Whether it’s a new technology being introduced, like a clinical decision support system, or a new workflow or protocol without a technological component, frontline leadership and change management savvy are needed to ensure effective knowledge translation – that is the synthesis, dissemination, and exchange of knowledge.1 It is well known that it takes, on average, 17 years for new knowledge or evidence to be broadly translated into standard bedside practice.2 This is likely due to a lack of frontline leadership and change management know-how.
The DIKW (data, information, knowledge, wisdom) model posits that information only takes on value when it interacts with information produced by others, and that information is transformed into knowledge through human social interactions.3 The clinical frontline must be afforded the opportunity to interact with new knowledge to transform it into applied knowledge, also known as wisdom. Leadership development and change management skill building broaden awareness of the larger system, creating context to focus the knowledge translation process, while equipping knowledge users (the clinical frontline) with critical skills needed to support group interaction with the knowledge (e.g.: strategic communication, conflict resolution, negotiation, overcoming resistance, team building, collaboration, systematic testing of ideas, etc.). As published in the AHRQ Innovations Exchange, ICLN’s Executive Director, Julie Kliger, MPA, BSN, RN, reminds those involved in quality improvement, “Technical “know-how” related to quality improvement science is insufficient. Attention to “soft” issues such as leadership development and change management are necessary to promote sustainability and spread”4
Knowledge translation is the path between knowledge and wisdom in the DIKW model, in other words it is the path from knowledge to application, the path whereby knowledge is interacted with and iterated to reach a place of understanding, and ultimately application. If this translation process is glossed over, and understanding is not achieved, then the application of the knowledge is diminished, resulting in unrealized value. Take for example a Med/Surg unit that undertakes the adoption of Early Goal Directed Therapy (EGDT) in Sepsis management. EGDT is an evidence-based practice supported by strong research. However, it isn’t necessarily standard practice in every hospital. If this hypothetical Med/Surg unit decides to implement EGDT with a top-down approach, they are likely to encounter a great deal of resistance and non-compliance by the frontline staff. However, if this same Med/Surg unit takes a bottom-up approach, utilizing frontline-led collaboration, then frontline staff have the opportunity to develop understanding as to “why” behind the knowledge (evidence supporting EGDT), supporting translation of the evidence into shared understanding, thereby making it far more likely to result in correct application – or applied wisdom and a meaningful and sustainable change in practice.
The bottom line is that when implementing new evidence-based practice, don't underestimate the importance of frontline engagement in the knowledge translation process.
- Tetroe, J. What does it mean to transform knowledge into action? The Center for Hip Health and Mobility. http://www.hiphealth.ca/media/research_cemfia_jacquelinetetroe_plenary.pdf. Accessed February 14, 2014.
- A Critical Analysis of Quality Improvement Strategies. Agency for Healthcare Research and Quality Web Site. http://www.ahrq.gov/research/findings/factsheets/quality/qgapfact/index.html. Accessed February 14, 2014.
- The DIKW Model of Innovation. Spreading Science. http://www.spreadingscience.com/our-approach/diffusion-of-innovations-in-a-community/1-the-dikw-model-of-innovation/. Accessed January 10, 2012.
- Kliger, J. Sustaining and Spreading Quality Improvement: A Conversation With Julie Kliger, MPA, BSN, Director, Integrated Nurse Leadership Program, University of California San Francisco. AHRQ Innovations Exchange Web Site. http://www.innovations.ahrq.gov/content.aspx?id=3433. Accessed February 14, 2014.