Hello this is Peter Levesque. Welcome to episode one of the Knowledge Exchange podcast. This podcast series is a product generously supported by the Canadian Council on Learning – a leading organization, committed to improving learning across Canada and across all walks of life.
I want to thank the Associate Director of Knowledge Exchange, Mr. Daryl Rock and his great staff for their wisdom and wonderful ideas 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 the nineteen future episodes in the series from my website at www.knowledgemobilization.net, or from iTunes directly, just search for KM podcast. Alternately go to knowledgeexchange.podomatic.com.
The conversation that you're about to hear, took place in Ottawa on Wednesday, May 2nd, 2007 in the office of Irving Gold, the Vice President of External Affairs, for the Association of Faculties of Medicine of Canada. Irving has been a leader for knowledge exchange in the healthcare world. He is consistently identified as someone who has influenced the thinking of literally thousands of people about the value of supporting knowledge exchange to improve how we do, what we do, in health care.
I think there are lessons here for education, for the environmental field, and for a whole series of sectors in Canada trying to improve what they do. Our conversation lasted over an hour and I've edited it down to what I think are the most interesting parts. I hope you agree.
Some highlights to look for include a discussion about the fundamentals of leadership in knowledge exchange, the concepts of vision, risk-taking, and sharing. There are some examples of leading organizations. We discuss the concepts of innovation, culture change within organizations, bridging communities, and bring some personal examples of lifelong learning.
Irving brings us his insight on questions of evidence, on decision-making, on the political process, on the value and limits of research, on how to build relationships, on questions of power, on the future of knowledge exchange and of opportunities for growth. I enjoyed this conversation very much and hope that you do also.
Peter: Good morning Irving. Irving: Good morning.
Peter: I appreciate you taking the time this morning and I'm wondering if you can start by introducing yourself and telling us a little bit about what you do. Irving: Irving Gold, Vice President of External Affairs, Association of Faculties of Medicine of Canada. Our organization represents the seventeen faculties of medicine in Canada. My primary role is to represent them externally.
Knowledge transfer was my previous world as Director of Knowledge Transfer and Exchange at the Canadian Health Services Research Foundation. And even before that at the Centre for Health Economics and Policy Analysis. So that's sort of been my professional zone of interest for the last ten years. Peter: In talking to a whole number of people, I used a typical snowball survey method to identify leaders and your name came up over and over and over again. And so why don't we start with leadership and in your mind, what is leadership? Irving: Well in this field and in the field of KT, leadership just means not dying and not changing focus. I mean there are so few people with any level of expertise in this particular area that, as much as I'd like to say it is some innate characteristic that I have, it isn't. It's about staying power and focus. But that being said, I will acknowledge probably I do possess some characteristics that make me able to assume the quasi leadership roll that I've been able to establish for myself but really, it's a small world in this community so it hasn't been that difficult to rise to the top. Peter: Okay, so you talk about some of those characteristics - what are some of those characteristics, especially with regards to knowledge exchange and knowledge transfer?
Irving: Well, I think being able to have a vision. I mean, I think there are people that are doers, there are people who are really good at operationalizing vision and then there are people who are really good at coming up with vision. And I, over the last ten years, have been very fortunate to work in environments that have provided me with the ability to vision. And I enjoy visioning and my visions are sometimes completely wrong but I'm also a risk taker and I think that's another part of being a leader. So being willing to take risk and articulate vision and open your self up for criticism, but also potentially having the ability to contribute to national and international discourse. So that's what it is. A lot of people are not comfortable, especially in public, floating out new ideas that are untested and that might be completely wrong. I love doing that. I'm very happy to be told I'm wrong because it's a learning opportunity. And in an area like knowledge transfer there have been lots of opportunities to be wrong and I can tell you lots and lots of stories where I went out on a limb with an idea that was completely wrong. So leadership to me is the ability to think at that sort of conceptual visionary level. To be able to take the risk and be willing to be wrong and to work with…and to know what you can't do. I mean the other thing is - I know I've surrounded myself by people who are able to operationalize vision. That has been key for me because I have a fairly short attention span as you know. So being able to have people that I can talk with and share ideas with and know that they're going to go and create in some magical way of making some of these experiments happen – that's been phenomenal. Peter: So in your previous job, and like you said this one is still evolving and emerging. But in your previous job, the Canadian Health Services Research Foundation (CHSRF) is considered by many around the world as THE leading agency around knowledge transfer. And you've tried a whole series of things and you're smiling so I think you might have some opinions on that. Irving: Well I'm smiling because the Canadian Health Services Research Foundation does some amazing things. There's absolutely no question and ten years ago it was one of the only agencies doing some of these things… There are other agencies and other organizations across the planet and even here in Canada and in this province and even in this city, that are doing things that are just as, if not more innovative, but they do it very quietly. I mean what CHSRF has done very well is that it has adopted the role of the spokesperson for the community in Canada – in the health sector at least - and it's maintained that position. But there's incredibly innovative stuff on the ground in organizations that just haven't taken the time or don't have the desire to spread the word. I mean, they're just busy doing instead of preaching and talking. Now I'm not at all trying to take away from the Foundation – the Foundation has been foundational. But I have to say that we do ourselves a great disservice as a community by overlooking some of the really neat innovations that are happening, like this for example.
Peter: Well let's talk about some of those innovations right now. I think one of the things that hopefully these podcasts will do, is begin a conversation about how innovation isn't always something completely drastically new, but it's ways of taking something from one place and putting it to another or bringing two things together in a different way. So given your ability to see all these things, what are some of the things that have struck you in other agencies that have been really innovative that you see as success stories?
Irving: That's hard but I can tell you for instance, that the CSSS in Quebec, in Montérégie for example, one of the most cutting edge I would say, Regional Health Authorities in Quebec, integrating all kinds of knowledge transfer processes and other organizational processes encourage the transfer of research based evidence throughout their organization. And they'll be the first to tell you that the concepts have been adopted from CHSRF's tireless marketing of the concept of KT. Appreciation for research-based evidence has become so fundamental to the day-to-day operations of that regional health authority, that it's almost imperceptible. Peter: right Irving: It comes from the CEO, who is an incredible leader and it goes all the way through the management structure right down to the program officers. At CHSRF we used to often say often that this is not about individual projects, it's about culture change and I think that's absolutely true and that regional health authority for example, really typifies the kind of organizational change we're looking for. Peter: Okay, so the organizational culture change I think, is a really important piece because one of the ways that knowledge exchange is described as bringing people and evidence together to influence behavior. And so influencing behavior, you're talking about cultural changes. That's the hardest thing to do to influence behavior. So how do you do that?
Irving: Well it is and we forget that that's all about. I mean one of the things that has frustrated me of late, and is the topic of an editorial that I've just written, is that the KT community has forgotten that what we're trying to do is not KT. We're not here to employ ourselves as KT specialists – we're not here to create a whole new sub-specialty. We're here to work on bridging communities as a cultural thing and one doesn't do KT, one does a whole bunch of things in order to facilitate the transfer of knowledge from one community to another. So it's an outcome – knowledge transfer is an outcome, it's not an activity. There are a million different activities that can feed into that outcome. But when you think of it that way, you realize that there's stuff happening all over the place in the name of knowledge transfer that doesn't carry that label and doesn't carry that rubric. I'll give you an example: yesterday I was at the launch at the Ivy League School of Business Health MBA program in Toronto and I'm sitting here at this launch of this MBA health program and I'm thinking “why have they invited me here? This has absolutely nothing to do with knowledge transfer”. And then in the opening comments by Senator Kirby and Allan Hudson and the Dean of the new program, I realized it's absolutely about knowledge transfer. What they're talking about is bringing the brightest minds from the business community and the brightest minds from the health sector – it's a partnership between the School of Business and the School of Medicine and Dentistry. And they're bringing the two communities together to transfer knowledge and work collaboratively to train a generation of people who are running the health system using the principles of business. And I realized right there that this isn't multi-stakeholder in the sense of KT that we think of decision maker or researcher, it's researcher-researcher and student, but it's about merging two academic disciplines in a way that hasn't been done before. And the over-arching message was, hey, there's a whole but of research and evidence around how to run a business, and a business in terms of someone with a supplier and a consumer and that's what the health system is in Canada. There are suppliers and consumers and it's paid for by the government but that's the difference - otherwise it's a marketplace. There are a whole bunch of principles that should be governing the running of any business that are not being used in the health system. The example of course, was the MRI machines – and I love it when Kirby talks about this, he says, in any other area of…in any other sector, if you have such a huge proportion of your money going to the capital expenditure – like an MRI machine, the bloody thing wouldn't be running from 9-5. The MRI machine doesn't care how many MRIs it does or how many hours it gets used in a day. He said in any other sector, that had such a huge proportion of it's money being spent on capital, you'd be making sure that capital was being used to it's maximum capacity. Peter: 24 hours a day.
Irving: In the health sector - 9-5. The point is that it's a huge transfer of knowledge transfer that needs to happen, or could happen, between the School of Business and Medicine. I guess my point is it really is about culture change and it isn't just about culture change among users of research and creators of research, it's all over the place – it's happening everywhere as we speak, knowledge transfer as a concept is happening constantly. I mean this is an exercise in knowledge transfer.
Peter: While we're on the topic of culture change, the Canadian Council on Learning is, in many ways about culture change about life-long learning, so I'm sure you have opinions on life-long learning and knowledge transfer. When you hear the term ‘life-long learning' what do you think of? Irving: Well it's funny you know, I heard for the first time, in a conversation with Daryl and I kind of rolled my eyes, and thought “oh please, you know what he's talking about is all this sort of formal educational opportunities that are available for people as they progress through their life” and I no longer think of it that way, I realize that life is a process of life-long learning – some of it's formal and some of it's informal. But just in the same way knowledge transfer often is informal. And so there are many different ways that we learn. And so the Internet is an amazing tool for life-long learning. You know my father is 72 and is now learning how to use the Internet. That's a process of life-long learning. It's not just about work support, it's not just about certificates in X, Y and Z – it's a process that we're all are continuously involved in Peter: So maybe the concept of support is actually an important one to follow-up on. When you think of an infrastructure or incentives for life long learning, what do you think about? I mean the Internet is an example of an infrastructure that's in place and it's growing… Irving: But we could get even less. Literature….literature Peter: yep Irving: nobody ever talks about that but you know…I…and that's part of this whole process right? I read a wonderful book called “Shantarum” the other month. It's a biography by a guy who escaped from prison and ran to India. Anyway, to make a long story short, I learned through reading that book, work of fiction in my personal time, in the hammock or whatever, I learned about the history of India, I learned about the political climate of India in the 1980s. I learned all kinds of things about the Jain religion, about the tensions between Sikh and Hindus in India. That's education – that's learning. Peter: Right Irving: It didn't feel like it - it wasn't a formal process - the stimulus was me buying a novel in an airport bookstore. You know this whole “what is Stephen Harper reading this month” that..I don't even remember his name… Peter: Yann Martel Irving: Right, so that process that he is going through is a process of trying to encourage our Prime Minister to engage in a process of life-long learning through literature. So we have to take our blinders off – this isn't just about research. Now that doesn't mean…many people who write literature do research in order to write their literature, so research does factor in here. I guess the walls are blurry to me. It's where knowledge ends up Peter: Okay Irving: You know it's hard for me to imagine any communication device that doesn't contain some element of knowledge transfer in it. I guess that's my big ‘aha' lately is that communication is knowledge transfer, period. And I used to bristle when people said that to me because I was, in my early days, trying to establish this new thing. And everybody said, “Irving, this is not new, this is about communication”.
Peter: So how do you support communication?
Irving: How do you encourage communication, is you make no question stupid. That's another thing that I've just realized - I mean part of what the knowledge transfer movement has done in the health sector, in terms of bridging the gap between research and decision makers, is it's made it okay for decision makers to say “I don't know”. That's a huge cultural shift. CEOs of regional health authorities are now actually allowed to say in public “gee, you know what, I'm not actually sure what the best way to pay primary care physicians is – I'm not really sure what the optimal number of MRI machines is in my region, I need to consult the evidence”. Twenty years ago they were expected to know the answer by virtue of being a CEO.
Peter: Right, so that's a fundamental…I mean going back to leadership – that's a fundamental shift in how leaders see their role. Irving: Absolutely – being able to question. Legitimizing the process of questioning is critical to the process. This is interesting I've never actually discussed this within this…but because of the way we fund research in this country in any….actually the way we fund research, is conducive to asking questions to which we already have the answer - most of the time we've got half of the data collected. You know people are very naive in terms of what they think research does. Researchers cannot ask stupid questions – I call it the stupid questions, I mean to me, stupid questions are where big pay-off answers lie. But nobody is going to fund a research application for which there's absolutely no… Peter: Why not? Irving: Risk. Risk Peter: It's too risky? Irving: Sure, I mean CIHR is going to fund research among seasoned researchers – questions that seem like they're logical progressions from existing stocks of knowledge – incremental pieces. The first thing people do is they look at an application and they see how grounded is it in the literature. If you're grounding in the literature, you're already asking questions that are… I see that very few people are asking really revolutionary questions. Creating an environment where it's ok to ask stupid questions is critical to this process of knowledge transfer because if you don't ask, you don't find out. Peter: It's interesting because there's this concept around evidence that evidence is what is most credible right – is the part that's the most certain as opposed to the part that we don't know. So where does this asking the risky questions and evidence fit together? How do they work together or can they work together? When we talk about evidence, increasingly the conversation that I hear about evidence is what is most credible right? That we look at… Irving: It's what we know for sure. Peter: For sure, it's the stuff that's pretty grounded and solid… Irving: Which is ridiculous. Peter: So you don't actually have to question it? Irving: Ya, but that's, I mean completely ridiculous.
