Sowing What We Know: Sowing What We Know: Research Utilisation and Research Utilisation and the Diffusion of Innovationthe Diffusion of Innovation

Dorothy Scott, Kerry Lewig & Mary Dorothy Scott, Kerry Lewig & Mary Salveron, Australian Centre for Salveron, Australian Centre for Child Protection, University of SAChild Protection, University of SA

Donald Schon, 1983Donald Schon, 1983

““In the varied topography of professional In the varied topography of professional practice, there is a high, hard ground, practice, there is a high, hard ground, where practitioners can make effective use where practitioners can make effective use of research-based theory and techniques, of research-based theory and techniques, and there is a swampy lowland where the and there is a swampy lowland where the situations are confusing ‘messes’ situations are confusing ‘messes’ incapable of technical solution. The incapable of technical solution. The difficulty is that the problems of the high difficulty is that the problems of the high ground, however, great their technical ground, however, great their technical interest, are often relatively unimportant interest, are often relatively unimportant to clients or the larger society while in the to clients or the larger society while in the swamp are the problems of greatest swamp are the problems of greatest human concern.” human concern.”

Translating Research Translating Research into Policy and into Policy and Practice Practice My early interest in this My early interest in this

was aroused by John was aroused by John Bowlby’s attachment Bowlby’s attachment researchresearch– Example of policy resistanceExample of policy resistance– Example of practice successExample of practice success

Classic Cases …Classic Cases …

Sister Elizabeth Kenny – Sister Elizabeth Kenny – maverick nurse and the polio maverick nurse and the polio epidemic of the 1930sepidemic of the 1930s

Sir Richard Doll – eminent UK Sir Richard Doll – eminent UK epidemiologist who epidemiologist who established the link between established the link between smoking and lung cancersmoking and lung cancer

Evidence Based Evidence Based PracticePractice The past decade has witnessed The past decade has witnessed

a growing emphasis on a growing emphasis on evidence based practices and evidence based practices and policies across a wide variety policies across a wide variety of fields including health care, of fields including health care, criminal justice, education and criminal justice, education and management. (Dopson, Locock, management. (Dopson, Locock, Gabby et al, 2003)Gabby et al, 2003)

Drivers of Evidence Drivers of Evidence Based Practice and Based Practice and PolicyPolicy political imperatives for practical political imperatives for practical

evidence of what works evidence of what works greater justification of resources greater justification of resources

directed into researchdirected into research accountability to the tax paying accountability to the tax paying

public public quality improvement through quality improvement through

efficiency and effectiveness efficiency and effectiveness (Davies, Nutley & Walter, 2005; (Davies, Nutley & Walter, 2005; Walshe & Rundall, 2001)Walshe & Rundall, 2001)

Conceptual/Conceptual/InstrumentalInstrumental Huberman (1992) distinguishes Huberman (1992) distinguishes

between conceptual use of between conceptual use of research (facilitates change in research (facilitates change in knowledge, understanding and knowledge, understanding and attitudes) and instrumental attitudes) and instrumental research use (changes in research use (changes in practice and policy)practice and policy)

The challenge …The challenge …

““The challenge is to promote The challenge is to promote uptake of innovations that have uptake of innovations that have been shown to be effective, to been shown to be effective, to delay spread of those that have delay spread of those that have not yet been shown to be not yet been shown to be effective, and to prevent uptake effective, and to prevent uptake of ineffective innovations.”of ineffective innovations.”

(Haines & Donald, 2002, p.4)(Haines & Donald, 2002, p.4)

Inter- disciplinary Inter- disciplinary AreasAreas

Knowledge Utilisation: Knowledge Utilisation: philosophy, science and philosophy, science and applied social researchapplied social research

Diffusion of Innovation:Diffusion of Innovation:rural sociology, medical rural sociology, medical sociology, communication sociology, communication studies and marketingstudies and marketing

Three related fields Three related fields

1.1. Knowledge managementKnowledge management

2.2. Organisational changeOrganisational change

3.3. Diffusion of innovationDiffusion of innovation

Knowledge Knowledge ManagementManagement

Largely focussed on ICT but Largely focussed on ICT but growing interest in types of growing interest in types of knowledge and the processes by knowledge and the processes by which knowledge is gained, which knowledge is gained, assimilated and circulated within assimilated and circulated within organisationsorganisations

(Nutley et a; 2002; Nonaka & (Nutley et a; 2002; Nonaka & Takeuchi, 1995)Takeuchi, 1995)

Organisational ChangeOrganisational Change

Seeks to understand the Seeks to understand the barriers to change and to barriers to change and to develop successful change develop successful change management strategies at the management strategies at the individual, group and individual, group and organisational levels (Nutley organisational levels (Nutley et al, 2002)et al, 2002)

Diffusion of InnovationDiffusion of Innovation

Explores factors relating to the:Explores factors relating to the:- adopter of the innovation- adopter of the innovation- characteristics of the - characteristics of the

innovationinnovation- social networks of the adopter- social networks of the adopter- environmental characteristics- environmental characteristics- characteristics of the - characteristics of the

promoters of promoters of innovationinnovation- patterns of diffusion (eg - patterns of diffusion (eg

centralised or decentralised) centralised or decentralised)

Enabling FactorsEnabling Factors

Successful implementation of Successful implementation of evidence into practice requires evidence into practice requires attention to:attention to:

- practitioners- practitioners- organizational context- organizational context- nature of evidence for EBP- nature of evidence for EBP- method(s) of - method(s) of

implementationimplementation(Barwick et al, 2005, p38) (Barwick et al, 2005, p38)

Practitioner Practitioner FacilitatorsFacilitators links between researchers and links between researchers and

practitioners practitioners participation in post graduate studyparticipation in post graduate study practitioner involvement in researchpractitioner involvement in research support from colleagues support from colleagues autonomy autonomy practicality practicality ease of use or ‘effort’ ease of use or ‘effort’ conformity with status quoconformity with status quo

Organisational Organisational FacilitatorsFacilitatorsOrganisation’s Absorptive Organisation’s Absorptive

capacity:capacity: – existing knowledge and skills baseexisting knowledge and skills base– related technologyrelated technology– ‘‘learning organization’ culturelearning organization’ culture– proactive leadership focused on proactive leadership focused on

sharing new knowledgesharing new knowledge

(Greenhalgh et al, 2004)(Greenhalgh et al, 2004)

Greenhalgh et al (2004) Greenhalgh et al (2004) continued:continued:

Organisation’s Receptive Organisation’s Receptive Context for Change:Context for Change: – strong leadershipstrong leadership– clear strategic visionclear strategic vision– good managerial relationsgood managerial relations– visionary staff in pivotal visionary staff in pivotal

positionspositions– climate conducive to risk takingclimate conducive to risk taking– effective data capture systems effective data capture systems

Inter-professional Inter-professional issuesissues

Social and cognitive boundaries Social and cognitive boundaries between different professions between different professions retard the spread of innovation retard the spread of innovation as individual professions as individual professions operate within unidisciplinary operate within unidisciplinary communities of practice.communities of practice.

(Ferlie, Fitzgerald, Wood & (Ferlie, Fitzgerald, Wood & Hawkins, 2005)Hawkins, 2005)

Nature of EvidenceNature of Evidence

Advantage in cost effectivenessAdvantage in cost effectiveness Compatible with current work Compatible with current work

practicespractices Low in complexityLow in complexity Adaptable to practitioner needsAdaptable to practitioner needs Program fidelity maintained Program fidelity maintained

through implementation, careful through implementation, careful modificationsmodifications

Researcher credibility Researcher credibility

Implementation Implementation MethodsMethods Knowledge of core componentsKnowledge of core components Knowledge of barriers to changeKnowledge of barriers to change Early involvement of all stakeholdersEarly involvement of all stakeholders Support of local championsSupport of local champions Time for people to absorb innovation Time for people to absorb innovation

and connect to their needsand connect to their needs Generating context specific Generating context specific

knowledge in shared wayknowledge in shared way(Fixsen et al, 2005; Schorr, 2004; Theis (Fixsen et al, 2005; Schorr, 2004; Theis

et al, 2000)et al, 2000)

Key ConclusionsKey Conclusions

Research utilisation is not a Research utilisation is not a linear process as previously linear process as previously understoodunderstood

Major challenge is not Major challenge is not dissemination or training but dissemination or training but implementation in complex implementation in complex organisational contextsorganisational contexts

Importance of careful design Importance of careful design of change process of change process

Key QuestionsKey Questions

What should count as evidence?What should count as evidence? How much research merits How much research merits

changing practice and policy?changing practice and policy? Will research priorities be Will research priorities be

guided by effectiveness or guided by effectiveness or efficiency?efficiency?

Do service users have a voice Do service users have a voice and if so, how? and if so, how?

Child Protection: From Child Protection: From Research to Action Research to Action PlanPlan1.1. Literature review and research Literature review and research

auditaudit

2.2. Retrospective study of child Retrospective study of child protection research re possible protection research re possible factors associated with impactfactors associated with impact

3.3. Prospective study of child Prospective study of child protection research to test protection research to test propositions derived from propositions derived from retrospective study and literature retrospective study and literature from other fieldsfrom other fields

Child Protection: Steps Child Protection: Steps in Diffusion of in Diffusion of InnovationInnovation

Retrospectively and prospectively Retrospectively and prospectively investigate examples of diffusion investigate examples of diffusion of innovation where there are of innovation where there are “good enough” grounds to believe “good enough” grounds to believe they are they are

- effective- effective

- efficient- efficient

- transferable- transferable

- sustainable- sustainable