Instead of being translated from research to practice, knowledge could be better conceptualised as being continually and dynamically exchanged. Circular models may not be sufficient to detail the complex exchange of different forms of knowledge that occur when identifying the most appropriate research finding to answer a clinical question, and then implementing and sustaining change within complex healthcare environments. An alternative dynamic model has been promoted to describe the way knowledge is actually exchanged in practice.
Five important components have been identified from a synthesis of theoretical models of knowledge exchange and they have been tested in three team based projects in healthcare organisations. While each component is separate, they occur together and have different relative importance throughout the whole project of using research to change practice.
1. Problem identification requires agreement about an important issue that needs improvement or change. While activity is greatest at the beginning of the project, there is a need to continue to clarify, focus and review the clinical problem over time. It is often difficult to fully understand the problem at the beginning of a project, and there is a need to be flexible to new information and perspectives.
2. Analysis of the context requires the identification and exploration of unique personal, interpersonal, organisational and professional influences and characteristics, which could both facilitate or constrain activities.
3. Locating and tailoring knowledge requires an assessment of the relevance, credibility and usefulness of various types of knowledge. This is likely to be influenced by professional, geographic and organisational contexts. It is most useful when relevant knowledge can be classified and coded for everyday language and use.
4. Knowledge exchange interventions need to be clarified, before they can be implemented. There is usually an iterative process of negotiation and monitoring that enables knowledge to be integrated into normal tasks. Knowledge exchange interventions include information management, linking people together, learning from the process and supporting decision making.
5. Knowledge use occurs directly, conceptually and politically, with different types of knowledge being used at different times. It is important to identify practical ways to spread and sustain knowledge use.
What is unique about this model is that these five components do not occur in a set sequence; instead they all occur together, but with different patterns of emphasis. At the beginning of each project, high levels of problem identification, context analysis and choice of knowledge exchange interventions are evident. As the projects develop, there is a greater emphasis on locating and tailoring knowledge. Towards the end of the projects there is an emphasis on implementing knowledge exchange interventions, and using knowledge.
Further the process of knowledge exchange is acknowledged to be a social and political phenomenon, where professional identities and cultural norms influence changes in individual beliefs and behaviours.The knowledge which was needed to solve the original problems came from many people and places across the organisation and was not limited to high quality research evidence. Many knowledge exchange activities were required and the use of knowledge was an integral part of each project, rather than a just an outcome.
Therefore future initiatives could benefit from looking beyond changing individual behaviour or organisational contexts, towards understanding how different types of knowledge and people are involved in processes of knowledge exchange.