Surely the creation of knowledge for use is a simple and noble endeavour that just needs a little help in translating the key information between two different audiences! How can the complex issues of power and politics influence this? This question has been troubling me recently as I see so much evidence of knowledge being manipulated, withheld and even actively avoided. I don’t want to indulge in paranoid thinking or conspiracy theories.
Therefore, I have turned back to what I know best – the theoretical literature – to try and understand some of the underlying challenges. I think it comes down to conceptualising knowledge. Knowledge is differentially defined by its creators and users. In academic worlds, evidence-based knowledge refers to the ability to distinguish effective interventions from those that are useless or at worst, harmful. In healthcare management worlds, knowledge is often about organising efficient and quality services and ensuring positive performance at many different levels. For healthcare clinicians, it is often about providing the best care you can at the time, in the system you are in, for the patient in front of you. For patients, it is often about knowing enough of the potential benefits and harms of possible interventions to make a shared decision with the healthcare professional. Further, these process of creating knowledge assume different hierarchies of knowledge, where certain types of knowledge are seen as more powerful because they are more rigorous, applicable, or important.
Therefore, the metaphor of simply packaging or translating knowledge for use by another is insufficient. We need to better understand the underlying hierarchies and processes of knowledge creation and utilisation. The systematic creation and organisation of knowledge is not just the business of academics, but rather it is core business for most professionals. However, the type of knowledge, its context and the system of storage and access are inevitably different. Further, most individuals will use whatever sources of knowledge are easily accessible and make sense for them. Over time, hierarchies are established and aspects of power are attributed to ‘successful’ sources.
Further the way in which knowledge is used is often more than just its instrumental use, of enacting what should be done. Knowledge can also influence our attitudes and ultimately organisational cultures. There are often questions about why and how knowledge is required and whether there are the appropriate resources in the physical environment, appropriately trained staff, supportive organisational cultures and appropriate management. Where knowledge is perceived as more powerful, barriers may be better managed and its use may be actively facilitated.
Therefore, the challenge of making research knowledge accessible and easy to use is truly interactive and multi-faceted. While the way in which research evidence influences the knowledge, attitudes and behaviour of managers, policy makers, clinicians, patients is being investigated, we need reliable and resilient explanations, alongside an understanding of the power of knowledge hierarchies.