In the last blog I presented, I discussed the concept of knowledge brokering and how it is operationalised within CLAHRC WM. I apologised for too much ‘management speak’, but at the same time threatened more of this in connection with a concept that underpins our implementation research theme, ‘absorptive capacity’ (ACAP). Since its inception, ACAP has been seen as a core element of increasing critical review capacity for R&D units in private sector firms, which is an idea now spilling over to healthcare for the development and implementation of evidence-based service delivery.   There are two dimensions of the concept particularly relevant to implementation research in CLAHRC WM. The first dimension is four stages of knowledge mobilisation crucial for developing ACAP:
- acquisition of knowledge;
- assimilation of knowledge;
- transformation of knowledge;
- exploitation of knowledge.
The second dimension of the ACAP concept are its antecedents, otherwise known as ‘combinative capabilities’, which encompasses systems capability, socialisation capability, and co-ordination capability. In this blog, I am going to deal with the four stages of knowledge mobilisation crucial for developing ACAP, and leave combinative capabilities for another day.
Rather than consider ACAP in R&D units in private sector firms, or healthcare commissioners (the subject of another NIHR HS&DR study I currently lead) and healthcare providers (the subject of a study I recently completed, which was also funded by NIHR HS&DR, examining the translation of patient safety knowledge), I am going to indulge myself and illustrate ACAP stages through evidence-based fly fishing for trout. It’s a great time of year to go fly fishing for trout, but unfortunately I am stuck in the office doing my day job. The next best thing is to write about it, and indeed I am still trying to think of a way to smuggle an analysis of fly fishing into an organisation studies journal. Maybe this blog is the beginnings of that.
Let’s start with the first stage of developing ACAP, that of acquisition of knowledge. The type of knowledge content (component knowledge) we might acquire to catch those trout relates to:
- What fly is best (e.g. hatching currently)?
- Do I use a sinking, intermediate or floating line?
- What are the weather conditions and its effect on the trout?
- At what depth might trout be at a certain time of the day or year?
- What is the topography of the lake, and where might I best fish?
- What speed might I best retrieve the fly?
The sources of this knowledge are many, but broadly, I might consult texts or internet sites, and then on arrival at the water seek out those already fishing or the fishery manager, to elicit local, current knowledge. Of course, I have a store of tacit knowledge related to what happened at this water last year, which I have been reflecting upon as I drove towards the venue for fishing. In short, acquisition of knowledge is not necessarily the challenge, particularly because the fly fishing fraternity are a friendly and open bunch towards sharing of knowledge. In healthcare, there is also a plethora of knowledge around, often held as data and information, which is readily accessible. Whilst some of the healthcare fraternity may be more or less open to knowledge sharing, nevertheless I contend knowledge acquisition is the least challenging dimension of ACAP in healthcare compared to assimilation, transformation and exploitation.
Moving onto assimilation of component knowledge, this proves more of a challenge for evidence-based fly fishing. What component knowledge do I privilege? Is it the fly selection that is likely to work? Might I catch on any fly, if I get the depth right? Or is it more about the speed of retrieve? How might I vary my fly fishing in different parts of the water? I can see trout taking flies on the surface, but it is windy so I lack control of presentation of my flies with a floating line. Further, whilst the textbook suggests a certain set of tactics, the local fly fishing fraternity have local knowledge at odds with this. What constitutes the best evidence – generic or local? Anyway, I have a gut feeling, based on years of experience, that the trout will chase brightly coloured lures today. Have I to follow my instinct? It’s worked before. Maybe I should ask the trout? Drawing parallels with healthcare, there are competing sources of knowledge, which may be at odds with each other, and intuitive clinical judgement may prove correct. Also the abstracted, more generic evidence doesn’t seem to fit. Maybe I should privilege what the patient thinks is best?
Assuming I do package different sources and components of knowledge in a coherent way, I have a fly fishing intervention, constituting transformation of knowledge. Let’s try it out. I have gone for a team of ‘buzzers’ (in essence a nylon line attached to the floating fly line, from which I hang pupae), which I let drift in the wind in a corner of the lake into which the wind is blowing. Bang, bang, within an hour I have caught four trout, but of a smaller size. In the following hour, the ‘takes’ dry up. So my ‘pilot’ intervention, resultant from acquisition, assimilation and transformation of knowledge, has worked to some extent, but only for a particular size of trout and I am unsure exactly why this has worked. When not catching fish, the rule in fly fishing is to change tactics and move around. What’s changed? The sun has come out, which might mean the trout are feeding deeper (they have no eyelids!). The wind has dropped a bit, so the buzzers are more static than drifting. It has become warmer. How do I adapt what was previously successful, so that it works more generically. How do I scale it up so it works in all circumstances? What is the panacea for catching big trout? This represents exploitation.
If I could exploit knowledge at the final stage of ACAP development to complement what I have done so far in evidence-based fly fishing, I would catch trout regularly. However, it might then be rather predictable and boring. The variation, including a frustrating ineffectiveness of chosen tactics on some days, is the essence of fly fishing. This is where evidence-based fly fishing and healthcare service delivery diverge. In healthcare, we are seeking to identify and scale up what works for all patients. CLAHRCs are at the heart of such acquisition, assimilation, transformation and exploitation of knowledge to deliver best care for all patients. Maybe my evidence-based fly fishing metaphor doesn’t hold for translational health research after all.
Next time, combinative capabilities, and why their absence explains why Aston Villa is threatened with relegation this year (only joking).
- Lane PJ, Koka BR, Pathak S. The reification of absorptive capacity: a critical review and rejuvenation of the construct. Acad Manage Rev. 2006; 31(4): 833-63.
- Berta W, Teare GF, Gilbart E, Ginsburg LS, Lemieux-Charles L, Davis D, Rappolt S. Spanning the know-do gap: Understanding knowledge application and capacity in long-term care homes. Soc Sci Med. 2010; 70(9): 1326-34.
- Ferlie E, Crilly T, Jashapara A, Peckham A. Knowledge mobilisation in healthcare: A critical review of health sector and generic management literature. Soc Sci Med. 2012; 74(8): 1297-304.
- Harvey G, Skelcher C, Spencer E, Jas P, Walshe K. Absorptive capacity in a non-market environment. Pub Manage Rev. 2010; 12(1): 77-97.
- Zahra SA, George G. Absorptive capacity: a review, reconceptualization, and extension. Acad Manage Rev. 2002; 27(2): 185-203.
- Van Den Bosch FAJ, Volberda HW, de Boer M. Coevolution of form absorptive capacity and knowledge environment: Organizational forms and combinative capabilities. Organ Sci. 1999; 10(5): 551-568.