KT in action: Manitoba's The Need To Know Team
Patricia J. Martens, PhD, Manitoba Centre for Health Policy, University of Manitoba
Sarah Bowen, PhD, University of Manitoba and the Winnipeg Regional Health Authority
Randy Fransoo, MSc, Manitoba Centre for Health Policy, University of Manitoba
The Need To Know Team
Manitoba's The Need to Know Team fosters collaborative, population-based health research between rural and regional health authorities, the province's department of health, and researchers at the Manitoba Centre for Health Policy. With a focus on new knowledge creation and development, individual and organizational capacity building, and research dissemination and application, the Team has made important contributions to rural and regional health planning in the province, and has won national recognition as a best practice model for knowledge translation (KT).
Stories can be powerful motivators of change. Our story—the origins of Manitoba's The Need To Know Team, the successes and challenges we have experienced in KT and the outcomes of this collaboration—is about what can be achieved when researchers and decision makers truly collaborate in research and its translation into action.
The realization that better research could result from user collaboration led to the vision, and eventual birth, of The Need To Know Team.
The Need To Know Team is a collaboration of: the Manitoba Centre for Health Policy (MCHP), a unit of the Department of Community Health Sciences, University of Manitoba; the ten rural and northern Manitoba regional health authorities (RHAs); and Manitoba Health. It is funded through CIHR's Community Alliances for Health Research program (2001-2006). The goal of the team is to: create new knowledge directly relevant to rural and northern RHAs; develop useful models for health information infrastructure, training, and interaction that increase the capacity for collaborative research; and disseminate and apply health research to increase the effectiveness of health services and the health of RHA populations.
The Need To Know Team evolved out of a contractual relationship between Manitoba Health and MCHP. Since 1991, MCHP has produced six research projects a year on the health and health care use of Manitobans. To encourage research dissemination, in 1994 MCHP began offering an annual Rural and Northern Health Care Day that highlights research of relevance to non-Winnipeg regions. In 1999, this workshop became highly interactive, with researchers facilitating RHA roundtable discussions to encourage planning based on MCHP reports. This new approach also gave RHA participants the opportunity to identify limitations in the research. The realization that better research could result from user collaboration led to the vision, and eventual birth, of The Need To Know Team.
The KT initiative
The Need To Know Team's KT vision is based upon three key themes: the need to undertake collaborative research of relevance to the intended users; the importance of capacity building and effective working relationships; and the need for researchers and planners to communicate findings and plan strategies to facilitate research that influences decision making.
The Need To Know Team includes MCHP academic researchers and graduate students, six planners from Manitoba Health, and up to two high-level planners, selected by the CEOs, from each of the ten non-Winnipeg RHAs, plus one Winnipeg RHA liaison. An advisory committee comprised of the director, program evaluator, three elected Team representatives (from northern RHAs, southern RHAs, and Manitoba Health), and representatives of key stakeholder groups (MCHP, Manitoba Health, the RHA CEOs, and a health services researcher) guides the initiative.
Two-day meetings, held three times a year, serve as the focus for Team activities. These meetings provide the forum for: selection, development and interpretation of Team research projects; participation in capacity-building activities (for example, "101" sessions on research concepts and methods); planning for dissemination of the research; and opportunities for both structured and informal networking. Capacity-building activities are not limited to a focus on RHA Team members. Team meetings provide an opportunity for academics to develop an understanding of the context faced by decision makers, as well as for decision makers to increase their understanding of research.
The research projects are selected through consensus, and speak to the questions facing RHA decision makers. They are grounded in strong health services and population health research methodologies and rely upon population-based administrative claims data to produce cross-comparative, geographically-relevant information. Three research projects have been completed to date: a regional indicators atlas1 showing health status and health care use patterns by RHA, district, and over time; a mental illness report2 documenting the prevalence and health care use patterns of people with mental illness; and a sex differences report3 analyzing male/female differences in health, health care use, and quality of care.
Between meetings, Team members undertake "homework" activities. Examples include consulting with RHA management on future research topics and developing research dissemination plans. For example, in spring 2005, Team members from five different RHAs planned one-day interactive MCHP/RHA workshops to ensure translation of the Team's research projects at the organizational level.
Collaborative evaluation has been an essential guiding component of the project from the very beginning. A variety of methods (key informant interviews, participant observation, pre- and post-test surveys, anonymous workshop evaluations, unobtrusive measures) are used. A structured feedback process enables each stakeholder group to review and provide input into the draft evaluation reports, and evaluation activities are used to model research principles and concepts. The evaluation process and activities, along with key findings, have been documented in two evaluation reports4,5 and have contributed to further development of KT theory.6
Results of the KT experience
Has The Need To Know Team been successful at meeting its objectives? We have succeeded in producing research of high quality and relevance to rural and northern RHAs. RHA attention to research findings has helped spur development of primary health care centres and nursing homes, cervical cancer screening programs, regional injury prevention programs, and proposed changes to mental health services.
The regional indicators atlas is being used extensively in strategic planning, and the mental illness report is contributing to regional, provincial, and national (through Senator Kirby's commission) mental health service planning. Team reports are in high demand, with seven times the number printed compared to typical MCHP reports (1,500 versus 200 copies). Hits to MCHP's website increased by 20,000 during the months when these reports were released.
The Team's reports are now released at the annual Rural and Northern Health Care Days. Attesting to the workshop's popularity, attendance has grown from around 30 in the 1990s to over 160 in the past two years. RHAs encourage diverse groups to attend, including board members, CEOs, VPs of planning, medical health officers, physicians, senior nurses, and front line workers. RHA Team members are now the principal facilitators of the RHA discussion groups, co-facilitated by MCHP staff. According to evaluations, the RHA Team members in this setting are indistinguishable from MCHP academics in understanding and interpreting research findings for participants.
We have found storytelling to be a powerful tool to affect change in decision making behaviour.
We have found storytelling to be a powerful tool to affect change in decision-making behaviour. The Need To Know Team members challenge each other to look for stories, or "golden nuggets," in each research report. This evidence-based story-telling7 helps identify important issues for RHA planners and decision makers and becomes especially relevant at the annual Health Care Day discussions.
Participant satisfaction with the project has been extremely high, with turnover of Team members limited to those who have left employment with the RHA. Evaluation indicates that this can be attributed to the benefits the Team members experience through participation, the "way we are treated and feel valued," and the opportunities for useful networking.4-6 Other essential elements in the Team's success include development of trust, the quality of relationships, adequate time commitment of partners, committed leadership, and genuine partnerships—mirroring previous literature on researcher/user interactions.8-13 RHA CEOs and the Ministry of Health also attest to The Need To Know Team's role in creating a culture that promotes KT and evidence-based decision making provincially.4-5 But have we found all the answers to KT?
Essential elements in the Team’s success include development of trust, the quality of relationships, adequate time commitment of partners, committed leadership, and genuine partnerships.
The evaluation found that the first three years fostered individual capacity building, relationship building, and networking. But Team members also identified the need to develop strategies for capacity building at the organizational level to ensure sustainability. So in 2005, priority was given to RHA site visits to build regional organizational capacity beyond the Team members. The Team has also recently received CIHR funding to identify and address organizational challenges to KT in the RHAs. However, we continue to find it challenging to convince traditional peer review panels to fund a process rather than a product—the process of utilizing a strong team model with a proven track record to conduct research in response to future needs.
Conclusions and implications
We continue to find it challenging to convince traditional peer review panels to fund a process rather than a product.
The Need To Know Team story has captured the imagination of researchers and decision makers throughout Canada. The Team has become nationally recognized, with over 80 oral and poster presentations by various Team members. The evaluator (Sarah Bowen) has made important contributions to the development of KT theory,6 and receives many cross-country requests for consultation. The Canadian Health Services Research Foundation (CHSRF) considers this initiative a best practice model for KT, and has funded workshops in Saskatchewan and Nova Scotia to discuss translating the model to other provinces. The director (Pat Martens) receives numerous invitations to discuss the Team model and its research, with groups such as CIHR's scientific directors and governing council, the University of Alberta, and CHSRF decision maker workshops. MCHP/The Need To Know Team also received the CIHR KT Award (Regional) for 2005. But the success of our KT initiative can best be summarized in the words of one RHA Team member, Sue Crockett:
"Although we work in different worlds, we can have a mutual relationship of respect. They can learn from us and we can learn from them. If we work together, we can produce amazing results—results that are meaningful, practical, and relevant."
1 Martens, P. J., R. Fransoo, The Need To Know Team, E. Burland, L. Jebamani, C. Burchill, C. Black, et al. 2003. The Manitoba RHA indicators atlas: Population-based comparisons of health and health care use. Winnipeg, MB: Manitoba Centre for Health Policy.
2 Martens, P., R. Fransoo, N. McKeen, The Need to Know Team, E. Burland, L. Jebamani, C. Burchill, et al. 2004. Patterns of regional mental illness disorder diagnoses and service use in Manitoba: A population-based study. Winnipeg, MB: Manitoba Centre for Health Policy.
3 Fransoo, R., P. Martens, The Need to Know Team, E. Burland, H. Prior. C. Burchill, D. Chateau, and R. Walld. 2005. Sex differences in health status, health care use, outcomes and quality of care: A population-based study for Manitoba's regional health authorities. Winnipeg, MB: Manitoba Centre for Health Policy.
4 Bowen, S. 2001. The Need to Know project evaluation 2001-2002 report. Winnipeg, MB: Manitoba Centre for Health Policy.
5 Bowen, S. 2004. The Need to Know project evaluation 2002-2004 report. Winnipeg, MB: Manitoba Centre for Health Policy.
6 Bowen, S., P. J. Martens, and The Need To Know Team. Forthcoming. Demystifying knowledge translation: Learning from the community. J Health Serv Res Policy.
7 Rachlis, M. 2004. Prescription for excellence: How innovation is saving Canada's health care system. Toronto, ON: Harper Collins Canada.
8 Lomas, J. 1997. Improving research dissemination and uptake in the health sector: Beyond the sound of one hand clapping. Health Policy Commentary Series. Hamilton, ON: McMaster University Centre for Health Economics and Policy Analysis.
9 Casebeer, A., and D. Johnson. 2000. Potholes in the information highway: The use of health service utilization data by Alberta health care managers. Healthc Manage Forum 13 (2): 58-64.
10 Denis, J. L., and J. Lomas. 2003. Convergent evolution: The academic and policy roots of collaborative research. Editorial. J Health Serv Res Policy 8 (Suppl. no. 2): 1-6.
11 Ross, S., J. Lavis, C. Rodriguez, J. Woodside, and J. L. Denis. 2003. Partnership experiences: involving decision-makers in the research process. J Health Serv Res Policy 8 (Suppl. no 2): 26-34.
12 Golden-Biddle, K., T. Reay, S. Petz, C. Witt, A. Casebeer, A. Pablo, and C. R. Hinnings. 2003. Toward a communicative perspective of collaborating in research: the case of the researcher-decision-maker partnership. J Health Serv Res Policy 8 (Suppl. no. 2): 20-25.
13 Germann, K., and D. Wilson. 2004. Organizational capacity for community development in regional health authorities: A conceptual model. Health Promot Int 19 (3): 289-298.
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