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JCPSLP
Volume 14, Number 1 2012
Journal of Clinical Practice in Speech-Language Pathology
through conferences, publications, and other forms of
written material does not work and will not ensure
consistent or effective transfer of evidence (Kagan et al.,
2010; Sudsawad, 2007). This point was made clear in the
Molfenter et al. (2009) study, where didactic teaching was
not enough to translate use of a new therapeutic tool into
practice. For system change to occur, “interactive
engagement” is needed between “those who create the
knowledge, those who disseminate it, and those who can
use it” (Lomas, cited in Kagan et al., 2010, p. 540). Perhaps
not surprisingly, research findings are most likely to be
“used in practice” when the clinician (or service) is linked to
a study or project from the outset (Kagan et al., 2010). For
example, in both the Molfenter et al. (2009) and Simmons-
Mackie et al. (2007) studies clinicians were engaged from
the planning phase and able to identify their own KTA goals
and needs. Their input facilitated engagement and “buy-in”
with commitment to KTE. It is only through actively
engaging “front-line service providers” and administrators
that sustainable, long-term changes to service quality (and
policy) can be made (Kagan et al., 2010).
Evaluate, measure, and disseminate change
It is of critical importance that the outcomes of any
implementation project are measured systematically to
determine success and to contribute to the evidence base
for knowledge transfer. Outcomes should be measured at
the level of the health professional (e.g., change in practice,
knowledge, or attitudes), the patient or consumer (e.g.,
improved client satisfaction or outcomes), and/or the
service itself (e.g., change in policy, programs, or staffing
ratios). Molfenter et al. (2009) and Simmons-Mackie et al.
(2007) provide useful examples of ways to measure
outcomes. To illustrate, Molfenter and colleagues (2009)
used a “blind assessor” not involved in the KTA intervention
to interview clinicians and collect feedback about the
success of the project. Simmons-Mackie et al. (2007) also
conducted interviews and focus groups with their
participants to explore changes in knowledge, attitudes,
and practices. When working within a KTA framework
“sustained knowledge use” is vital and requires inclusion of
follow-up measures to ensure that robust changes in
practice are made and clearly demonstrated (Molfenter et
al., 2009). Kagan et al. (2010) state that sound
methodology for evaluating the results and success of
knowledge transfer is critical and that a strategy for
dissemination of findings should be determined at the
outset. Considering the key message of the research, the
key stakeholders to engage, and the best ways for sharing
the results to support and facilitate further transfer into
practice are important, continuing the knowledge action
cycle (Graham et al., 2006; Kagan et al., 2010).
Ensure continued KTE dialogue between
clinicians and researchers
The final theme to emerge emphasises that effective
knowledge transfer is dependent on effective
communication between researchers and “end users”,
ensuring appropriate and well targeted use of best evidence
in practice (Graham et al., 2006; Kagan et al., 2010;
Molfenter et al., 2009). This exchange must be bi-
directional, mutually inclusive, and cyclical. Researchers
play an important role in ensuring that research findings are
synthesised and disseminated in an “accessible format for
end users” (Macdonald & Wiseman-Hakes, 2010, p. 486),
by adopting “practice-friendly research” (Small, 2005, p.
327). Furthermore, it is important that scientific findings
have relevance to situations of practice and address areas
KTA intervention. As an example, Molfenter et al. (2009)
clearly identified a gap in dysphagia rehabilitation, whereby
clinicians had learnt about a new therapeutic tool
(
knowledge creation
), but had failed to translate its use into
everyday practice (
knowledge action
). The clinical scenario
presented is similar: clients are not able to reap the benefits
of trialled and tested interventions. In reality, identifying “the
gap” is often the easiest, but most crucial, step in a
translation project. Such gaps often make their way quickly
on to departmental wish lists or to-do plans; however,
finding the time, resources, and sometimes the confidence
to address them can be more difficult and the right KTE
strategies or frameworks can thus be useful.
Use clients as partners and agents
for change
Another key message to emerge is that the most success
ful translation projects are those conducted in partnership
with clients or consumers (Kagan et al., 2010; Simmons-
Mackie et al., 2007). As a profession we need to be creative
in how we survey and gather information from our clients
about treatment services and service delivery models as
satisfaction data can provide a powerful impetus for change.
Engaging and empowering our clients also encourages
them to participate more actively in their own treatment and
demand the highest level of care. The recommendation has
been made that more energy should be directed into
informing our clients and key stakeholders about current
best evidence to enable them to become drivers of
knowledge transfer. Kagan et al. (2010, p. 541) highlight the
need to identify “credible messengers” who may best
contribute to a “tipping point” in ensuring that research is
translated into practice. One choice might be a client with
aphasia and their families; others could include champions
in the field. Finding the right spokesperson may determine
the power and capability of a translation project (Kagan et
al., 2010). Simmons-Mackie et al. (2007) identified not
involving the right spokesperson as a limitation of their
research and strongly encourage including consumers or
clients in the planning and evaluation of KTA interventions.
Identify readiness for and barriers
to change
Simmons-Mackie et al. (2007) demonstrate the importance
of identifying potential barriers to change in the planning
(and evaluation) stages of an implementation project. In this
study, systems-level change was made in two out of the
three facilities involved in the project. While positive
changes in attitudes, knowledge, and service were seen in
the rehabilitation and long-term care facilities, the outcomes
were not as positive in the acute care setting and pervasive
systems-level change was not achieved. It is extremely
important that such “negative results” are reported and
shared with the professional community, providing
information about barriers and variables that influence
systems change and knowledge translation (Simmons-
Mackie et al., 2007). Assessing team readiness for change
is another important consideration and once “local barriers”
are identified, KTA interventions can be tailored accordingly.
KTA models and frameworks guide clinicians through this
process, enabling them to
adapt knowledge
to the local
context (Graham et al., 2006).
Form partnerships and collaborations as
drivers of change
Knowledge transfer and exchange are dynamic and
interactive processes and strategic partnerships play a
critical role. Passive dissemination of research findings