Knowledge Broker Stories: Tinker, Tailor, Soldier, Spy: Building the Science, Practice, and Profession of Knowledge Translation

Story #12

Tinker: to manipulate experimentally

Tailor: to make, alter, or adapt for a particular end or purpose

Soldier: a person who works diligently for a cause

Spy: to discover by close observation or investigate intensively

I fell into the field of knowledge translation without warning.  In 2001, I accepted responsibility and leadership for a provincial project that, ostensibly, involved training practitioners in child and youth mental health organizations to use a standardized outcome measure that would enable them to measure functional improvements in their clients and to manage treatment change.  Use of the tool was mandated by the province, and we were tasked with ramping up 120 provider organizations; number of practitioners – unknown!  This, in itself, was a large undertaking.  In retrospect, there were many things I didn’t know about my assignment when I started. Not the least of which was the term “knowledge translation”.

Training practitioners to learn a new skill is an educational activity, or so I thought at the time.  One develops a training workshop and makes it available to the target audience.  Knowledge is provided orally, through didactic instruction and discussion.  Manuals and other written documentation support learning, and hands-on instruction is provided in how to master the new practice; in this case, how to score, interpret, and use the outcome tool.  A standard is set to measure mastery of the material, and then training is over.  Or is it?

It was probably in the third year of this outcome initiative that I realized the following: 

1. Effective training is not a one-off endeavour,
   
2. training is only the first component of practice change; implementation and adoption must follow,
   
3. many factors influence the change process and need to be addressed, and
   
4. people don’t want to change – this last point is a real sticker! 
   
   

Practitioners we had trained earlier came back requesting refresher training, either because they hadn’t actually used their new skills when they were first trained, and/or because they had experienced significant staff turnover since their original training.  Questions buzzed around me and my team:

Why weren’t people using what they’d learned? 

Why didn’t they see the value of this new skill for their practice and for the kids? 

How could we distribute training expertise and ensure that new staff were trained on-site? 

Why did some organizations embrace the new practice while others waxed and waned or merely blocked us out? 

How could we share the knowledge and enthusiasm of the early adopters with those who were not so keen to change? 

It was about then, as we crested the mountain of our training labours, that we glimpsed the chain of mountains extending beyond.  Oh dear.

Click went the proverbial light bulb!  I was now aware that the assignment was a wee bit more complex than originally envisioned.  The task was not simply training for a new skill.  The task was to enable practice change in thousands of practitioners across the province.  Like most academics, I went to the books and started to read. Surely someone has done this before!  I was quickly immersed in multiple disciplines – business, education, health, and psychology – where I learned that practice change was an emerging field of study, and that while many were beginning to recognize the need for successful ways of changing practice and bringing evidence to the real world, very few had attempted this feat, relatively few had studied it empirically, and fewer still had attempted to change practitioner behaviour on the scale that we were. 

My first inroad into applying what we would now refer to as a knowledge translation strategy came from the work of Jean Lave and Etienne Wenger in communities of practice (1991).  This tried and true approach was proving useful in education, NGOs, and business in facilitating knowledge sharing on specific topics for communities of people. Might this be a useful approach for bringing the early adopters and the laggards together?  Five years of regional communities of practice for practitioners, and one CIHR-funded study later, we know it is. (To date, approximately 6,000 practitioners have been trained to be reliable raters of the outcome measure.)

And in this way, my work on supporting practice change, and the program of research in knowledge translation that is embedded in this systems work has taken shape.  Our team has studied communities of practice as a support strategy for practice change, developed a range of supports to augment the two-day training workshops that enable new learners to maintain ongoing contact with the experts, and we are now exploring the use of social media to support practice change.  A 5-year CIHR Emerging Team grant with colleagues at McMaster is supporting the development and evaluation of an implementation framework that has us working with five child and youth mental health provider organizations and two school boards to figure out how to bring evidence-based practices into schools and mental health centres. 

All the while, my foray into knowledge translation has followed another path.  As I’ve watched the field develop over the last decade, it has been apparent that there are new developments in both the science and the practice of knowledge translation.  With respect to the latter, this has been most evident in the rise of knowledge translation positions within health care organizations, educational institutions, community-based and volunteer sector organizations.  I have taken an interest in these postings, whenever they found themselves in my ‘in’ box, and have met many of the people who have filled them.  Many have found their way to the Ontario Knowledge Translation and Exchange Community of Practice, formed by me and my SickKids colleagues in collaboration with the Institute for Work and Health and the Health Systems Research and Consulting Unit (HSRCU) at CAMH.  The KTE CoP has met three or four times a year since 2005, and we have helped one another learn about KT practice, methods, and science.  Around the same time, my colleagues at HSRCU and I were funded by CHSRF to develop and evaluate a knowledge translation training workshop for scientists, the purpose of which is to help health scientists understand how KT plays a role in their science, how to engage with multiple stakeholders, and how to develop KT plans for science and measure the impact of their work.  The Scientist Knowledge Translation Training© course continues to be offered through the SickKids’ Learning Institute. 

These two activities coupled with a growing market for KT Managers, KT Directors, and KT Specialists highlighted, for me, the need to develop professional training for individuals seeking careers in knowledge translation – as practitioners, not as clinicians or scientists.  And so, the Professional Certification in Knowledge Translation is in the making.  Sponsored by The Hospital for Sick Children and its Learning Institute, and with the support of the University of Toronto’s School of Graduate Studies and Continuing Education for Professional Development office, work is underway to survey KT professionals across Canada and to develop a competency framework and curriculum.   A link to the KT professionals survey will be posted on the Learning Institute website and the KTE CoP website, and circulated widely, in late January 2010.

It’s an inspiring area to be working in, and I greatly value all I have learned along the way, thus far, from my KT colleagues – the scientists, the practitioners, and the community partners who have joined us on the journey!  There are new mountains ahead and much to tinker, tailor, and spy for this soldier.

Melanie A. Barwick, Ph.D., C.Psych.

The Hospital for Sick Children

To cite:

MLA format

Barwick, Melanie, "Knowledge Broker Stories: Tinker, Tailor, Soldier, Spy: Building the Science, Practice, and Profession of Knowledge Translation.” Weblog Entry. Knowledge Mobilization Works Blog. Posted January 3, 2010. Accessed (enter date).http://bit.ly/7xlBz6

APA format

Barwick, M. Knowledge Broker Stories: Tinker, Tailor, Soldier, Spy: Building the Science, Practice, and Profession of Knowledge Translation. Retrieved (enter date) from http://www.knowledgemobilization.net [http://bit.ly/7xlBz6]

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