Peter: So time is really the key?
Cathie: Time is the key. Rehab has been really good even with staff shortages. They've placed a value on learning in practice that means that someone can apply for a time grant. They can…if they have a burning question, they can get a day a week for a period of time to go and sit in a knowledge centre and talk to a librarian, do some net-searching, find out more about what is… Peter: So, it's usually around a practical question, something that's in their practice? Cathie: One thing that's happened with that, especially rehab at the children's hospital, is there is a series of time grants given to people, which came together into a project proposal…resulted in a project proposal and they now have external funding for projects to pursue questions that initially came out of the time grants initiative. Peter: So it's an externality – it wasn't planned for but it's an output that has been created? There's a tension between doing what you do better and more effectively, needing to improve your skills, but not necessarily having the time to be able to improve your skills but absolutely having to have it. So how do you convince the managers, the administrators, the people who are the…who make the difficult decisions about where resources get allocated, that this is in fact something that will bring new value or use what we already have in more efficient ways or…because this is…part of the evaluation…maybe we can talk about evaluating this. I mean you've just talked about here's an example where some positive things are coming out of it, but how do you evaluate this process and how do you show that evaluation to the people that make the decisions about where resources go? Cathie: It has something to do with readiness. It has something to do with going where people…going with innovative risk-taking type strategies because that's what they are – it's taking a risk to invest in something that looks on the surface as if it won't give you immediate results – probably won't give you immediate results. So it means that you're taking a risk to do something that's a bit different – a bit innovative. So you initially have to go with places…support people, who are already willing to take that risk.
In doing so, you have people like the people in rehab, who did it totally without much external support. There was support from their managers to do this and then you demonstrate what's accrued because of that. One person within that time grants program who initiated it, has just completed an evaluation of it, looking at those things that I mentioned. The people in practice are more energized by the fact that they feel like they have a opportunity to make a difference, they're looking at a different way of doing things in a very systematic way and hope that that feeds back into the other people that they work with. Part of… I think the way that we have…believe we have to go, is go with those areas of readiness first. If they've already piloted it, then make sure evaluation has been done or is being done, so that we can use that to demonstrate the success of an investment in unique risk-taking type behaviors. Peter: I think there's a clear link between taking risk and leadership and so maybe talk a little bit about…well you've been identified as a leader in knowledge exchange. Right - as somebody who's taking a lead position, who's implementing things that are new – that is on the cusp between two, “normal” – quote, unquote – “normal” types of organizations. So you're in fact leading on something that is quite difficult. So when you talk about leadership and you talk about risk - maybe talk a little bit about the style of leadership here in Calgary and how it may be changing or whether there's new leaders needed or the types of leaders that you see emerging as these things progress. Cathie: I think that there are, within this region, there are people who are committed to doing things differently. With any large organization or institution, whether it's a university or health region, the bigger it gets, the greater the tendency for things not to change. And I think that you find within this region, that there are…there is probably more than average, the number of people who actually are committed to change.
So maybe that's what's happening; there's a coming together of people who see that in the new millennia, that if we don't change the way we practice health care, then we're not going to be able to sustain the system - that we have to change. There are a number of leaders who are on that page here in Calgary – in the Calgary Health Region. And so I think we may not have existed as a K to A Department in another place – in another time, if there wasn't a coalescing of leadership that saw the need for doing things differently. And those people are not only seeing the need, but walking that talk in terms of saying, “ well, if we're going to do things differently, we to have to think differently first and we have to have the infrastructure in place to support thinking differently, so that we can act differently”. And so I think there are leaders that have that as a modus operandi.
Peter: You mentioned evidence earlier and you referred to evidence from many different sources, from research journals – so research-based evidence, from people's practice, from what patients are going through specifically. So I take it from that, that your view of what is considered evidence is quite broad.
Cathie: It is.
Peter: How do you fit? You know, when you're in this interaction, between these silos, and between these various views of what's going on, and you have these various forms of evidence or various forms of knowledge – how do you bring them together – how do you get beyond the power struggles of “my evidence is better than your evidence”? Cathie: Part of what we do is talk about the value of all of them – not trying to give priority to any one source of evidence but to talk about how, on a practical level, we know that when we make a decision, and it may be a practice decision, it may be a decision about who we're going to go and talk to next about x, y, or z, that we aren't just using one source of evidence, but we may have made our decision based on something we've read about – a new idea. And something someone has told us about someone else who is doing something similar. So we try to bring it back to the practical – to where you live and breath and work and say...so when you make a decision of one sort or another, what sorts of things help you make that decision? And quite often people, when they think about it, recognize they don't use one source of evidence to make a given decision - that they've actually done it by combining a number of different sources. Peter: Right at the beginning of what you just said, you talked about value and making sure that people are getting…that when they're doing things that are producing value or trying to produce value. And so how do you determine value? How do you make sure that you're getting full value? How do you see where value is found? How do you make sure that you are getting more value? Maybe talk about the….you talk about….we can talk about evaluation but really what evaluation is - are we getting the value from this and where is the value found, and being explicit and transparent about that. Maybe talk a little bit about ensuring that you're getting the full value from your processes. Cathie: I'll be honest – it's a challenge. We are living and working in systems that have been doing things the same way for quite some time. And there are people who have been…who are quite comfortable with the same way of doing things. As I've said before, we've tended to go to begin our work in places where people are ready to work differently as opposed to butting heads with people who are going to resist because there is a fair bit of that – that we could be trying to push that brick wall and try and make change where there are areas of high resistance. But it's not a good use of our resources if and in the end, we won't demonstrate the value of something if we haven't actually made a difference. Peter: So you've just talked about a challenge. So what are your greatest challenges? What are some of the barriers that are up in front of you? I know that we've talked about this in some other contexts…it make sense to go into the places that are most likely to change because the barriers are of the least. But we all work within circumstances where there are hurdles. So what are the hurdles here?
Cathie: I'll just preface what I'm going to say by saying that some of the work that I've read around communities of practice and there's a fellow who has been kind enough to mentor me in this area, who has done some writing about the value of barriers and how in our…we don't socialize people very well to think of barriers as something they need to work with. That we tend to talk about barriers in a very negative way and we actually need to think about barriers as a fact of life.
Barriers are something that actually exist and we need to learn how to work with them in order to move forward. Some of the barriers that we're working with right now are barriers related to a very – well to be quite frank – an old model – the medical model and narrow definitions of evidence as research that are tied together in evidence-based practice discussions. Those discussions, quite often have an underlying assumption that if people were given the guidelines, if people knew what best practice was, they would just do it. And I think that's one of our challenges. One of the barriers is finding ways to convey that behavior change – practice change, isn't going to happen by giving people …just give people the guidelines where we tell them what the best practice is…that there has to be…. Peter: So knowing and doing are not the same… Cathie: …thing. Knowing and doing are definitely not the same thing. One of the things that we've talked about in other contexts is the value of relationships and I think one of things that is made invisible within our work is quite often the value added of investing in relationships. That process work about connecting with people and talking with people is quite often seen as a waste of time – if you could just give them the tool – if you could just give them the journal article – if you could just give them the podcast, then all would be solved. But all of those tools need to have structure and process attached to them. They need to have….
Peter:..access isn't utilization necessarily? Cathie: No. They can be there but people won't know where they are. They won't know why they should access them. So people could have the tools, but not use them. One of the really classic examples that I think I ran across early on in this work was someone that I was talking to who was really exited about the fact that she was going to have, potentially, better access to evidence and she was very supportive of the idea of...that health information network partnership that I told her about where – I told you about earlier and I was telling her about – where she would have more easy access to library and services and search services to answer questions that she might have and she said “I just love getting journal articles – I have a stack of journal articles on my desk about a foot deep”. She said, “I just love having them, but I never get a chance to read them”.
Peter: Right.
Cathie: So it's about trying to create the space for actually using all those tools that we have out there. And that's the hard thing to convince people that we need to do. Peter: So this is complex work right? There are a lot of pieces involved and it's emerging so people do things because they expect rewards. So what are the rewards that you expect from this? Where's this going? Cathie: You asked me what I expect personally… Peter: Okay, then we can talk personally. Cathie: ah personally…I actually… Peter: Why do you do this work? Cathie: Why do I do this work?
Peter: Really may be the simple question here.
Cathie: I think I've always, since I was a practitioner in the health system and even before that, I've been curious and I wanted answers to questions that I couldn't readily get so I had to take some time trying to find them. And I come at this in the context that I'm in now, because I really do passionately believe that we can provide health services better than we do now and part of the barrier to that happening is a lack of sharing of information about what's worked in different contexts and why. I passionately believe that we, even from a population health perspective – I'm not just talking acute care services here, which is usually what people tend to talk about when they're talking about evidence-based practice or evidence informed work - but from a population health perspective, we have a responsibility to the next generations to actually take what has been a system that has been held up around the world and keep it there. I can see the opportunity for us to disintegrate very quickly given our human resource issues currently – given what will become, I think – our economic resources – given the growing population. We just can't continue as we are and we need to be really creative about designing a system that meets people's needs when they need it. My commitment to knowledge exchange and transfer or making better use of evidence in practice is about believing that by sharing what we know better than we currently do, we can actually make this a better place to work and live.
Peter: Let's scope out ten years down the road – you have your crystal ball and you're like “okay, we're doing all this work, things are getting into place in the Calgary Health Region here and perhaps shared across the country and internationally”. Ten years down the road, where do you see knowledge exchange to be?
Cathie: When I started this work, when this department was first set up and actually I came on board nine months ago now, I thought to myself that if we're really doing a good job, 10 years from now, the Knowledge into Action Department may not exist because this way of working will actually be a natural way of doing business – openly sharing information within the workplace and across sites within the region, will be the way we will function on a day-to-day basis. And may need to still be centrally facilitated, but won't be centrally run. People within each work site will know what it's all about and will have infrastructure and processes and resources at their disposal so that they can take the time within a day, to reflect on what's happened during that day and say “well tomorrow, I'm going to do this differently and this is what I'm going to do differently and this is what I hope to learn from doing it differently”. I hope that there's less need for us rather than more and I hope that there are fewer barriers rather than more. And I hope that people are collaborating across professional boundaries better than we currently do. And that evidence development is something that we take for granted – that we're all contributing to knowing something better. Peter: That would be good. So that's the end of the questions that I've written down – is there anything that in this discussion, whether a discussion that we've have before or this discussion that we've just had, that you would like to add - something that we haven't covered is kind of burning away? Cathie: One of the things that I've found most valuable is being able to find people within the system who understand what I'm talking about and being able to bounce ideas off of them. If you're leading change of this kind, and it is risky, you do tend to feel a bit isolated at times. But actually it's been really helpful to me that…to know on a national level, there's great interest in what we're doing here in the Calgary Health Region and that within the Region, there's also my very strong supporters for this kind of work so that when I do hit some of those low points, when I feel like I'm not having any success, then I'm able to step back and talk to people and feel better. Peter: Because fundamentally, knowledge exchange is all about people.
Cathie: Yup, it is Peter: Well Cathie, as always, it was a pleasure - thanks Cathie: Thanks Peter.
