Friday, August 28, 2015

Knowledge Broker, My Next Career

Marie Prothero RN, MSN, FACHE
PhD Student University of Utah College of Nursing



What is a Knowledge Broker?

Do you believe there is a gap between practice and research?  Do you wonder if your patients are receiving the most clinically relevant care? If you answered yes to either of these questions then you may need a knowledge broker.  A knowledge broker is an intermediary between the people who produce research (scientist) and those who use it (policy makers, general public and people working in healthcare).   A knowledge broker works to bridge the gap that exists between these two groups. 
Close to two million research papers are published each year in 28,000 journals.  Last year the Food and Drug Administration approved 41 drugs and in 2013 27 new drugs were approved.  When you start to compound these numbers year and after year it’s no wonder healthcare providers are unable to keep up with current research.  Synthesizing, analyzing and translating relevant research findings are complex and require a specific set of skills.  One strategy that might resolve this dilemma is the implementation of a Knowledge Broker.

Knowledge brokering is the process of bringing people together for the purpose of moving knowledge forward.  Knowledge Brokers work to let end users know about current research and work with researchers to make their work more accessible and meaningful to healthcare providers and policy makers.  This translates to transferring knowledge from one group to another in order to foster implementation of clinical research and at times, create new knowledge. 

Examples of successful implementation
In 1996 the Canadian government founded The Canadian Health Services Research Foundation  with the purpose of establishing a knowledge broker group.  This organization has individuals with expertise in healthcare and research.  Their goals include bringing researchers and decision makers together to identify gaps in research and fund the researchers who investigate those gaps.  The final outcome of this work was to bring healthcare leaders, patients and families, and researchers together in a collaboration to find optimum solutions to current healthcare issues.
Another successful example includes Healthcare Improvement Scotland.  This organization uses apps to help guide physicians and other providers to sift through the large number of research articles and find the most cost effective solutions.  They scrutinize research to establish clinical evidence to solve some of their most pressing issues to improve patient care.  This organization also provides regulatory oversight to the hospitals in Scotland. 

What does it take to be a successful Knowledge Broker?
  • Opinion leader and an entrepreneurial spirit
  • Credibility in research and practice settings
  • Excellent communicator, must be able to translate research into easy to understand practical information
  • Negotiator of both the research and decision making environments
  • Be able to see and think about the big picture
  • Build relationships and ask researchable questions
  • Problem solver, innovator and change agent
  • Be able to present one-on-one and in large groups

Driving forces to push this paradigm shift forward

The need to identify and implement evidence based practice continues to be a top priority.  Effective knowledge exchange depends on groups of individuals with common concerns, values and a desire to work together.   There is an increased need for research to reach all levels and have a big impact to society and the economy.  In a highly competitive world market knowledge has become increasingly important. 
Passive dissemination of research has not been as successful as one would hope (Haynes & Haines, 1998).  Hospitals continue to struggle with full implementation of CMS core measures in the care of stroke, anterior myocardial infarction, pneumonia and venous thrombosis prevention.  

Researchers and users do not speak the same language nor do they have the same incentives.  A Knowledge Broker could facilitate the lack of common language, culture, unspoken rules to bring both parties together. 

Barriers to adoption/Why has this concept not been more widely accepted?

One barrier to adoption is finding the right person for the job.  Most experts in research stay in research and experts in the practice setting often are lacking skills to analyze and synthesize research.  Additional barriers could be funding of the position and the need to develop the skills and credibility to maneuver between both settings?  

Organizations must also commit and support research implementation.  This can be difficult without support from all levels of management in an organization.   Many organizations struggle to implement change particularly in practice settings where evidence base practice implementation is not embedded in the culture of the organization. 

Academic structure promotes grant procurement and academic publication over engagement with health service.  Researcher to researcher collaboration is well organized while the opposite of researcher to practitioner interchanges about implementation of research findings is sporadic.  Structures and incentives in healthcare organizations do not do any better in advancing scientific research.  Most healthcare organizations are focused on market share, cost reduction and containment, and regulatory compliance.  Unless the healthcare setting is part of a large academic setting they are not equipped to translate the plethora of research into practice.   The lack of understanding and recognition from both sides continue to push both parties apart.

Do Knowledge Brokers have a future?
The practicality of KB is still being scrutinized.  There are examples in the literature that suggest they play a role in assisting with knowledge dissemination and implementation.  However an important note in the literature is the credibility of the KB with both groups and their ability to promote collaborative relationships and networks.  A continued focus on designing implementing and evaluating solutions may further the need for KB or it may eliminate the need.
Individuals who are facilitating this work may not always be called a “knowledge brokers”.  Often they are called change agents, facilitators, technology transfer officers, knowledge translators and innovative brokers.

Nurses at all levels of an organization must take all opportunities to engage with researchers to solve problems and generate new knowledge whenever possible.  The nursing profession must also identify research needs and lobby for an active role in the research process.  
When an organization decides to utilize a KB they must commit financial resources and personnel time in order to create a positive change.  Many organizations may want to move in this direction but simply don’t know how.  Knowledge brokers will need to continue to market their value to researchers and healthcare providers.

K* (Star) Initiative was established in the United Kingdom to help knowledge brokers organize and create a support system.  This organization is facilitating knowledge brokers with the tools they need to be successful in their jobs.  Most examples of knowledge brokering are in countries with a single payer model (socialized medicine).  This may be one reason why coordination of resources and implementation of evidence based practice has become some important. 

Future Implications: Is it right for me?
Knowledge brokering is somewhat new and seems to be gaining momentum in healthcare to fast-track the exchange of knowledge between research, practice and policy environments.  Working as a nurse, nurse administrator, hospital administrator and quality director has given me skills to communicate and mediate at all levels of a healthcare organization.  My next endeavor is to build my skills as a nurse researcher.  Could combining my new research skills with my previous skills facilitate my role as a knowledge broker?  My desire to advance science where it matters most is at the bedside.  This new and exciting role as a knowledge broker could be my next career.

References:
Clark, G., & Kelly, L. (2005). New directions for knowledge transfer and knowledge brokerage in Scotland: Scottish Executive Social Research.

Haynes, B., & Haines, A. (1998). Getting research findings into practice: Barriers and bridges to evidence based clinical practice. BMJ: British Medical Journal, 317(7153), 273.

Holgate, S. (2008). Emerging professions: Knowledge broker. Science.
Lomas, J. (2007). The in-between world of knowledge brokering. BMJ: British Medical Journal, 129-132.

Meyer, M. (2010). The rise of the knowledge broker. Science Communication, 32(1), 118-127.

Ward, V., House, A., & Hamer, S. (2009). Knowledge brokering: the missing link in the evidence to action chain? Evidence & Policy: a Journal of Research, Debate and Practice, 5(3), 267.

Ward, V. L., House, A. O., & Hamer, S. (2009). Knowledge brokering: exploring the process of transferring knowledge into action. BMC Health Services Research, 9(1), 12.

Wright, N. (2013). First-time knowledge brokers in health care: the experiences of nurses and allied health professionals of bridging the research-practice gap. Evidence & Policy: a Journal of Research, Debate and Practice, 9(4), 557-570.

Links to Resources
Canadian Health Services Research Foundation http://www.chsrf.ca/
Healthcare Improvement Scotland http://www.healthcareimprovementscotland.org
Knowledge Broker by PHCRIS: https://www.youtube.com/watch?v=knUj6HjsHro


This work is by Marie Prothero and is licensed under a Creative Commons Attribution 4.0 International License



1 comment:

  1. Great Blog posting Marie. I am testing the comments option.

    ReplyDelete