The translation of health research and innovation into public health policy and practice is at the basis of improving population health and providing the best health care services. The knowledge that is produced by researchers such as those within CLAHRC CP is intended to find its way along a pathway to the patient, but this pathway is a complex journey starting with knowledge creation and knowledge synthesis and then moving towards knowledge exchange, dissemination and then meaningful interactions between a multiplicity of academics, policy makers, educators, decision-makers and service providers. Knowledge does not make its own way along this path, there are may theories of how it can be ‘pulled’ and ‘pushed’ towards its goal, there is no one way to achieve the ultimate aim, and context is everything, but the basic pathway can be depicted as a number of fundamental steps. Knowledge (evidence/research) to practice pathway.
The need to actively manage this process has been Department of Health policy since the Cooksey Report was published which described a pathway for the translation of health research into healthcare improvement, identifying two gaps in the translation pathway, the T1 and T2 gaps. The CLAHRCs were set up to address the T2 gap and methods to bridge this gap that are utilised include health services research and knowledge managtement.
At the basis of all implementation science/knowledge translation theory is the need for a common language to create a collaborative working environment between all these different role players. Cultural differences between academic, policy and service environments can lead to communication misunderstandings, perpetuation of ‘silo’ working and a gulf between research, policy and practice. It is now recognised that there is a need for knowledge brokers, who operate as go-betweens linking all these parties together.
Greenhalgh and colleagues used the term ‘knowledge purveyors’ in How To Spread Good Ideas,their important research into diffusion, dissemination and sustainability in the NHS.(1) Methods for adoption and implementation of innovation also include using ‘change agents’ to facilitate change of clinical practice within primary, secondary and tertiary care.
By applying methods of improvement science we aim to ensure that quality of service redesign is consistent and successful. A major part of the success of our implementation strategy is the engagement of clinical commissioners and NHS service providers in the process. Another key factor is increasing research capacity which is fundamental to the adoption of research and innovation. The CLAHRC CP has increased the capacity for applied health research and innovation in the region through a programme of CLAHRC Fellowships. We have also increased the range of decision tools to help decide which of many potential innovations will lead to best value for the NHS and social care; it is not often acknowledge that not everything that is new is effective or indeed that not every intervention we currently use is the most clinically and cost effective.
Knowledge exchange within mental health care pathways depends on creating mechanisms and processes to ensure that clinicians and social care practitioners can engage with research. Stakeholders play an active role in developing research and transforming services, based on evidence.
Within the CLAHRC we also aim to research and understand the nature of the mechanisms of knowledge translation, identifying the key concepts of adoption, implementation, and sustainability, and evaluation, while recognising fundamentals such as the context of every potential intervention. We aim to add to the knowledge base of successful dissemination and implementation strategies as well as preparing the ground for implementation of CLAHRC CP research.
In CLAHRC CP, much of the activity in the themes is project focused, but our overall aim is to improve services and care pathways beyond project timescales, and embed the capacity and capabilities in staff and organisations to continue improving services. We seek to embed appropriate implementation tools, concepts and models within the research. We have a unique, multi-disciplinary approach to implementation which brings perspectives from business (Judge Business School), public health (Institute of Public Health) and engineering design (Engineering Design Centre). The collaboration is very much about applied research. It is testing new ways of working in specific clinical areas to see if they are effective and appropriate for everyday use in the health service.
(1) Greenhalgh, T. How to spread good ideas. A systematic review of the literature on diffusion, dissemination and sustainability of innovations in health service delivery and organisation. 2004.