Peter: Whereas what you've just said is increasingly good leaders are asking risky questions, in public formats so that they open it up to everybody that's in the room because they are usually smart people assembled in that room, to get their input - to say that collectively “we don't know, so how do we find out?”. And here's the leader, I think part of going back to your vision, as saying “if we can find out, here's the return”. Irving: Sure, but it's usually politically incorrect – right? I mean that the point Peter, for me is that you asked about the characteristics of leadership. I guess one of them is to be willing to ask the politically incorrect questions.
Peter: Okay.
Irving: So in the health sector for instance, people are starting to say things like “do we need to revisit the Canada Health Act?”. Nobody would have asked that 20 years ago.
Peter: Right Irving: Liberals are asking it now. Right - people are asking these questions. It's because they're realizing that only by asking those questions are we going to get the true meaningful answers about…and we may get the answer that “no we don't want to revisit it”. But…you know, those are the questions we need to be looking at. Would the health sector run equally well or better in Canada as a business, as opposed to a moral obligation of the Government?
Peter: We don't know? Irving: We don't know. We have this arrogance with the sense that we know without the evidence that it oughtn't be. But I guess that's the tension between evidence and other forms of knowledge and at the presentation yesterday – actually it was very interesting because Allan Hudson created this diagram of where he was showing on the left side of the diagram, the processes that lead to decisions from the evidence but then on the right-hand side he had all the processes that lead to decisions that are political. And as they came together, he made the argument is that this spectrum right - some decisions are made that are purely political and the MRI machine goes to riding of Jonquière because it's a swing riding - the Government wants to secure those votes – that's where the MRI goes - purely politically driven decision. On the left-hand side would be a purely health economical based algorithm. These are the places in Canada where the MRI machines should go. His argument is MRI machines are not placed according to either of those pure models. They're hybrids of the two. And that the real leaders, the person who's able to figure out where on that spectrum a decision should be made - balancing formal evidence based types of knowledge with other inputs into the process. His point was we don't have many leaders in the Canadian health sector who are willing or comfortable to do that. Peter: So what kind of culture – you talk about culture change – what kind of culture would grow more leaders that would be willing to do that?
Irving: I think we need to stop reifying knowledge. I think we have to stop thinking that research based evidence provides us with a type of knowledge that trumps others. A systematic review only tells you that this is what the current research says. It doesn't tell you what is – that's a huge difference. The current research is only a fundamental reflection of what current researchers have asked or past researchers have asked. But that's not a function of what is or what ought to be. In the health sector particularly, we get into decisions that are not necessarily about what is, but what ought to be. And sometimes what ought to be, factors in much more than…. The CHEO example – my client – I use it every time I speak about this issue – right? Do we shut down the Pediatric Cardiac Care Unit in Ottawa? The answer was “no”, it flew in the face of the research evidence and I think it was a wise decision. I think the Government made the right decision by rejecting the research evidence. But we can't call that a non-evidence based decision and I guess that's the cultural shift that we need. That was an evidence-based decision it just wasn't an evidence dictated decision. Peter: That's actually a really important point that there are other forms of knowledge and the evidence seems to be something that people are comfortable with because of the certainty related to it. Irving: That's right. Peter: But what you're saying is that the certainty is narrow. It's only around the things that we've currently have asked questions about, that we've written about, that we've collected. So there's in fact, much more knowledge than shows up in terms of evidence… . Irving: Absolutely.
Peter: and we risk…we're risking something. Irving: We have this crazy idea that research is unbiased. I mean as a sociologist, my fundamental academic training is on questioning all kinds of knowledge and on questioning research knowledge particularly.
Peter: What a culture of life-long learning does….says is that everybody knows something. And so how do we learn from one another and how do we support that ongoing learning?
Irving: And it's about de-privileging those that have been historically privileged. Peter: How do you do that? That's fundamentally a question of power. Irving: It is… Peter: So how do we share power that's Irving: It's funny certain disciplines are better than others. My father is 72 as I said, no formal education beyond I think, the first year of university. He started university and ended up working for financial reasons. Worked in the private sector for many, many years - ended up working as Vice-President of a major chain of hardware stores. Anyway, when he was 65, he spent five years teaching at Concordia University in the School of Business, I mean this is a man who didn't have a Bachelors degree. But the School of Business at Concordia said, “wait a minute, this is a man who's got a ton of …who embodies a ton of tacit knowledge”. I gotta tell you that it's very rare that you would find an academic discipline that would hire a professor and give professor status to someone without a bachelor's degree. They got it, but most don't. So who knows more for instance, about deviance? A drug addict who's lived on the street for ten years, or someone with a PhD in Criminology? De-privileging those with certain types of credentials I think, is absolutely critical to this process of life-long learning. My father was able to transfer 55 years of private sector experience running a retail chain, to students. Had we just gone by the normal academic model of PhD plus publications and tenure equals a faculty position, those students would not have had access to his knowledge. So that's what life-long learning is for me. Peter: Well that's interesting because what I hear and what you're saying is that the University recognized a great value in the experience of your father and further value in the exchange between your father and students. Irving: Absolutely Peter: That would allow them to further go out into the world and create more value. Let's talk about value and how do you create value through learning and knowledge exchange and knowledge transfer? Because I think there's been an underestimation of the value process - the value propositions that… Irving: No because we can't count it… Peter: Right, so how do we move beyond…you talk about the reification of academic knowledge, and I think we fetishize things that we can count. And so how do you move beyond that, especially if we want a culture because a culture is a very difficult thing to count?
Irving: So is leadership and that's why leadership suffers. That's why leadership suffers – we're really good at pumping out of our universities, people with really high grades and high levels of intellect and formal knowledge and the ability to regurgitate things that they've read and they've studied for - the leadership suffers because we can't count it. There's no scale. I can't attach some instrument to your body and have it spin out a coefficient that tells me how good a leader you are so that's why it suffers…right. Peter: So what are…in the work that you do now, which is a really an interesting kind of position, and you told me in a previous discussion that we had, that the full value of your organization and the people that it represents, was not being realized and you were helping to change that. And so what are the most valuable relationships that you have now and when you don't have what you need, where do you go? Irving: Oh that's a really interesting question. Well in my life, this is other… where do I go? I go to people with whom I've had a meal with. I mean it sounds so ridiculous but I don't trust anyone I haven't had a meal with and so in my process of working here and in my process of building relationships between members of our organization and other stakeholder organizations, I sit down and have a meal with people. It sounds ridiculous.
Peter: You're saying that dinner is a form of knowledge transfer? Irving: Oh, I've always said that – at Canadian Health Services Research Foundation, one of the earliest battles I had when I started there was dealing with university departments who refused to allow catering expenses on research grants. Even research grants that had significant knowledge transfer portions. And I used to phone the universities and say “look, it's actually a requirement of our researchers that they do this stuff. So this relationship building is critical and you need the grease that lubricates those relationships and that's usually an informal setting – some type of food process. And we know this - the literature actually demonstrates that there's...the irony is that there's research that shows this - that people are much more likely to listen to what you have to say and to be open to your opinion and ideas during the various points in the social interaction and it's usually…I believe it's in the first third of a meal but I'd have to go back and consult the research but I do know it's expressed in terms of a meal. Peter: Well that's really interesting because what I've heard is that some of the real basics of knowledge exchange and knowledge transfer are things that, as humans, we already do… Irving: Absolutely Peter: And do really well. Irving: You know Peter, what is new is acknowledging that these are important processes. We actually know how to interact quite well. Every kid knows….kid….every 15 year old child knows, or 16 year old child knows, you don't ask your dad if you can have the car before he's had his cup of coffee… So why is it that we think that the best way to influence a decision maker in the health system is to go into their office at 3:00 when they are trying to end their day and they're tired and they've had a long day and they're 3 hours from lunch – from when they've had their last meal, and we think that that's the best time to go in and tell them that this is where you need to put the MRI machine. That's ridiculous right? The best place to do that is over some social encounter where you say, “look, I have some information I've gathered in my research, that might help you in the whole MRI decision”. That's where the window is. Peter: But I think one of the challenges that people will run into is – and it goes back to our question around power – is some people have access to decision makers and other people don't have access. Irving: Absolutely.
Peter: And so how do you deal with that? How do you deal with that imbalance that some opinions get heard and some don't? Irving: Well, I mean how do you deal with it? The first step is you acknowledge it and you accept it – we're not going to change that. And so that is why we have lobbyists – that is why we have associations and organizations who's sole mandate is to influence public policy. We're not going to get around that, that's just the way it is. Peter: Okay so where does the evidence fit within that? I mean one of the criticisms of the face-to-face, the lobbying, what not, is that it's opinion driven. Irving: Ya but again, if you take Allan Hudson's point – if you want to influence a decision… Peter: It's both… Irving:…you need to be hitting it from both sides. I do not believe in purely….you know when I say…and again, I'm overstating this for the sake of making my point right, I mean I don't just take people for dinner all the time – but at the end of the day there's got to be some evidence or research base or knowledge base that's credible for me to put forward. I'm not just there to say, “I think”. Irving: No one cares what I think.
Peter: So what you're saying is that it's not one way or another way? Irving: It has to be… Peter: …both Irving: It has to be both. Peter: Multiple sets Irving: That's right. Those of us that try to use the research as a self…as an obvious item that ought to be incorporated without using those other factors and understanding the other types of evidence that go into the equation, will never succeed. And those of us that try to do advocacy work or influence the public – public policy, using only ideological arguments, are also never going to win.
Irving: It's got to be balancing the two and that's what knowledge transfer is about. Peter: So you've got ten years of experience, let's draw upon your vision and think ten years into the future - where do you see knowledge exchange, knowledge transfer – that whole….the field? Irving: It will be gone.
Peter: It will be gone?
Irving: It will be gone and we'll all be smiling and saying “isn't that funny that it took us 20 years to recognize the importance of what humans have known forever?”. I really, really believe that. This is not…I'm reminded of Andy Hargadon, who's based at UC Davis, and his book How Innovation Happens I believe is the title of the book. And his premise is…his thesis is, that there are no new ideas, there's no invention anymore, that there's just the recombination of things that we know from other contexts. Knowledge transfer is no different – nothing has been created here. We've just realized “gee…this thing that we know intrinsically, also works here”. And so in ten years, my hope is that we will have moved way beyond….
Peter: That we won't call it - in the business world for instance, we won't call it knowledge management we'll just call it management. Irving: Ya, ya exactly - it's part of the process Peter: it's part of the process. Irving: Exactly and I think that's what's happening in the health sector with these new MBA – big executive MBA programs and the linkages between academic disciplines, people are realizing that in the administration and the running of our health sector, there's a role for research and there's a role for public opinion and there's a role for all of those factors and it all goes together. And I think that we won't consider good managers within our health system, unless they are people who do all these things together and consult their research as a matter of course. Peter: And do you think that this is a society-wide movement – would you say the same thing about education?
Irving: No I don't. Peter: Where are some of the more risky areas where this is not happening?
Irving: See and that's the important thing Peter is I've been in the health sector for a decade, and I'm only now starting to look outside, out of my own interests. And we haven't caught up - criminal justice is the example that I use a lot now because I have a criminology degree and I can tell you that our North American - well it's probably a global phenomenon, but at least our North American vision of crime and justice is completely devoid of any research based evidence. And so in the health sector I think we're ahead of the curve. The environment is another fantastic example of, and in fact, I'm speaking at a conference on knowledge brokering for the environment and that…my talk will be talking about that …there's an enormous body of knowledge that - about the environment, that hasn't made it's way into public policy. And it isn't because of the lack of research - I mean this is a great case because it makes my argument – there's no dearth of research. The scientific community knows but there's been no, what I call knowledge transfer going around. And it's been because of those…so what we need to do for instance, is as a society, is look at the successes of KT in the health sector, and start moving those into the environment discourse. And I guarantee you we'll see success. Peter: Okay.
So then maybe that's where the future lies – is looking at the areas that are underserved and helping to grow it here. So that what you just said about vision, about leadership, about multiple ways of bringing this together, and about basic human relationships happens in all sectors that affect us.
Irving: Absolutely and if I….and I guess, I find it somewhat frustrating to see our country spend millions of dollars in the name of knowledge transfer within our health system, which is a system that is globally one of the best - it's not a broken system – it has some squeaks – but I look at areas like the environment and realize that this is a pending global catastrophe. Peter: Right.
Irving: Public policy needs the investments and the processes, such as KT processes and we're not making those investments. Peter: What would it take to make those investments?
Irving: Well this is not meant so sound egomaniacal but someone like me, moving sectors – that's what it takes. It takes leaders who've sort of mastered this discourse and can point to success stories within a field like heath to say “you know what, I'm going to move into another sector now to try to bring these messages to another sector”. That's what it takes because someone has to shake it up there. But there needs to be somebody championing non-threatening…the creation of neutral spaces for the exchange of knowledge and information, which is what KT is all about.
Peter: Okay and I think that actually a pretty good place to close. Is there anything that we haven't discussed that you would like…..some final words. Irving: Peter, I have no idea what we've discussed. This has been the most non-linear conversation about KT I've ever engaged in. It's probably the most interesting as well. No I think we've probably hit it all. Peter: Good, well thanks.
