Knowledge Brokering in Health Care

Keeping Current © Lori Roxborough, Lisa Rivard, & Dianne Russell, 2009

Introduction

In both research and health service organizations, there is a growing recognition of the gap between research and practice and a desire to bridge this gap through the use of effective knowledge translation (KT) strategies. Knowledge translation is defined by the Canadian Institutes of Health Research (CIHR) as:

"… a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. " (Canadian Institutes of Health Research, 2008)

An overview of knowledge translation issues and strategies is provided in a previous Keeping Current: 'Knowledge Transfer in Healthcare' (Law et al., 2004).

Recognition of the complexity of interactions which are required for effective knowledge translation and the importance of interactive engagement has spurred interest in the potential of research intermediaries to help bridge the research-to-practice gap. The bridging activities performed by research intermediaries are referred to as knowledge brokering.

This Keeping Current provides an overview of the knowledge brokering literature and is intended to help researchers, service providers, managers and policy makers who are considering establishing knowledge brokering activities within their organizations.

What is knowledge brokering?

Serving as a knowledge brokering agency for the past 10 years, the Canadian Health Services Research Foundation (CHSRF) supports a network of knowledge brokers across the country. The CHSRF defines knowledge brokering as:

"…all the activity that links decision makers with researchers, facilitating their interaction so that they are able to better understand each other's goals and professional cultures, influence each other's work, forge new partnerships, and promote the use of research-based evidence in decision-making. Knowledge brokering activities include finding the right players to influence research use in decision-making, bringing these players together, creating and helping to sustain relationships among them, and helping them to engage in collaborative problem-solving. Knowledge brokering in this context is ultimately about increasing evidence-based decision-making in the organization, management, and delivery of health services." (Lomas, 2007, p 131)

What do we know about knowledge brokering?

Brokering activities are often part of a multifaceted organizational approach to knowledge transfer. Focusing on interpersonal interactions, knowledge brokering encompasses a wide range of activities designed to build relationships and foster effective knowledge exchange (Lomas, 2007; Robeson, Dobbins & DeCorby, 2008; Canadian Health Services Research Foundation, 2003). 

Activities include:

• Creating networks of researchers and decision-makers
  
• Promoting evidence use
  
• Transforming clinical or management questions into research questions
  
• Helping researchers and decision-makers establish priorities
  
• Guiding decision-makers in accessing, appraising, adapting and applying research evidence
  
• Helping decision-makers find, develop, or commission synthesized research and develop tailored messages
  
• Assessing context with attention to supports and barriers for knowledge exchange
  
• Developing, implementing, and evaluating knowledge transfer plans
  
• Establishing knowledge management systems
  

Survey responses from 400 Canadian health system knowledge brokers (KBs) revealed that 30% of their time was spent in knowledge transformation activities (assessing evidence and adapting it to circumstances), 20% in intermediary activities (linking researchers and decision makers) and 50% in other roles within the organization (Lomas, 2007).

Individuals who perform brokering activities have many different titles in organizations and multiple terms are used in the research literature for aspects of the knowledge brokering role (e.g., knowledge broker, linking agent, facilitator, translational researcher, champion, opinion leader). Although a common feature of these linkage roles is the use of interpersonal engagement, inconsistent use and definition of terms makes comparison and synthesis of studies using these knowledge transfer strategies difficult (Thompson, Estabrooks & Degner 2006).

What do we know about the effectiveness of knowledge brokering?

As knowledge brokering is an emerging role in healthcare, its effectiveness has not yet been extensively studied. 

The small body of available research indicates:

• a knowledge brokering approach improves the culture for evidence informed decision-making (Lomas, 2007).
  
• following implementation of knowledge brokering activities, decision-makers place higher value on evidence-informed decision making and gain knowledge and skills in the evidence-based process (Dobbins et al., 2007).
  
• knowledge brokering activities which are customized to decision-maker contexts are more likely to support the movement of evidence into policy decisions (van Kammen et al., 2006).
  
• one-on-one interactions with a KB (plus tailored messages) may not be as effective as tailored messages alone in influencing public health policy decisions in some settings (Dobbins et al., 2007).
  
• opinion leaders influence evidence use by decision-makers in some settings, but not others (Doumit, Gattellari, Grimshaw, & O'Brien, 2007; Stevenson, Lewis, & Hay, 2006). It is not yet known which professional and personal characteristics of opinion leaders are most influential, for which types of decision makers, for which types of evidence, and in which contexts.
  
• opinion leaders who are identified by the individuals in an organization are more likely to be effective than those who are pre-selected (Doumit, Gattellari, Grimshaw, & O'Brien, 2007).
  
• pediatric physical therapists report an increase in their familiarity and use of evidence-based measures after a six month period of knowledge brokering activities (Russell et al., 2009).
  

What skills does a knowledge broker require?

While a unitary job description is not possible for the wide range of roles performed by KBs, a core set of brokering skills has been identified (Lomas, 2007; Robeson, Dobbins & DeCorby, 2008; Canadian Health Services Research Foundation, 2003) and include:

Personal Attributes

KBs should be inquisitive, enthusiastic, flexible, inspirational, imaginative, highly credible and keenly interested in learning. They should be skilled analysts, able to see the 'big picture' and be able to readily identify links between ideas and pieces of information.

Evidence Gathering Skills

KBs should be aware of the best sources of synthesized evidence and original studies within their content area and have focused expertise in searching these sources for research evidence. They should also be skilled in searching for less formal contextual evidence such as policy documents and evaluation reports. The ability to evaluate the effectiveness of knowledge brokering activities is also a necessary skill for an effective KB.

Critical Appraisal Skills

KBs should be adept at appraising evidence to evaluate its quality, importance, and applicability to a particular context. In addition to traditional critical appraisal skills, they should have knowledge of the sector, the broader healthcare environment, its key players and controversies - and use this to gauge the applicability and adaptability of new evidence to user contexts.

Communication Skills

KBs should have strong oral and written communication skills and use a variety of methods targeted to the needs of the diverse stakeholders (e.g., researchers, clinicians, policy-makers, managers, and healthcare consumers). They should use active listening skills to gain insight into the interests, issues and innovations of their network members.

Mediation Skills

To function as effective relationship builders, KBs should be skilled mediators. They assemble teams and foster collaboration amongst individuals and groups who would not normally work together. They reconcile misunderstandings, facilitate the identification of shared goals, and negotiate mutually beneficial roles for all group members.

Summary

Knowledge brokering is a relatively new approach that is gaining momentum in healthcare in an attempt to accelerate the exchange of knowledge between the research, practice and policy environments. Much of the published work to date has focused on the definition and analysis of terms, the experiences and skills of individuals performing brokering activities, and proposed methods of evaluating effectiveness. The small body of available effectiveness research remains inconclusive but presentations of preliminary results of recently completed studies (Dobbins et al., 2007) and the publication of knowledge brokering study protocols (Ward, House, & Hamer, 2009) hold promise for the future emergence of insights into the brokering process and the effectiveness evidence for this knowledge transfer strategy.

Want to know more about knowledge brokering?

Contact: Lori Roxborough, Coordinator
Child Development and Rehabilitation Evidence Centre
Sunny Hill Health Centre for Children
3644 Slocan St
Vancouver, BC V5M 3E8
Tel: 604-453-8317 Fax: 604-453-8309
lroxborough@cw.bc.ca