Six actions to mobilise knowledge in complex systems

By Bev J. Holmes and Allan Best

What are the practical implications of mobilising knowledge in complex systems? How can the rules, regulations, incentives and long-entrenched power structures of a system be changed so that knowledge mobilisation is maximized?

We propose six interdependent actions, briefly described below, undertaken at two levels, by those who: (1) are managing specific knowledge mobilization initiatives (initiative managers), and (2) are in a position to make the environment more receptive to change (key influencers). These people may not necessarily be involved in specific initiatives.

At either of these two levels, people may also play other roles including:

• Organizational leaders (those with decision making power in health care-related and academic institutions)
• Research funders (eg., National Institute for Health Research in the UK, Canadian Institutes of Health Research in Canada as well as charitable organizations)
• Researchers
• Health care providers
• Government policy makers (ministry staff as well as elected officials)
• Research users (those intended to benefit directly from the knowledge mobilised, including the above as well as patients and the public)

While our focus is on health care systems, the actions are more broadly relevant.

1. Co-produce knowledge

Researchers and research users need to be supported to co-create solutions for health and health care. Knowledge co-production requires role clarity, attention to power imbalances, discussions about rigour versus relevance, and constant monitoring. Initiative managers should resource co-production and make use of existing methods and models or frameworks to ensure that the process is effective. In the key influencers category, funders can offer awards or launch competitions that require a co-production model; organizational leaders in health care can create research positions; and academic leaders and funders can start important discussions on how to make co-production valued in the current “publish or perish” incentive structure.

2. Establish shared goals and shared measurements

Without purposeful discussion to define a problem and establish ideal outcomes, progress is difficult (see also Jane MacMaster’s blog post on barriers to dealing with complex problems in the public sector). But it’s surprising how much work is underway that assumes everyone is on the same page. Focusing people on the shared ‘what’ of a problem helps keep them from advancing their own specific interests, even if they don’t realize they are doing so. It’s up to initiative managers to make it happen, but key influencers can play a role too. For example, funders can require shared goals and measurements as part of applications, and organizational leaders can offer training.

3. Enable and support leadership

Initiative managers should set objectives specifically related to leadership, for example “communicating a clear vision and plan,” and “creating and fostering an environment that supports emergent change.” Key influencers, especially health system and academic leaders, can invest in leadership development at different levels.

4. Ensure adequate resourcing

Initiative managers should set realistic budgets, ensuring they are able to bring on the necessary expertise, for example expert facilitation and communications support. They can budget for the training and mentoring necessary to enable others involved in the initiative to play their part. Key influencers such as funders and organizational leaders should recognize the importance of long term resourcing.

5. Contribute to the science of knowledge-to-action

Initiative managers can draw on the knowledge-to-action literature to plan their activities, capitalising on the increasing evidence of what may work in specific situations. They can also commit to the study of their own initiatives for the benefit of the field overall. Key influencers can encourage the advancement of the field through specific intiatives, and in some cases even require it, for example in the case of funders.

6. Be strategic with communication

Strategic communication is undervalued in knowledge mobilisation. Initiative managers can ensure the development of a strategic communication plan that identifies audiences and sets realistic and measurable objectives for each based on their respective priorities, motivations and other elements of the context in which they work.

What now?

We can all make a commitment to acknowledging complexity in our work – to do what we can individually but also to support and hold others accountable for changing things that aren’t working.

For example, we can all check ourselves and call others out for passive statements like “this needs to happen” and vague statements like “we need to do this” (who is we?).

Realistically, not everyone in the role of initiative manager or key influencer will embrace or even acknowledge the part they could play – especially if they feel they have something to lose or think the ‘negatives’ of change outweigh the ‘positives.’ But those of us who do recognize this potential can commit to the slow-and-steady journey of encouraging, advocating, supporting and holding each other accountable for change.

We can also collaborate to generate empirical evidence on mobilising knowledge in complex systems. This blog post and the paper it is based on offer a set of integrated actions as a starting point. Suggestions for improvement – or better, ideas for comparative case studies – are welcome. Let the conversation begin!

Further reading:
Holmes, B. J., Best, A., Davies, H., Hunter, D., Kelly, M. P., Marshall, M. and
Rycroft-Malone, J. (2016). Mobilising knowledge in complex health systems: a call to action. Evidence and Policy. Open access online (DOI): 10.1332/174426416X14712553750311

To see all blog posts from the partnership with the journal Evidence and Policy:
https://i2insights.org/tag/partner-evidence-and-policy-journal/

Biography: Bev Holmes PhD is Acting President & Chief Executive Officer of the Michael Smith Foundation for Health Research, a research funding agency in British Columbia, Canada. She holds adjunct professor appointments at Simon Fraser University and the University of British Columbia, and has previously worked as a health communications and knowledge translation consultant, researcher and writer. She regularly collaborates on research projects spanning knowledge mobilisation/translation, health communication, and public involvement in health research. Current specific interests include knowledge mobilisation in complexity and health/health care discourse analysis.

Biography: Allan Best PhD is Managing Director for the InSource Research Group, a health services and population health research group in British Columbia, Canada. He is also Associate Scientist at Vancouver Coastal Health Research Institute and Clinical Professor Emeritus in the School of Population and Public Health at the University of British Columbia. His research focuses on systems thinking and organizational change: creating the teams, models, structures and tools that foster effective knowledge to action for health policy and programs that improve the health of the population.