Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation

Document Type : Original Article

Authors

1 Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia

2 Green Templeton College, University of Oxford, Oxford, UK

3 Adelaide Dental School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia

4 Institute of Dentistry, Queen Mary University of London, London, UK

5 Alliance Manchester Business School, University of Manchester, Manchester, UK

6 Faculty of Health and Medical Sciences, The Joanna Briggs Institute, University of Adelaide, Adelaide, SA, Australia

7 Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia

Abstract

Many representations of the movement of healthcare knowledge through society exist, and multiple models for the translation of evidence into policy and practice have been articulated. Most are linear or cyclical and very few come close to reflecting the dense and intricate relationships, systems and politics of organizations and the processes required to enact sustainable improvements. We illustrate how using complexity and network concepts can better inform knowledge translation (KT) and argue that changing the way we think and talk about KT could enhance the creation and movement of knowledge throughout those systems needing to develop and utilise it. From our theoretical refinement, we propose that KT is a complex network composed of five interdependent sub-networks, or clusters, of key processes (problem identification [PI], knowledge creation [KC], knowledge synthesis [KS], implementation [I], and evaluation [E]) that interact dynamically in different ways at different times across one or more sectors (community; health; government; education; research for example). We call this the KT Complexity Network, defined as a network that optimises the effective, appropriate and timely creation and movement of knowledge to those who need it in order to improve what they do. Activation within and throughout any one of these processes and systems depends upon the agents promoting the change, successfully working across and between multiple systems and clusters. The case is presented for moving to a way of thinking about KT using complexity and network concepts. This extends the thinking that is developing around integrated KT approaches. There are a number of policy and practice implications that need to be considered in light of this shift in thinking.

Highlights

Commentaries Published on this Paper

  • Knowledge Translation in Healthcare – Towards Understanding its True Complexities; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”

          Abstract | PDF

  • Connections, Communication and Collaboration in Healthcare’s Complex Adaptive Systems; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”

          Abstract | PDF

  • Applying KT Network Complexity to a Highly-Partnered Knowledge Transfer Effort; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”

          Abstract | PDF

  • Using Complexity to Simplify Knowledge Translation; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”

          Abstract | PDF

  • From Linear to Complicated to Complex; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”

          Abstract | PDF

  • The Paradox of Intervening in Complex Adaptive Systems; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”

          Abstract | PDF

 

Authors' Response to the Commentaries

  • The Knowledge Translation Complexity Network (KTCN) Model: The Whole Is Greater Than the Sum of the Parts - A Response to Recent Commentaries

          Abstract | PDF

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References

  1. Schuster M, McGlynn E, Brook R. How good is the quality of health care in the United States? Milbank Q. 1998;76:517-563.
  2. Sung NS, Crowley WF, Genel M, et al. Central challenges facing the National Clinical Research Enterprise. J Am Med Assoc. 2003;10(10):1278-1287.
  3. Runciman WB, Coiera EW, Day RO, et al. Towards the delivery of appropriate health care in Australia. Med J Aust. 2012;197(2):78-81.
  4. Kline SJ, Rosenberg N. An overview of Innovation. In: Landau R, Rosenberg N, eds. The Positive Sum Strategy: Harnessing Technology for Economic Growth. National Academies Press; 1986:275-305.
  5. Haines A, Jones R. Implementing findings of research. Br Med J. 1994;308:1488-1492.
  6. Landry R, Amara N, Pablos-Mendes A, Shademani R, Gold I. The knowledge-value chain: a conceptual framework for knowledge translation in health. Bull World Health Organ. 2006;84(8):597-602.
  7. Graham ID, Tetroe J. Nomenclature in translational research. JAMA. 2008;299(18):2149. doi:10.1001/jama.299.18.2149-a
  8. Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care. 1998;7:149-158.
  9. Harvey G, Fitzgerald L, Fielden S, et al. The NIHR collaboration for leadership in applied health research and care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy. Implement Sci. 2011;6:96.
  10. Ferlie E, Dopson S, Fitzgerald L, Locock L. Renewing policy to support evidence-based health care. Public Adm. 2009;87(4):837-852.
  11. Dopson S, Fitzgerald L. Knowledge to action? Evidence-based health care in context. Oxford: Oxford University Press; 2005. doi:10.1093/acprof:oso/9780199259014.001.0001
  12. Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A. An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs. 2004;13:913 - 924.
  13. Greenhalgh T, Wieringa S. Is it time to drop the 'knowledge translation' metaphor? A critical literature review. J R Soc Med. 2011;104(12):501-509. doi:10.1258/jrsm.2011.110285
  14. Drolet BC, Lorenzi NM. Translational Research: Understanding the continuum from bench to bedside. Transl Res. 2011;157(1):1-5.
  15. Lander B, Atkinson-Grosjean J. Translational science and the hidden research system in universities and academic hospitals: a case study. Soc Sci Med. 2011;72:537-544. doi:10.1016/j.socscimed.2010.11.019
  16. Ferlie E, Fitzgerald L, Wood M. Getting evidence into clinical practice: an organisational behaviour perspective. J Health Serv Res Policy. 2000;5(2):96-102.
  17. Denis JL, Lehoux P. Organizational theory. In: Strauss S, Tetroe J, I G, eds. Knowledge Translation in Health Care. London: Wiley-Blackwell & BMJ Books; 2009.
  18. Davies H, Nutley S, Walter I. Why 'knowledge transfer' is misconceived for applied social research. J Health Serv Res Policy. 2008;13(3):188-190. doi:10.1258/jhsrp.2008.008055
  19. Resnicow K, Page SE. Embracing chaos and complexity: A quantam change for Public Health. Am J Public Health. 2008;98:1382-1389.
  20. Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT. How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts. Soc Sci Med. 2013;93:194-202. doi:10.1016/j.socscimed.2012.05.040
  21. Paley J, Eva G. Complexity theory as an approach to explanation in healthcare: A critical discussion. Int J Nurs Stud. 2011;48:269-279. doi:10.1016/j.ijnurstu.2010.09.012
  22. Tenbensel T. Complexity in health and health care systems. Soc Sci Med. 2013;93:181-184. doi:10.1016/j.socscimed.2013.06.017
  23. Graham ID, Logan J, Harrison MB, et al. Lost in Knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26:13-24.
  24. Kitson A, Powell K, Hoon E, Newbury J, Wilson A, Beilby J. Knowledge translation within a population health study: how do you do it? Implement Sci. 2013;8:54. doi:10.1186/1748-5908-8-54
  25. Fraser SW, Greenhalgh T. Coping with complexity: educating for capability. Br Med J. 2001;323:799-803.
  26. Lissack M. Complexity: the science, its vocabulary, and its relation to organisations. Emergence. 2000;1(1):110-126.
  27. Orr MG, Plautt WC. Complex systems and health behaviour change: insights from cognitive science. Am J Health Behav. 2014;38:404-413.
  28. Provost SM, Lanham HJ, Leykum LK, Reuben RMJ, Pugh J. Health care huddles: managing complexity to achieve high reliabilility. Health Care Manage Rev. 2015;40:2-12. doi:10.1097/HMR.0000000000000009
  29. Hannigan B. Connections and consequences in complex systems: Insights from a case study of the emergence and local impact of crisis resolution and home treatment services. Soc Sci Med. 2013;93:212-219. doi:10.1016/socscimed.2011.12.044
  30. O'Sullivan TL, Kuziemsky CE, Toal-Sullivan D, Corneil W. Unraveling the complexities of disaster management: a framework for critical social infrastructure to promote population health and resilience. Soc Sci Med. 2013;93:238-246. doi:10.1016/j.socscimed.2012.07.040
  31. Chandler J, Rycroft-Malone J, Hawkes C, Noyes J. Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice. J Adv Nurs. 2016;72(2):461-480. doi:10.1111/jan.12815
  32. Brainard J, Hunter PR. Do complexity-informed health interventions work? A scoping review. Implement Sci. 2016;11(1):127. doi:10.1186/s13012-016-0492-5
  33. Harvey G, Marshall RJ, Jordan Z, Kitson AL. Exploring the hidden barriers in Knowledge Translation: A case study within an academic community. Qual Health Res. 2015;25(11):1506-1517. doi:10.1177/1049732315580300
  34. Rycroft-Malone J, Kitson AL, Harvey G, McCormack B, Seers K, Titchen A. Ingredients for change: revisiting a conceptual framework. Qual Saf Healthcare. 2002;11. doi:10.1136/qhc.11.2.174
  35. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008;3:1. doi:10.1186/1748-5908-3-1
  36. Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016;11:33. doi:10.1186/s13012-016-0398-2
  37. Westfall JM, Mold J, Fagnan L. Practice-Based Research- "Blue Highways" on the NIH roadmap. J Am Med Assoc. 2007;297(4):403-406.
  38. Woolf SH. the meaning of translational research and why it matters. J Am Med Assoc. 2008;299(2):211-213.
  39. Khoury MJ, Gwinn M, A IJP. The emergence of translational epidimiology: From scientific discovery to population health impact. Am J Epidemiol. 2010;172:517-524.
  40. Brook AH, Liversidge HM, Wilson D, et al. Health research, teaching and provision of care: applying a new approach based on complex systems and a knowledge translation complexity network model. International Journal of Design & Nature and Ecodynamics. 2016;11(4):663-669. doi:10.2495/DNE-V11-N4-663-669
  41. Caldarelli G, Catanzaro M. Networks. Oxford: Oxford University Press; 2012.
  42. Barabasi A-L. Linked. London: Plume, Penguin Books Ltd; 2003.
  43. Mitchell SA, Fisher CA, Hastings CE, Silverman LB, Wallen GR. A thematic analysis of theoretical models for translational science in nursing: Mapping the field. Nurs Outlook. 2010;58:287-300.
  44. Page SE. Diversity & Complexity. Princeton: New Jersey: Princeton University Press; 2011.
  45. Holland J. Complexity. A Very Short Introduction (Series). Oxford, UK: Oxford University Press; 2014.
  46. Trenholm S, Ferlie E. Using complexity theory to analyse the organisational response to resurgent tuberculosis across London. Soc Sci Med. 2013;93:229-237. doi:10.1016/j.socscimed.2012.08.001
  47. Rhodes ML, Murphy J, Muir J, JA. M. Public Management and Complexity Theory: Richer Decision-Making in Public Services. Abingdon: Routledge; 2011.
  48. Stacey R. Complexity and Creativity in Organizations. San Francisco: Berrett-Koehler; 1996.
  49. Eidelson RJ. Complex Adaptive Systems in the Behavioral and Social Sciences. Rev Gen Psychol. 1997;1(1):42-71.
  50. Miller JH, Page SE. Complex Adaptive Systems: An introduction to computational models of social life. Princetone: Princeton University Press; 2007.
  51. Mitchell M. Complexity. A guided tour. New York: Oxford University Press Inc; 2009.
  52. AlQahtani SJ, Hector MP, Liversidge HM. Accuracy of dental age estimation charts: Schour and Massler, Ubelaker and the London Atlas. Am J Phys Anthropol. 2014;154(1):70-78. doi:10.1002/ajpa.22473
  53. Brook AH, Brook O'Donnell M, Hone A, et al. General and craniofacial development are complex adaptive processes influenced by diversity. Aust Dent J. 2014;59:13-22. doi:10.1111/adj.12158
  54. Fischer MD, Dopson S, Fitzgerald L, et al. Knowledge leadership: Mobilizing management research by becoming the knowledge object. Hum Relat. 2016;69(7):1563-1585. doi:10.1177/0018726715619686
  55. McKeon S. Strategic Review of Health and Medical Research: Better Health Through Research (Final Report).  http://www.mckeonreview.org.au/downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013-Final_Report.pdf.  Accessed September 10, 2015. Published 2013.
  56. Fitzgerald L, Harvey G. Translational networks in healthcare? Evidence on the design and initiation of organizational networks for knowledge mobilization. Soc Sci Med. 2015;138(8):192-200.
  57. Bornbaum CC, Kornas K, Peirson L, Rosella LC. Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health-related settings: a systematic review and thematic analysis. Implement Sci. 2015;10:162. doi:10.1186/s13012-015-0351-9
  58. Kislov R, Waterman H, Harvey G, Boaden R. Rethinking capacity building for knowledge mobilisation: developing multilevel capabilities in healthcare organisations. Implement Sci. 2014;9:166. doi:10.1186/s13012-014-0166-0
  59. Carlile PR. A pragmatic view of knowledge and boundaries: boundary objects in new product development. Organ Sci. 2002;13(4):442-455. doi:10.1287/orsc.13.4.442.2953
  60. Sharif N. Emergence and development of the National Innovation Systems concept. Res Policy. 2006;35(5):745-766. doi:10.1016/j.respol.2006.04.001
  61. Greenhalgh T, Raftery J, Hanney S, Glover M. Research impact: a narrative review. BMC Med. 2016;14:78. doi:10.1186/s12916-016-0620-8

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History

  • Receive Date: 11 March 2016
  • Revise Date: 30 June 2017
  • Accept Date: 01 July 2017
  • First Publish Date: 01 March 2018

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