Theory and practice of knowledge brokers – Diffusion, Leadership and Patient Fellows in CLAHRC WM

Knowledge brokering is increasingly seen as a panacea for the problem of translating evidence-based innovation into practice. More specifically, a ‘knowledge broker’, someone who, “gets the right knowledge into the right hands, at the right time,” is prescribed as a solution to the translation problem, not just in health and social care,[1] but as a longer standing phenomenon in the private sector.[2] [3]

The concept of knowledge broker provides the starting point for the design of CLAHRC WM processes and structure to ensure effective collaboration across research and practice. Within CLAHRC WM, we have developed three types of knowledge broker:

  • Diffusion Fellows
  • Leadership Fellows
  • Patient Fellows.

Each of these types have distinct, but interdependent roles, in translating evidence-based innovation into practice. This is not a new idea, nor is it distinctive to CLAHRC WM. All CLAHRCs commissioned 2008-13 encompassed knowledge brokers in some form. For example, within CLAHRC Birmingham and Black Country (CLAHRC BBC) (forerunner to CLAHRC WM), John Middleton’s facilitation of the programme linking data on home improvement with data on hospital admissions to drive improvement in service, represented a classic example of an effective knowledge broker.

What is different this time, at least within CLAHRC WM, is understanding that the presence of knowledge brokers is necessary, but not sufficient, for translation of evidence-based innovation into practice. First, knowledge brokers tended to be limited in number; e.g. one or two connected to each of the studies within a CLAHRC. As such, they generated no more than a ripple in any regional healthcare system, and this was only within the discrete service to which they are attached. Second, they were commonly limited to the middle of a healthcare organisation; e.g. a senior nurse or doctor in a service domain that CLAHRC intended to impact [4]; and so exerted less influence upon strategic levels of the organisation than was required to scale up interventions and learning. Responding to these limits, CLAHRC WM has extended the number and range of knowledge brokers, to encompass not just those in the middle of healthcare organisations (Diffusion Fellows), but those at senior levels (Leadership Fellows), and those receiving care (Patient Fellows).

What do different types of knowledge broker do? As in CLAHRC BBC, those in the middle, Diffusion Fellows, work into and out of specific research studies within a service theme. Working into the research study, they may help define the problem in the first place, co-produce the design of the research, and/or comment upon emerging analysis in the course of the research. Working out of the research study, they help engage stakeholders important to translate evidence-based innovation into practice, through developing communities-of-practice [5] and facilitate the often complex management of change (e.g. in workforce roles and leadership arrangements) necessary for service improvement. Meanwhile, Leadership Fellows are responsible for maintaining visibility of CLAHRC WM at strategic levels of health and social care organisations, and ensuring the efforts of CLAHRC are aligned and integrated with organisational strategy where relevant. For example, if a CLAHRC WM partner is bidding for ‘new business’ in an area within which CLAHRC studies are taking place, then this should be invoked in support of the bid. My previous experience in another CLAHRC suggests this is not always the case. Meanwhile, Patient Fellows ensure that the patient and carer experience is considered (and actioned) as an important source of evidence in improving service, and potentially helping scale-up service improvements. Their role is likely to prove wide-ranging as they work into academic teams and practice partners to ensure that the patient and carer experience is not marginalised relative to evidence related to cost considerations, clinical effectiveness or frontline professional experience, when pursuing service improvement.

Third, CLAHRC WM is not just about ‘knowledge brokers’, but about ‘knowledge brokerage’. This is not just a semantic difference, but an important practical one. Effective translation of evidence-based innovation into practice, despite the extension of numbers and levels of knowledge brokers within CLAHRC WM, depends upon more than the agency of individuals, however influential such individuals are within health and social care organisations and systems. The organisations and systems themselves represent an infrastructure that may inhibit or facilitate translation. For example, professional organisation can be fragmented or hierarchical in a way that retards the translation of evidence-based innovation.[6]  Meanwhile managerial organisation might be one orientated towards compliance with policy pressures, rather than towards organisational learning necessary for service improvement.[7] So, at the same time as we introduce ‘knowledge broker’ into the CLAHRC WM system, we need to introduce ‘knowledge brokerage’ to mediate the effect of professional and managerial organisation upon translation of evidence-based innovation into practice. This is a matter of ‘absorptive capacity’ [8] [9] and ‘co-ordination capability’,[10] but that’s enough ‘management speak’ for one blog.

–Graeme Currie
Deputy Director CLAHRC WM, Implementation & Organisation Studies Lead.

References:

[1] Currie G, White L. Inter-professional barriers and knowledge brokering in an organizational context: the case of healthcare. Organ Stud. 2012; 33: 1333-61.

[2] Hargadon AB, Sutton, R.  Building an innovation factory. Harvard Bus Rev. 2000; May-June: 157-66.

[3] Verona G, Prandelli E, Sawhney M. Innovation and virtual environments: Towards virtual knowledge brokers. Organ Stud. 2006; 27: 765-88.

[4] Rowley E, Morriss R, Currie G, Schneider J. Research into practice: Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire and Lincolnshire. Implement Sci. 2012;7: 40.

[5] Lave J, Wenger E. Situated learning: Legitimate peripheral participation. Cambridge: Cambridge University Press. 1991.

[6] Martin GP, Currie G, Finn R, McDonald R. The medium-term sustainability of organisational innovations in the National Health Service. Implement Sci. 2011; 6:19.

[7] Burgess N, Currie G. The knowledge brokering role of the hybrid middle manager: The case of healthcare. Brit J Manage. 2013; 24(s1): s132-42.

[8] Cohen WM, Levinthal DA. Absorptive capacity: A new perspective on learning and innovation. Admin Sci Quart. 1990; 35: 128-52.

[9] Zahra SA, George G. Absorptive capacity: a review, reconceptualization, and extension. Acad Manage Rev. 2002; 27: 185-203.

[10] Volberda HW, Foss NJ, Lyles MA. Absorbing the concept of absorptive capacity: How to realize its potential in the organization field. Organization Science. 2010; 21: 931-51.

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