you're influencing behavior but not just the way that people see it, but the way people act? Cathie: And the way people think about it. I think the first challenge is changing the way people think about their everyday practice – becoming more reflective on what they're doing in practice and taking that a step further to then say, well this didn't work well – why didn't this work well? So then maybe connecting them with an opportunity to look at the evidence in that area, on that particular thing that emerged from practice and then the next thing would be, if they've seen…if they've gathered other evidence besides their own local practice and they see that other people have been testing this out. But maybe there's a gap in knowledge – that they take it to the project level and actually try something at project level and then moving towards changing behaviors. It's a long process but as we know, I mean we don't change behaviors by giving people a journal article. Peter: You don't? Cathie: You don't..haha Peter: Okay, I'll stop doing that! Haha. So what's interesting in Calgary is that there's a lot of places that have been talking about doing something like this and have done this similar kind of thing – they've done a scan – they know what's going on out there. But the creation of an office within the Calgary Health Region, which is a fairly large, complex environment – create an office that does this, took a set of circumstances - so what lead to the creation of the office? Because you can go from the scan, in knowing something but in fact, there was an action taken in Calgary that said, “Okay we're going to create this Knowledge to Action office”. What happened there? What practically were some of the steps that were involved in the creating of that office?
Cathie: Well there are a few things, as in many cases, a few things coming together at one time. There was a national push from funding agencies to ensure that there was a knowledge translation transfer plan whenever research was funded for example. So that was one thing – there was sort of a push from the funding agency research side. There was also a push for large integrated health regions to become more evidence-based. The patient safety movement, I'll say, was a place where people began to realize that there were better ways of doing things that would have an impact on patient safety. There's a push for more evidence-based practice and other organizations across the country are talking about more evidence-informed practice to improve how we make decisions at many levels within the organization. So there were many of those things coming together on a practical level within the Region – there were champions. There were people at senior exec level who saw all of these things in the external environment and realized that if the Calgary Health Region was going to make the best use of their resources, that an evidence-informed, evidence-based approach to the way they came up with solutions to problems, was probably where they had to go. So there were champions at senior levels and there were also people nested within the organization in many different places who are also on the same page. So there was a convergence of energy, if you will, around that idea.
The first step was the Scan. The results showed that there were a lot of good things happening and so the energy then became focused on capitalizing what was already happening and listening to the direction that people had given about what would make their lives even easier if they were going to continue to do that work. So now we're at the stage where there's been investment in people in a unit to try to come up with local strategies that support people to make better use of evidence. And we're at the stage where we've got a lot of good ideas, we need to now get the pilots in place to try out some of these ideas. Peter: This particular project is funded by the Canadian Council on Learning, and part of their mandate is to promote a culture of ongoing or life-long learning. Phone ringing – pause. When we were first talking, when I heard what you were doing, I said, “okay well that actually fits very much”, because you trying to improve both the practice outcomes, but also the learning from what goes on within the context of doctors, nurses, patients, administrators. So talk a little bit about what you consider important to life-long learning, especially within the field that you're in now and how your unit might be supporting the learning processes of the people that you work with. Cathie: Well it's interesting, quite often we get so immersed in what we're doing that we think that we're the only ones sometimes that are doing these things but there are people within the Calgary Health Region, in our People and Learning Department who have a responsibility for ongoing learning within the workplace, who have been for the past number of years, thinking about communities of practice as a strategy for life-long learning and engagement within the Health Region. So we've connected with them and I think that's one of the really important things about taking something like this on is getting to know the environment really well before you appear on the stage as the “expert” who is telling people what's best for them and showing them a new tool because chances are there is some brilliant person there ahead of you who's already thought of this and is trying to make it go forward. There had been a lot of thought put into life-long learning in the workplace and how that connects to retention and recruitment within the Region. Life-long learning in a place like the Calgary Health Region, I think there are a lot of people here already who see…finding ways to support that as a way of strengthening the Health Region. So providing people with a way to grow within their current profession or to grow beyond their current profession.
Peter: When you want to encourage behavior, there has to be incentives for the behavior and once you've created incentives for that behavior in order to sustain it, there has to be an infrastructure that supports it. So before this interview, I saw some of what was over at the Health Sciences Centre, with regards to tele-health and linking up all of the regions of Alberta - I mean that was pretty much all of Alberta that was on-line this morning.
So that's an infrastructure that's in place that allows people to get involved. So maybe talk a little bit about the types of incentives that you've … because the challenge around knowledge exchange is the exchange process – it's the sharing. So I've heard you say, “people want to try an idea and they go off and they try it and then they come back”, but there has to be a mechanism to share that idea with others and to get feedback from them. So there's that loop – that ongoing conversation that people then learn from what they put into practice, what they've learned from putting it into practice, what other people have tried and that process. So maybe talk a little bit about how you're helping to support the development of incentives for engaging in this kind of work, but also some of the infrastructure might be in place to support that. Cathie: On one side Alberta has envy in Calgary - have a lot of advantages. We do have, the things you saw this morning where this Research Transfer Network of Alberta, which was funded through the Alberta Heritage Foundation for Medical Research, which has been in the business of connecting people across the province for a long time. On the other hand we still, within health systems, tend to work within our silos and so we don't…we haven't to this point, really shared what we've learned in one place well with another. In terms of trying to incent that sharing of what's been learned. I think one of the things that we hope to do, and we talked about this today was around your…related to your project on pod-casting, was to try and actually come up with different learning strategies to meet different learning needs across this region. One of the realities of our situation is that, as with many other places in the country, the people resources are at the low end. And so people are stretched just to do their jobs and there isn't a lot of time left over for creativity and for stepping back and reflecting on practices. It's a get-it-done-now sort of place that we're at. And so we've been trying to think about how we can inject into that very busy workplace – some learning opportunities. We're fortunate in that the University of Calgary libraries and the Calgary Health Region libraries have developed a partnership called the Health Information Network and they are setting up learning centers and facilities throughout the Calgary Health region and…Knowledge Centers is actually what they are calling them. And so we're working with them to think about needs to go along with that in order to make them spaces that are used. As it stands now in this busy, busy environment, people don't have the time to go to a knowledge centre. What do we need to do to support use of those places and use of that service. And so we're thinking of different strategies, we're thinking of podcasting as being one that we put out there which podcasts - that profile what's been done in the Region so that people become more aware of it. Things that people can use for shift change in information exchange- one minute podcast that says, this is new in the region – this is something that you can use. But beyond that, we've got to find ways that we can support managers to find time. Time is the..
