Integrating knowledge translation and systems thinking for organizational change

Description

This method provides a critique of knowledge translation (KT) and how organizational change is conceptualized in health care systems. Integrating systems thinking with KT models may provide a more realistic and accurate perspective of how organizational change occurs in health care settings, and support how research evidence can be applied in practice.

Systems thinking is increasingly being used to support KT initiatives. To see examples of KT interventions that have used systems thinking to move evidence into practice, see resources from the Public Health Agency of Canada and Butler et al., 2010.

Key arguments in this paper include the following:

• Systems thinking involves a shift from examining linear, cause-and-effect events to examining inter-relationships between people and stakeholders involved in a change process.
• Health care systems are dynamic, complex systems where an action can have very different effects on different parts of the system, at different points of time, and have unintended consequences.
• Organizational change, or the innovation journey, involves people developing and implementing new ideas through their relationships with others and making adjustments to achieve desired outcomes within an institutional and organizational context.
• Organizational change in health care settings is a complex, multilevel process where context exerts a significant influence. Adopting new knowledge is contingent on organizational culture, group norms, etc.
• Trained experts who function as facilitators are needed to support organizational change processes. (To learn more about the importance of context and facilitation in KT, see the Promoting Action on Research Implementation in Health Services Framework).

Steps for Using Method/Tool

Integrating knowledge translation (KT) with systems thinking is based on five propositions:

1. KT is a necessary but not sufficient mechanism to transform systems.
2. The ‘system-as-machine’ metaphor is profoundly unhelpful to knowledge translation.
3. The health care system is best viewed as a complex entity.
4. Successful innovation is a function of the level of local autonomy experienced by individuals, teams and the unit involved.
5. Innovation is most effective when it involves key stakeholders.

Successful KT to support organizational change in health care settings involves:

• the way in which participants (individuals) in the system understand the nature and characteristics of the new piece of knowledge and accept it;
• the level to which they can make informed, autonomous decisions about how they can use the new knowledge to improve outcomes;
• how they negotiate and renegotiate relations with others (individuals, teams, internal, external relations) in their system; and
• how they attract necessary resources to sustain the changes/improvements in practice.