Research findings need to be translated into information that is meaningful for clinicians, managers, policy makers, patients and their families. There is a need to exchange and transform knowledge between those producing and using it. Not only do clinicians need to be able to understand and apply the research evidence, but organisations need suitable leadership structures and a culture to value research. Successful knowledge translation is therefore an interactive and reciprocal process that requires consideration of the nature of the research evidence, the clinical context and methods to change practice.
There is an inherent challenge in building the evidence for how to do this. Most research evidence is focussed on specific implementation plans for particular clinical scenarios or problems. There are only a few theoretical models for incorporating research evidence into healthcare practice. Two will be introduced here.
The Canadian Health Research Foundation has emphasised a dynamic model of pushing researchers to communicate clearly, pulling research evidence for policy making and exchanging research priorities for clinical practice needs. At its core are relationships between researchers, clinicians and managers. Commonly, doctoral students who were experienced managers and clinicians, learn about research. They utilise their familiarity with their own healthcare systems to integrate research into everyday practice. Just-in-time teaching experiences are designed to be responsive to the clinical setting. Projects that have organisational support are the focus for change and improved evidence-informed practice.
In the UK, the National Institute for Health Research (NIHR) has established Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) to use research in clinical practice. Eight core principles have been identified to drive implementation:
- healthcare professionals draw on different sources of evidence beyond research
- research evidence needs to be interpreted in context, and in relation to other competing priorities
- implementation is an iterative, cyclical and interactive process
- the environment of proposed change needs careful evaluation, in consultation with key stakeholders
- effective multi-faceted interventions need to be adapted to respond to the unique context
- relationships and networks need to be created for learning and sharing information
- unique implementation structures and leadership processes are required to manage change
- co-production of knowledge enhances its relevance and transferability to practice
At the end of the day, there is a need for researchers and clinicians to have shared ownership about how research findings inform clinical care at the individual and organisational level.