TY - JOUR
T1 - Creating conditions for effective knowledge brokering
T2 - a qualitative case study
AU - Burns, Prue
AU - Currie, Graeme
AU - McLoughlin, Ian
AU - Robinson, Tracy
AU - Sohal, Amrik
AU - Teede, Helena
N1 - Funding Information:
Established in 2008, The Program is an ongoing policy intervention that aims to improve the efficiency, effectiveness, and quality of care in hospital health services, by enabling hospitals to redesign care processes. This enablement work hinged on introducing process improvement knowledge into the jurisdiction, and encouraging its adoption by frontline medical professionals. At the inception of The Program, most health services possessed neither the capability nor the capacity to achieve the required improvements to care delivery; process improvement was novel knowledge to most frontline medical professionals. Recognising this to be a serious problem, policy makers sought to transfer new process improvement ideas and practices (specifically, Lean thinking and its derivatives) into 30-plus health services. Central to the policy intervention was the funding and training of full-time knowledge broker positions (henceforth, “Improvement Advisors / IAs”), who were embedded in participating health services. Policy makers commissioned the delivery of training in improvement methods and techniques for IAs, who were then tasked with building the improvement capacity of the clinical and managerial workforce in the health services where they were employed. IAs were supported by executive sponsors, who were drawn from the ranks of senior management and clinical leadership within the host health service. Critical to the policy intervention was its capacity building aims; it was not the intention of the policy intervention for IAs to actually do the process improvement work themselves, but rather to educate, guide, facilitate, and support frontline workers to improve the processes affecting their work. However, some IAs occasionally became “hands on” in their roles, and participated in or conducted some of the actual process redesign. Nevertheless, the ambition of the intervention was to achieve the wide-scale integration of improvement knowledge into frontline practice by enabling frontline medical professionals to lead improvement projects themselves. This was expected to generate sector-wide improvements and system-level impact, because manifold health services would possess the know-how to improve care delivery. However, when our research commenced in 2015, it was already clear via an independent evaluation that this expectation had not come to fruition []. This was due to a number of issues revolving mainly around governance, management, organizational culture issues, and the engagement of senior medical professionals. The lack of clinical engagement was reportedly an especial frustration of knowledge brokers. Some knowledge brokers connected clinical engagement problems to broader issues of organisational culture, citing insufficient expertise and understanding of process improvement at the governance and executive levels of the hospital in which they worked. At some hospitals, uncompelling leadership on the issue of improvement led to the intervention being saddled with a low-profile and no sense of urgency amongst staff, which stymied knowledge brokers’ efforts to engage their clinical colleagues. These matters proved significant barriers to embedding process improvement into clinical practice. While the individual projects within participating hospitals achieved meaningful returns-on-investment, the upshot of these challenges meant that the primary aim of the intervention, at this early stage of its existence, had not successfully transfused process improvement knowledge into the everyday practices of frontline medical staff.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022
Y1 - 2022
N2 - Background: Process improvement in healthcare is informed by knowledge from the private sector. Skilled individuals may aid the adoption of this knowledge by frontline care delivery workers through knowledge brokering. However, the effectiveness of those who broker knowledge is limited when the context they work within proves unreceptive to their efforts. We therefore need greater insight into the contextual conditions that support individuals to broker process improvement knowledge to the frontline of care delivery, and how policy makers and organizations might generate such conditions. Methods: Our research took place in a healthcare system within an Australian State. We undertook a qualitative, embedded single case study over the four year period of a process improvement intervention encompassing 57 semi-structured interviews (with knowledge brokers, policy makers, and executive sponsors), 12 focus groups, and 137 h of observation, which included the frontline implementation of actual process improvement initiatives, where knowledge brokering took place. Results: We identified four phases of the process improvement intervention that moved towards a more mature collaboration within which knowledge brokering by improvement advisors began to emerge as effective. In the first phase knowledge brokering was not established. In the second phase, whilst knowledge brokering had been initiated, the knowledge being brokered lacked legitimacy amongst frontline practitioners, resulting in resistance. Only in the fourth and final phase of the intervention did the collective experience of policy makers result in reflections on how they might engender a more receptive context for knowledge brokering. Conclusion: We highlight a number of suggested actions that policy makers might consider, if they wish to engender contextual conditions that support knowledge brokering. Policy makers might consider: ensuring they respect local context and experience, by pulling good ideas upward, rather than imposing foreign knowledge from on high; facilitating the lateral diffusion of knowledge by building cultural linkages between people and organizations; strengthening collaboration, not competition, so that trans-organisational flow of ideas might be encouraged; being friend, not foe, to healthcare organizations on their knowledge integration journey. In sum, we suggest that top-down approaches to facilitating the diffusion and adoption of new ideas ought to be reconsidered.
AB - Background: Process improvement in healthcare is informed by knowledge from the private sector. Skilled individuals may aid the adoption of this knowledge by frontline care delivery workers through knowledge brokering. However, the effectiveness of those who broker knowledge is limited when the context they work within proves unreceptive to their efforts. We therefore need greater insight into the contextual conditions that support individuals to broker process improvement knowledge to the frontline of care delivery, and how policy makers and organizations might generate such conditions. Methods: Our research took place in a healthcare system within an Australian State. We undertook a qualitative, embedded single case study over the four year period of a process improvement intervention encompassing 57 semi-structured interviews (with knowledge brokers, policy makers, and executive sponsors), 12 focus groups, and 137 h of observation, which included the frontline implementation of actual process improvement initiatives, where knowledge brokering took place. Results: We identified four phases of the process improvement intervention that moved towards a more mature collaboration within which knowledge brokering by improvement advisors began to emerge as effective. In the first phase knowledge brokering was not established. In the second phase, whilst knowledge brokering had been initiated, the knowledge being brokered lacked legitimacy amongst frontline practitioners, resulting in resistance. Only in the fourth and final phase of the intervention did the collective experience of policy makers result in reflections on how they might engender a more receptive context for knowledge brokering. Conclusion: We highlight a number of suggested actions that policy makers might consider, if they wish to engender contextual conditions that support knowledge brokering. Policy makers might consider: ensuring they respect local context and experience, by pulling good ideas upward, rather than imposing foreign knowledge from on high; facilitating the lateral diffusion of knowledge by building cultural linkages between people and organizations; strengthening collaboration, not competition, so that trans-organisational flow of ideas might be encouraged; being friend, not foe, to healthcare organizations on their knowledge integration journey. In sum, we suggest that top-down approaches to facilitating the diffusion and adoption of new ideas ought to be reconsidered.
KW - Australia
KW - Healthcare policy
KW - Knowledge brokering
KW - Process improvement
KW - Receptive context
UR - http://www.scopus.com/inward/record.url?scp=85140906578&partnerID=8YFLogxK
U2 - 10.1186/s12913-022-08559-1
DO - 10.1186/s12913-022-08559-1
M3 - Article
C2 - 36309675
AN - SCOPUS:85140906578
VL - 22
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 1303
ER -
