By way of an example, the Center for the Study of Healthcare Management⁵⁸ suggests that "a physician who acts within the spirit of a complex adaptive system views the patient as a human organism, not an indication for a procedure; understands the patient is embedded in a variety of systems – physiological, family, political, and social – that continuously recalibrate themselves; and appreciates that small interventions at the correct leverage points can have large results."

In response to increasing levels of change, uncertainty, complexity and anxiety in the work environment, Alex and David Bennet⁵⁹, of the Mountain Quest Institute,^E developed the Intelligent Complex Adaptive System (ICAS) model and potential ICAS structures. In the ICAS model, systems and complexity thinking help to shape an organization that emphasizes:

• shared purpose and internal unity;
• multidimensional capabilities and competencies;
• data and information selectivity;
• knowledge centricity;
• targeted and active flow of data, information and knowledge;
• optimal human experience;
• optimum levels of internal complexity;
• creativity and innovation;
• effective problem solving;
• sound decision-making;
• efficient implementation processes;
• permeable boundaries.

In combination, these characteristics promote timely organizational intelligence and high performance.

Failure to understand the fundamental differences between (and implications of) simple, complicated and complex problems & systems, and to adjust your thinking, actions and processes can have an adverse impact on knowledge transfer, dissemination and utilization.
_________

[Footnote E = The mission of the Mountain Quest Institute (MQI) is "through research, consulting and workshops create learning experiences for individuals and organizations to help them achieve and sustain high performance in a rapidly changing, uncertain and incredibly complex world." http://www.mountainquestinstitute.com/]

4.2.2    Cultures

Culture plays an important role in knowledge processes.

Organizational Culture: Organizational culture reflects the:

• symbols (e.g., age, language, space, diversity, design, etc.);
• actions (e.g., pursuit of talent/clients, rewards and recognition, training, development, communication, decision-making, etc.); and
• beliefs (e.g., core values, focus of attention, core competencies, character, role in the community, etc.) of an organization.

Smith et al⁶⁰ describe the influence culture has on knowledge:

• culture shapes people’s assumptions about what knowledge is important;
• culture determines the relationship between levels of knowledge (e.g., what knowledge belongs to the organization and what knowledge belongs to the individual);
• culture creates a context for social interaction about knowledge (e.g., what is sensitive, how much interaction or collaboration is desirable, which actions and behaviors are rewarded and punished);

• culture shapes the creation and adoption of new knowledge.

Brown et al⁶¹ remind us that organizational culture varies with the practices of the organizational units that may be found on the organization chart.

The "Not Invented Here Syndrome"⁶² is an extreme example of embedded obstructive behavior. Knowledge hoarding, another counterproductive behavior, may be limited to the controlling personalities of a small number of individuals or it may be widespread and deeply embedded in the culture. Commonly reported reasons for knowledge hoarding⁶³ are listed in Table 4.2.2a,b.

National Culture: Ford et al⁶⁶ define national culture as "the collective programming of the mind which distinguishes the members of one human group from another". They describe how national cultures and knowledge sharing intersect:

• cultures that are high on Individualism [valuing the accomplishments of the individual] may have more difficulty in knowledge sharing than cultures that are high on Collectivism [valuing the accomplishments of the collective];
• culture that are high on Power Distance [the extent to which the less powerful members of institutions and organizations within a country expect and accept that power is distributed unequally] may have a more top-down flow of knowledge than cultures that are low on Power Distance;
• cultures that are high on Masculinity [focused on pay security and job content] vs. Femininity [emphasizes relationships and physical conditions] may have less knowledge sharing between organizational members if the competitiveness is individually based. There may be no difference if competitiveness is organizationally based;
• knowledge sharing between heterogeneous cultural groups may be more difficult (i.e., require more time and effort) than knowledge sharing within homogeneous cultural groups.

Dixon³⁸ frames knowledge sharing as "voluntary, and appreciation is the reciprocal act."

Failure to nurture a knowledge sharing culture, or to understand the influences of national culture, can have an adverse impact on knowledge transfer, dissemination and utilization.

The social nature of knowledge processes highlights the importance of establishing relationships, encouraging engagement, and promoting involvement.

Royle et al⁶⁷ identify the stages (e.g., identifying, prioritizing, commissioning, designing, managing, undertaking, analyzing, disseminating, and evaluating) and levels of research involvement that consumers^F should consider. Consumer involvement is defined as "doing research with consumers rather than to, about, or for consumers." Baxter et al⁶⁸ provide helpful hints for involving consumers in research (e.g., suggestions about how to make sure that all the relevant people are involved, encourage lay people to become involved in research, work towards sustainable outcomes, involve lay people in all types of research; research techniques, tools for self-reflection, and monitoring and evaluating lay involvement in research). They also identify factors that help or hinder involvement (e.g., knowledge, attitudes, values, diversity, resources and power), present a framework for analyzing balance of participation, provide a matrix that captures the quality of participation and document lessons learned.

Hanley et al⁶⁹ complement the work of Royle⁶⁷ by framing consumer involvement for the researcher.

Ross et al⁷⁰ focus on the involvement of decision-makers (health system managers and public policy makers) in the research process, and describe the:

• types of involvement:
  • "decision-makers sometimes organized and facilitated interactive forums to engage a broader range of decision makers in research-related activities … Decision makers did not expect to be involved with research tool and methods development, data management, initial data analysis … The stages of the research process in which decision-makers were most actively involved were research conceptualization, data collection, results interpretation and knowledge transfer."
  • "researchers commonly prepare written research updates or briefing notes, schedule standing research meetings or ad hoc consultations, and engage in informal e-mail and telephone exchanges with decision-makers.";
• levels of decision-maker involvement:
  • formal supporter: not actively involved;
  • responsive audience: actively involved – respond to researcher with ideas, information or tactical advice;
  • integral partner: actively involved – helps researcher to shape the research process.
• factors associated with decision maker involvement: perceived benefit, extent of the time commitment, alignment of the research with needs, an established relationship with the researchers
• benefits of involvement:
  • decision-makers: more reflective about their practices; gained ‘big picture’ perspective
  • researchers: better understanding of the decision making environment; research ‘grounded in reality’; access to expertise, advice and ideas
• costs of involvement: time and money (interaction, facilitation, conflict resolution, administration and associated travel, accommodations and resources); impact of the research on the organization

The authors make the following recommendations for optimizing decision-maker involvement:

• "be strategic about establishing partnerships (pick and choose whether and how to involve decision-makers, find the right person to work with, define the goals of decision-maker involvement)."
• "be intentional about supporting partnerships (build in more allowance for involvement activities, educate participants about their roles)."
• "be committed to building partnerships (build relationships over time, invest in relationships)."

Golden-Biddle et al⁷¹ view researcher/decision-maker collaboration from a communicative perspective and identify four key elements:

• disclosing the relational stance (‘seeing below the water line’): treating each other as equals; acknowledging the complexities, constraints and opportunities inherent to each other’s work environment; engaging each other with respect;
• engaging the purpose at hand for developing and using knowledge: "identifying, understanding and engaging the overlapping and situated purposes." For example, "decision makers are interested in using knowledge to implement change; researchers are interested in gaining an awareness of the issues to inform and contextualize their study of change.";
• enacting knowledge sharing practices: In response to the question "How could the researchers provide information that would add value to the issues faced in real time by the decision makers?," the authors identified four knowledge sharing practices:
  • providing relevant research and management articles;
  • presenting research findings along the way;
  • providing pedagogical resources that assist change efforts in a qualified manner;
  • sharing research observations, but not advice;
• identifying forums for accessing and sharing research knowledge: creating joint interpretive forums – formal or informal interactive spaces – where stakeholders can access and interpret knowledge.

The authors view partnerships as "social processes consisting of elements of linkage and exchange." They believe that an effective researcher/decision-maker partnership can be demonstrated when "researchers see the value of contextualizing their work … and present, process and interpret research findings together with practitioners, preferably in face-to-face interaction" and "decision-makers see how this work can help them to accomplish their purpose at hand."

Goering et al⁷² propose a four-tiered knowledge "linkage and exchange" model to optimize collaboration between researchers and policy-makers:

• Tier 1 – Inter-organizational relationship (foundational): Establish a formal partnership, based upon jointly-developed objectives, terms of engagement and a work plan. Explore cultural and procedural differences. Understand timeline differences between research work and policy development. Build trust;
• Tier 2 – Interactive research projects: Research objectivity is promoted at the initiation stage through a grant process and at the execution stage through a stakeholder-representative advisory committee;
• Tier 3 – Dissemination: Consider conducting a policy forum. Share and learn from the research. Establish a common language;
• Tier 4 – Policy formation: Synthesize the principles and recommendations.

Levin et al⁷³ suggest that trust^{G, 74} is the "magic ingredient" that enables strong relationships to be formed and powerful knowledge sharing practices to flourish.

They describe two kinds of trust:

• benevolence-based: where an individual’s interactions with others are motivated by respect, cooperation, kindness or interest;
• competence-based: where an individual’s interactions with others are motivated by level of skill, experience, or knowledge.

Each type of trust can exist independently or in varying combinations and intensities (e.g., I may be confident that you would be willing to help me with a task [benevolence-based], but I may have no confidence in your ability to the do the task [competency-based trust]).

They also found a correlation between knowledge type and trust type. When tacit knowledge was involved, knowledge seekers depended upon high levels of competency-based trust in the knowledge source. With explicit knowledge, knowledge seekers relied on benevolence-based trust in the knowledge source.

To facilitate trust in the workplace, they encourage managers to:

• create a common understanding of how the business works;
• demonstrate trust-building behaviors;
• bring people together.

They also made a "somewhat surprising discovery," trust can even develop in situations where individuals interact infrequently.

Stewart⁷⁵ believes that in addition to competence, trust is supported by:

• communities of practice: which create and validate competence;
• commitment: to the needs of the community or the goals of the organization;
• communication: telling the truth.

Cross et al⁷⁶ identify four factors that contribute to effective project-based relationships:

• knowing what another person knows and thus when to turn to them;
• being able to have timely access to that person;
• willingness of the person sought out to engage in problem solving rather than dump information;
• a degree of safety in the relationship that promote[s] learning and creativity.

Failure to establish and nurture trusted relationships can have an adverse impact on knowledge transfer, dissemination and utilization.
_________

[Footnote F = Consumers are defined as "patients, carers, long-term users of services, organizations representing consumers interests, members of the public who are potential recipients of health promotion programs and groups asking for research because they believe they have been exposed to potentially harmful circumstances, products or services."]

[Footnote G = Galford et al provide the following equations:     Individual trust = C + R + I        Where:    C = credibility, R = reliability,
                                                                                                                        S                             I = intimacy,    S = self-orientation

                                                                                         Organization trust = (A1 + A2 + A3) x (A4 + A5)    Where: A1 = aspirations, A2 = abilities,
                                                                                                                                        R                                   A3 = actions,      A4 = alignment,
                                                                                                                                                                             A5 = articulation, R = resistance]

4.2.4    Communities^H

Communities can have a dramatic impact on the creation and flow of knowledge.

Communities come in many forms: communities of interest, communities of learning, communities of practice, communities of commitment, etc.

One type of community in particular – a community of practice⁷⁷ – is recognized as being essential to the sustainability of knowledge-driven organizations. Saint-Onge et al⁷⁸ define a community of practice as "a group of self-governing people whose practice is aligned with strategic imperatives and are challenged to create shareholder value by increasing capabilities and improving their practice." They share the following characteristics:

• a common purpose;
• self-managed through principles and conventions, shared leadership of members, and some form of facilitation;
• self-governed on the basis of agreed upon conventions;
• utilize productive inquiry (answering practice-specific questions);
• generate knowledge that supports the practice;
• assume accountability for supporting one another;
• collaborate via multiple channels;
• receive support from the organization.

Failure to create the conditions that enable communities to thrive can have an adverse impact on knowledge transfer, dissemination and utilization.
_________

Footnote H = Health Organization Change, a multi-university Canadian research team, is exploring the benefits of communities of practice. http://www.healthorgchange.com/index.htm]

4.2.5    Networks^I

Ruminez⁷⁹ describes a network as "consisti[ng] of people who know each other. While not everyone knows everyone else, there is an overall pattern of connection. There is also mutual aid and reciprocity."

Shirky⁸⁰ states that "we are living in the Golden Age of network theory, where sociology, math, computer science, and software engineering are all combining to allow the average user to visualize, understand, and most importantly, rely on the social and business networks that are part of their lives."

Cravey et al⁸¹ describe six types of knowledge network nodes (related to access to health information):

• primary potential: places individuals visit; rate favourably; do not have access to health information; would like to have access to health information;
• secondary potential: places individuals visit; rate favourably; do not have access to health information; want to have access to health information;
• reluctant: places individuals visit; rate unfavourably; have access to health information; do not want to have access to health information;
• latent: places individuals do not visit; but rate favourably; and access to health information is available;
• isolated: places individuals do not visit; and do not rate favourably; even though access to health information is available
• irrelevant: places individuals do not visit; do not rate favourably; and access to health information is not available

Cross⁸² describes five ways that networking can make a positive contribution to knowledge creation and use:

• individuals get answers to their questions (know how, know what);
• individuals get pointed to relevant domains of knowledge, databases and people (meta-knowledge);
• individuals learn how to reformulate their questions or challenge (perspective);
• individuals obtain feedback that validates their thinking (confidence);
• individuals gain recognition through interaction respected parties (prestige).

Social network analysis⁸³ is a methodology that is used to map the characteristics of relationships between members of a network. Analysis of the map occurs along four dimensions:

• knowledge: knowing what someone else knows;
• access: strength of relationships, proximity, organizational design, collaboration tools;
• engagement: understanding from the other person’s perspective, actively thinking with others, involved in problem solving;
• safety: open admission of knowledge gaps or acknowledgement that thinking and conversations may diverge.

Value network analysis³ is a methodology that is used to map the web of tangible (e.g., patient referrals, medical services, etc.) and intangible (e.g., patient knowledge, medical knowledge, etc.) exchanges for a given network – which is represented as a living system. Value exchange is the focus (not processes). Analysis of the map enables one to answer a range of value-based questions, including:

• Is there a coherent logic and flow to the way value moves through the system?;
• Does the system have healthy exchanges of tangibles and intangibles?;
• Is there an overall pattern of reciprocity?

Failure to take advantage of the capacity to connect and communicate through networks can have an adverse impact on knowledge transfer, dissemination and utilization.
_________

[Footnote I = The Canadian Research Transfer Network is committed to "building a national network of Research Transfer professionals in Canada; providing a forum to share and explore ideas and best practices; promoting the value and importance of research transfer; promoting best practices for transfer; advocating research and evaluation of transfer methods and strategies; and providing information and professional development opportunities to members."]

4.3    KNOWLEDGE PROCESSES

Nonaka et al⁸⁴ suggest that current economic and organizational theories cannot adequately explain the knowledge creation process. Nonaka describes knowledge creation as a dialectical process – "in which various contradictions are synthesized through dynamic interactions among individuals, the organization, and the environment … Knowledge is created in a spiral that goes through seemingly antithetical concepts such as order and chaos, micro and macro, part and whole, mind and body, tacit and explicit, self and other, deduction and induction, and creativity and efficiency." He proposes a environment called "ba" which is characterized by needs-driven opportunities to resolve individual contextual contradictions through interactions in time and space that rely upon dialogue and synthesis to achieve shared context and situated action.

Failure to establish an environment that surfaces and resolves contradictions can have an adverse impact on knowledge transfer, dissemination and utilization.

Effective sharing of knowledge is at the core of knowledge transfer, dissemination and utilization.

Smith et al⁶⁰ identify three organizational attributes that sustain a strong knowledge sharing culture:

• high solidarity (deeply shared goals and tasks) and sociability (strong relationships and community);
• fair processes and outcomes;
• recognition of work.

While considerable attention has been focused on the knowledge provider, Dixon³⁸ points out that little attention has been paid to the knowledge receiver. Absorptive capacity, which refers to the ability of the receiver to connect newly received knowledge to their existing base of knowledge and thereby make sense of the new knowledge, is seen as a key to effective knowledge transfer. Well-developed inquiry skills are essential for knowledge seekers.

Failure to understand the needs of the knowledge receiver can have an adverse impact on knowledge transfer, dissemination and utilization.

A sampling of knowledge-related challenges that are associated with management frameworks is presented below:

Huy et al⁸⁵ describe 3 types of organizational change, which interact dynamically:

• dramatic change: descends from the top; incites revolution, which provides impetus (e.g., restructuring the organization);
• systematic change: presents laterally; orchestrates reform, which instills order (e.g., strategic planning);
• organic change: emerges from the grass roots; nurtures rejuvenation, which spurs initiative (e.g., skunk works).

Senge et al⁸⁶ identify ten challenges associated with the change process:

• Initiating change:
• not enough time
• no help (coaching & support)
• not relevant
• not walking the talk
• Sustaining change:
• fear & anxiety
• assessment & measurement
• non-believers
• Redesigning & rethinking for change:
• governance
• diffusion
• strategy & purpose

Resistance can be found in varying degrees in every change process⁸⁷. The key factors that contribute to resistance include:

• existence of deep-rooted values;
• differing interests of management and staff;
• poor communications;
• organizational silence;
• gaps in capabilities.

Kotter et al⁸⁸ describe eight factors that facilitate change:

• establishing an increased sense of urgency;
• building the guiding team;
• getting the vision right;
• communicating for buy-in;
• empowering for action;
• creating short-term wins;
• not letting-up;
• making change stick.

The United States Department of Navy⁸⁹, recognized as a leader in knowledge management, leverages its knowledge through a twelve-element change strategy:

• creating a shared vision;
• building the business case;
• demonstrating leadership commitment;
• facilitating a common understanding;
• setting limits;
• sharing new ideas, words, and behaviors;
• identifying the strategic approach;
• developing the infrastructure;
• measuring and incentivizing;
• providing tools;
• promoting learning;
• visioning an even greater future.

At the level of the individual, Bateson⁹⁰ believes that "to thrive under conditions of change, you have to be learning all the time."

Anderson et al⁹¹ insist that you help individuals to "understand the change, why it is needed, what is expected of them, how it will unfold, and what is in it for them to want to succeed in making the change. If they don’t have this understanding, chances are they will resist the change or even prevent it from being successful. Each will need attention from the change leaders to be engaged, prepared, and supported to succeed." – and they provide a tool to capture the necessary information.

The Modernization Agency of the National Health Service⁹² emphasizes the human dimensions of change.

Failure to determine stakeholder preparedness for, and receptivity to, change can have an adverse impact on knowledge transfer, dissemination and utilization.

Canada’s Innovation Strategy^K defines innovation as "the process through which new economic and social benefits are extracted from knowledge."

The American Productivity and Quality Center⁹³ identified 15 characteristics that were common to the way organizations use knowledge management to drive innovation:

• efficient innovation: "access to information, ideas, and experience enables individuals and teams to devote their time to build on good ideas and incorporate them into innovative products and processes … study partners use KM as one way to do that by: reusing designs, knowledge, and lessons learned and thus avoiding to repeat mistakes; helping people to connect and knowledge to flow across boundaries";
• managing technical and scientific information: "the technical and scientific nature and intensity of the partners’ processes and products impel them to incorporate information issues into their knowledge management approaches";
• more conscious knowledge management: "the ever-increasing challenges of efficient innovation require more robust information management and KM approaches";
• a bias toward reuse of knowledge: "study partners have a variety of approaches to overcome the strong cultural and professional bias [against reuse of knowledge] including facilitating diverse teams, making experts available to explain how an earlier invention could work in a new setting, rewarding for reuse, and sharing success stories.";
• expertise locators: "when knowledge is highly specialized, creating context to make it understandable and useful becomes more challenging. Delivering information is not enough. Access to people with knowledge is at least as important as access to information.";
• building social capital and spanning boundaries: "enabling people with ideas and experience to connect with others who can incorporate those ideas into their own creations catalyzes innovation … causing knowledge to cross boundaries is a challenge … knowledge is sticky and only moves when a process exists to facilitate it.";
• enabling work: "partners use a variety of KM approaches and principles to put information and knowledge in the hands of people when they need it, be it before, during or after projects and just in time, just enough, and ‘just for me’ …";
• communities of practice: "primarily used to provide a forum for cross-disciplinary knowledge sharing among professionals";
• culture change: "partners create an awareness of available resources for knowledge sharing, connect people across boundaries, and address reward systems that help or hinder knowledge flows. They also publicize knowledge sources and resources and showcase success stories and lessons learned.";
• human resource practices: "partners have processes to recruit for certain innovative personalities";
• KM and learning: "the focus is to improve team accomplishments (immediate performance) and mastery (performance over time)."
• external collaboration: "knowledge sharing with the external world is present in all of the partners";
• KM infrastructure and resources: "organizations typically has three critical elements in their knowledge management support structures: a steering group, … a core KM group, and resources from different business units …";
• measurement: "the most frequent methods to measure success of knowledge transfer are conducting user surveys, tracking the number of knowledge objects accessed and used, tracking knowledge transfer activities, and capturing meaningful stories of the power of knowledge capture and transfer for innovation."

Rogers⁹⁵ believes that the response to an innovation follows a predictable pattern. There are:

• early adopters: that apply the innovation immediately;

• early majority: that set the general trend for use of the innovation;
• late majority: that accept the innovation once it is mainstream;
• laggards: that may or may not accept the innovation.

Ho et al²⁷ believe that a different knowledge translation approach is required for each of the above groups.

Fitzgerald et al re-conceptualize the processes of diffusion and adoption based upon the following key themes:

• "the process of establishing credibility of evidence in interpretive and negotiated";
• "adoption decisions involve active, not passive adopters, with interaction between actors and innovations and between groups and actors";
• "the progress of diffusion is influenced by the interlocking characteristics of communities of practice and contexts"

They conclude that it is the interplay of these factors that determines the pattern of diffusion for a given innovation – there is no single or uniform pattern that applies to all innovations.

Denis et al⁹⁶ revealed five innovation dilemmas. They found that dissemination and adoption of clinical innovations:

• must be rationally based on solid, clearly defined scientific evidence. Evidence also forms part of a complex social dynamic, which means that players and organizations will not reach the same conclusions on the nature and scope of evidence;

• are inevitably accompanied by negotiations over the true nature of an innovation and the adaptations required for implementation. This is because evidence-based medicine gives predominant weight to scientific evidence. The scientific evidence associated with a clinical innovation is always partial;
• require varying periods of experimentation. Experimentation can generate risks and limit the benefits of a clinical innovation;
• are generally addressed as a rational problem of bringing practices into compliance with standards. Retention of clinical innovations is also dependent on ideological factors and the interests of the players and organizations involved;
• are often accompanied by pressure for standardization. This means that everyone (players and organizations) agrees, which is not necessarily consistent with innovative dynamics.

They found two factors that increased the probability of clinical innovations being adopted:

• the interests and values of players, groups and organizations may be specifically recognized and, to some extent, are met;
• the players, groups and organizations are able to state their preference and develop compromises.

Failure to create the conditions that encourage innovation can have an adverse impact on knowledge transfer, dissemination and utilization.
_________

Footnote J = The Innovation Everywhere! @ Memorial Hospital and Health System believes that "creating a culture of innovation is the best way to maintain a world class service leadership position, attract and retain the best staff, attract resources and build a financially stable organization and most importantly, provide quality care for our patients and physicians" http://www.qualityoflife.org/innovation/]

Footnote K = Canada’s Innovation Strategy (2002) http://napoleon.ic.gc.ca/gol/innovation/interface.nsf/engdocBasic/3.html]

4.4.3    Projects

Projects are a central organizing feature in research.

The Project Management Institute (PMI)⁹⁷ defines a project as "a temporary endeavor undertaken to create a unique product, service, or result" and project management as "the application of knowledge, skills, tools and techniques to project activities to meet project requirements." Projects are "accomplished through the use of the processes of initiating, planning, executing, monitoring and controlling, and closing." The PMI Project Management Framework encompasses:

• scope;
• human resources;
• time;
• communications;
• risk;
• quality;
• cost;
• procurement;
• integration.

This complex management framework has led Turner et al⁹⁸ to re-frame projects as "temporary organizations."

Matta et al⁹⁹ believe that many project failures are the result of managing "execution risk" (which focuses on how planned project activities are conducted – avoidance of mistakes), but neglecting "white space risk" (which focuses on correctly anticipating needs, activities and resources – avoidance of gaps in the project plan) and "integration risk" (which focuses on – avoidance of component incompatibilities). Matta describes the benefits of using "rapid-results initiatives", mini-projects that are embedded throughout the primary project plan.

Ward et al¹⁰⁰ advocate changing "risk management" to "uncertainty management." Their rationale is that the typical perspectives associated with risk are threats and events, whereas uncertainty perspectives are broader, and relate to ambiguity and variability.

Snider et al¹⁰¹ advocate for greater attention to the flow of explicit and tacit knowledge in projects.

Taking an informal approach to project planning and execution can have an adverse impact on knowledge transfer, dissemination and utilization.

A sampling of knowledge-related challenges that are associated with technologies is presented below:

Information and communication technologies (ICT) have the potential to enable greater connection and interaction between people (and sharing of resources) – in physical and virtual work or social settings. ICT also facilitates data, information, and knowledge structures and processes. It can reduce or eliminate time and space barriers, and enhance mobility.

ICT can be grouped in many ways.

Lindvall et al¹⁰³ provide the following architectural model:

• low level IT Infrastructure: Web browsers, word processors, e-mail, file servers, database management systems, multimedia tools, messaging tools, Internet, Intranets, etc.;
• information and knowledge sources: e-mails, electronic documents, databases, multimedia files, bulletin boards, newsgroups, etc.;
• document and content management: knowledge repositories, etc.;
• organizational taxonomy: knowledge maps, etc.;
• KM services: data and knowledge discovery, collaboration services, expert networks, etc.;
• personalized knowledge gateways: knowledge portals, etc.;
• business applications: customer relationship management, e-learning, competency management, intellectual property management, etc.

Luan et al¹⁰⁴ use the following categories to classify ICT: business intelligence, knowledge base, collaboration, content and document management, portals, customer relationship management, data mining, workflow, search, and e-learning.

Eng¹⁰⁵ proposes a 5C model for eHealth^M:

• content: information presentation, information search assistance, health behavior change, informed decision- making, and distance learning and training;
• connectivity: clinical and public health information systems, health services and systems integration, administrative transactions, clinical and biomedical research;
• community: peer-to-peer and person-to-person messaging, information exchange, emotional support and community building;
• commerce: eCommerce and shopping;
• care: self-care, care coordination and information portability, electronic health records, shared clinical decision-making, expert systems, disease management, telemedicine/telehealth.

Wenger¹⁰⁶ describes a range of technologies that facilitate communities of practice, which he describes as being the "social fabric of a learning organization"¹⁰⁷, and he groups them into the following categories:

• work and project spaces;
• social structures;
• conversations;
• interactions;
• instruction and learning;
• access to expertise;
• access to documents.

Allee³ warns that the usefulness of information technology decreases as the complexity of the knowledge or task increases. Solving complex problems requires advanced thinking skills and access to tacit knowledge, which are currently not well supported by technology.

In agreement, Tiwana¹⁰⁸ states that "technology helps collect, store, transfer, and distribute information. Information does not necessarily translate into knowledge, for much knowledge is too tacit and too obliviously ingrained in people’s heads to be codified – let alone transferred electronically."

Emerging technologies to watch include: narrative databases¹⁰, expert locator systems^N, personal knowledge networks^O, ambient technologies^P, persuasive technologies^Q, and nanotechnology^R.

Failure to address the human side of technology, or failure to match the technology to individual need and organizational culture or failure to make it usable (and useful) can have an adverse impact on knowledge transfer, dissemination and utilization.
_________

[Footnote L = Turkle believes that "technology has moved from being a tool to a prosthetic to becoming part of our cyborg selves … [and] designers, businesspeople, and consumers [must] keep human purpose in mind as they design and deploy technology and then choose how to make it part of our daily lives … authenticity in relationships is a human purpose." Applied to health care technology, "Many hospital have robots that help health care workers lift patients … It can be designed, built and marketed in way that emphasize its identity as a mechanical ‘flipper’ … Alternatively, we can step back and imagine this machine as a technological extension of the body of one human being trying to care for another."]

[Footnote M = eHealth is defined as "the use of emerging information and communication technology, especially the Internet, to improve or enable health and health care. This term bridges both the clinical and nonclinical sectors and includes both individual and population health-oriented tools."

[Footnote N = Expertise Locator Systems: Finding the Answers (APQC)
http://www.apqc.org/portal/apqc/site/generic2?path=/site/products_services/research_reports/cs_prop_els.jhtml]

[Footnote O = Waves of Information Disruption Due in 2003 – GartnerGroup http://www4.gartner.com/DisplayDocument?doc_cd=111807]

[Footnote P = With ambient devices "the physical environment becomes an interface to digital information." For example "chronic disease state management is a complicated mix of monitoring and educating the patient. Ambient’s embedded technology provides a cheaper, more effective way to keep a patient, and a loved one, regularly informed about their own condition. Ambient also connects physicians and patients, dieticians and dieters, trainers and clients, clinical trial administrators and subjects, elderly and caretakers." http://www.ambientdevices.com/cat/index.html]

[Footnote Q = Stanford Persuasive Technology Lab – "insight into how computing products -- from websites to mobile phone software -- can be designed to change what people believe and what they do." http://captology.stanford.edu/]

[Footnote R = National Heart, Lung, and Blood Institute - Nanotechnology in Heart, Lung, Blood, and Sleep Medicine http://www.nhlbi.nih.gov/meetings/nano_sum.htm]

5.    KNOWLEDGE-RELATED OPPORTUNITIES        [Back to the Table of Contents]

Each of the challenges described in the previous section represents an opportunity. The opportunities presented in Table 5 are grouped into the following categories: general, knowledge, values, governance, management, culture, clients/stakeholders, application, infrastructure, accountability, performance, measurement, outcomes and value.

FIGURE II: A GENERIC KNOWLEDGE TRANSFER AND DISSEMINATION MODEL

The applied research process involves three steps: defining relevant research questions, conducting related research activities, and transferring and/or disseminating research findings. When done in a timely manner, they positively impact policy-making, decision-making, and practice.

Knowledge transfer and dissemination play important roles within and across the applied research process. For example, within the Questions step, the definition of relevant research questions is greatly enhanced by the exchange of knowledge. Sharing researcher knowledge about the applied research process, and developments in other jurisdictions, helps clients (stakeholders) to better understand the environment in which applied research findings are generated, to better frame and focus the knowledge they share, and to place it in context. Conversely, clients (stakeholders) sharing knowledge about their issues, challenges, needs and preferences helps the researcher to better understand the environments and ways in which applied research findings are used and to better plan applied research activities. This kind of dialogue and sharing enables clients, stakeholders and the researcher to: balance advocacy and inquiry, heighten awareness and insight, think and reflect together, build capacity for new relationships and behaviors, and take mutual responsibility for choices, actions and outcomes¹¹⁶. In another example, engagement and interaction with clients and stakeholders across Questions, Activities, Findings and Outcomes, enables the researcher to better: design and execute research activities, understand what should be transferred/ disseminated, determine to whom (and by whom) knowledge should be transferred/ disseminated, tailor how knowledge should be transferred/disseminated, and assess the effects of knowledge transfer/dissemination.⁴⁶

The key principles that guide knowledge transfer and dissemination in the applied research process include:

• Knowledge: it is integral to the applied research process. The creation, transfer, and dissemination of knowledge is the only way we can answer client or stakeholder questions;¹¹¹

• Engagement: clients and stakeholders are engaged throughout the entire applied research process. They appreciate being consulted and are more likely to trust applied research findings that are delivered by researchers they know and have determined to be credible;⁴⁶

• Interaction: knowledge transfer and dissemination are social processes. Knowledge requires context to be understood – which requires interaction and communication with others⁶; and

• Interdependence: knowledge, learning and performance are interdependent. Every aspect of knowledge (knowing) is supported by a corresponding learning activity. Learning is demonstrated by improved performance. Each learning mode supports a different performance focus³.

7.1.1    Stakeholders

Stakeholders are subdivided into four groups: basic and applied researchers (e.g., clinical, social, economic, biomedical, etc.), government and non-government administrators (e.g., strategists, analysts, planners, adjudicators, etc.), primary and allied providers (e.g., physicians, nurses, pharmacists, counselors, etc.) and citizens (e.g., veterans, families, general public, media, etc.). It is becoming increasing obvious that early and interactive engagement of all relevant stakeholders⁴⁶ throughout the research cycle leads to the identification of clearer, needs-driven research questions, more focused and collaborative research activities, better contextualization of research findings, more targeted dissemination vehicles and enhanced outcomes.

Research questions must be informed by relevant stakeholders. The questions may be influenced by social and economic forces; stakeholder perceptions and expectations; organizational objectives and challenges; existing agreements; current practices; and differing contexts for action. Deep listening skills are required to correctly elicit needs. Careful attention must be paid to avoid the potential for bias to be introduced as a result of stakeholder involvement.⁴⁶ Glasziou et al¹¹⁷ remind us that different types of questions require "different types of evidence."

Techniques that may be used to surface research questions include: stakeholder engagements, environmental scans, and strategic planning. Models and frameworks (research, policy, service, funding, etc.) and critical success factors may be used to validate the research questions. By way of an example, the CHSRF¹¹⁸ identified eight steps that a decision-maker can use, while interacting with a researcher, to turn the decision-maker’s issues into the right research questions: commit enough time, get a knowledge broker on the team, understand your research partner, help your research partner to understand you, separate value choices from information needs, unpackage the problem, choose an approach, and make a plan for long-term interaction.

Research activities include: strategic initiatives, targeted research projects, commissioned research, clinical trials or protocols, pilot projects, peer reviews, policy reviews, program reviews, surveys, interviews, focus groups. Research activities must be guided by appropriate methods, tools, standards and protocols. A sustainable research environment requires that attention be paid to resourcing, promoting, supporting and capacity building.

Research findings must be contextualized to the respective stakeholders or audiences and translated into actionable messages. Dissemination vehicles include: publications, town halls, dialogues, conversations, stories, narratives, discussions, meetings, conferences, peer groups, exchange networks, clinical rounds, expert panels, professional bodies, etc. Dissemination may be facilitated by knowledge brokers, knowledge networks, communities of practice, professional bodies, etc. Research findings may be synthesized into best practices or practice guidelines and retrievable from clearinghouses or repositories. Research findings will also inform future research directions. By way of examples, the Program in Policy Decision-Making¹¹⁹ program provides guidelines for actionable messages and the Organizing Committee¹²⁰ for the Knowledge Transfer: Looking Beyond Health conference provides guidelines related to the audience, the message and its delivery.

Positive research outcomes encompass informed policy making; evidence-based planning and decision-making; targeted resource allocations; effective products, services and systems; shared responsibility and benefits; modified behavior; relevance and value; and improved stakeholder/population health. Positive outcomes may be reinforced by facilitating the delivery and usage of just-in-time knowledge and concentrating on effective communications, performance improvement, capacity-building, relationship enhancement, lessons learned, return on investment, audits, evaluations, etc.

Infrastructure refers to the supporting elements of the research environment that enable knowledge transfer to flourish. Individuals, teams groups and communities specializing in human resources, information technology and other organizational disciplines contribute to the establishment of a strong and diverse research culture. Effective and efficient organizational processes (e.g., governance, management, sense-making, serving, learning, etc.), practices (e.g., communications, change, quality, performance, etc.) and standards (e.g., confidentiality, privacy, ethics, etc.) contribute to the sustainability of the research environment.

Figure III: A Sustainable, High-Performance, Applied Research Environment (SHARE)

• conducting research and providing information;
• monitoring external research and partners;
• transferring and disseminating knowledge;
• managing research activities.

9.2.1    Clients and Stakeholders

9.2.1    Clients and Stakeholders

A clear understanding of client and stakeholder issues, challenges, needs and, where relevant, work processes guides research priorities and activities.

A comprehensive picture of local, national and global drivers of applied research will emerge from targeted environmental scans.

Consultations with clients, stakeholders and research experts will help to clarify existing demand and emerging needs.

Client/stakeholder needs and demands will inform a Vision Statement (which describes the desired future state) and a Mission Statement (which will guide decisions and actions).

9.2.5    Strategic Priorities

To enable timely and relevant activities and outcomes, the needs, vision and mission must be translated into Strategies Priorities.

The SHARE Research Plan lays out the management framework (mandate, key activities, governance, domains of research, organization and funding, and privacy and ethics), results from consultations on research needs and major research initiatives and timeframes.

Sustainability of the SHARE will be enhanced by the development of the following strategies:

• Financial Strategy; Describes how the necessary financial resources will be sourced;
• Knowledge Management Strategy: Identifies how people, processes and structures will be engaged to optimize the knowledge cycle (e.g., create/ acquire, use/learn, contribute/transfer, sustain/protect and divest/unlearn);
• Learning Strategy: Reveals how to align education, training and learning cycles with the SHARE vision, mission and mandate and its staff’s learning and professional development plans;
• Change Strategy: Captures how to promote committed leadership, common understanding, shared vision and ideas, focused performance, and adoption of the requisite tools, techniques and measurements.
• Partnerships/Strategic Alliances Strategy: Divulges how to build capacity to dynamically leverage competencies and resources, create new value and opportunities, establish critical mass and stability, and develop new relationships, products and services.
• Innovation Strategy: Describes how creative people, processes and structures will be used to transform learnings and knowledge into client and stakeholder benefits.
• Communication Strategy: Discloses how communication goals, target audiences, engagement mechanisms, key messages, data capture and analysis methods, specific actions, information dissemination techniques, media choices, risk management, performance measures and desired outcomes will be established and shared.

9.2.7    Operating Plan and Budget

The operational activities that will leverage each of the above strategies will be reflected in the SHARE operational plan, which spell out its planning assumptions, operational priorities, core activities, supporting projects, capacity-building approaches, resource requirements and allocations, budget scenarios, expected outcomes, action plans and implementation approaches (all linked back to the SHARE strategic plan).

Proposals for funding may be directed toward applied research (e.g., open grant competitions, commissioned research, etc.) or capacity assessment & development (e.g., evaluation; operations, equipment, personnel and training; communications and social marketing; organizational, community, or network design; etc.).

Internal and external funding proposals should address:^S

• potential impact:
• significance of the research for clients and stakeholders;
• involvement of clients and stakeholders as partners in the research;
• extent and appropriateness of the communication and dissemination plans;
• nature of co-sponsorship;
• potential added value from program funding;
• scientific merit:
• clarity of research questions and objectives;
• appropriateness of the methods and analytical frame;
• generalizability and validity of
  the research results;
• experience and skills of the investigative team;
• institutional environment and administrative capacity;
• track record and capacity of the investigative team in the proposed area of research;
• rationale and coherence of the proposed program of research;
• administration:
• human resources, infrastructure, financial and project management

_________

[Footnote S = Proposal information sources: 
Canadian Health Services Research Foundation - 2004 CHSRF Open Grants Competition Descriptor Statements - Letters of Intent http://www.chsrf.ca/funding_opportunities/ogc/ogc_descriptor_statements_e.php; 
Canadian Institutes for Health Research – Grants and Awards Guide 
http://www.cihr-irsc.gc.ca/e/services/3880.shtml]

9.2.9    Projects

Projects will be established in accordance with the operating plan. Capacity must be built-in for ad hoc projects and activities, based upon newly identified or emerging needs.

Actions will be guided by priorities, strategies and plans and may include: strategic initiatives, targeted research, surveys, pilot projects, and products and services. Research activities will enhance capacity for sense-making, knowledge creation, knowledge transfer, policy-making, decision-making and overall knowledge use.

9.4.1    Learning

Clients, stakeholders and research staff must engage in continuous learning.

Research staff will have the ability to continuously scan for new and relevant concepts, developments, expertise, processes, practices, products, services, etc. Strong professional networking and information retrieval skills are required.

Collaboration will be driven by purpose (e.g., executing, contributing, sharing, practicing, coordinating, cooperating, learning, etc.), supported by structures (e.g., programs, products, services, summits, clearinghouses, working groups, alliances, networks, mentoring, discussion groups, print and electronic media, etc.) and technologies (e.g., portals, decision support, simulations, document management, workflow management, e-mail, productivity applications, etc.) and focused on outcomes.

A variety of communications approaches (person-to-person, social marketing, storytelling, electronic conferencing, etc.) and vehicles (meetings, focus groups, townhalls, web sites, mail lists, newsletters, etc.) will be required to facilitate the engagement and participation of clients and stakeholders throughout knowledge transfer, dissemination and use cycles.

To reap/share the benefits from expertise and developments related to the SHARE key activities, networks will be sought out, participated in, or developed.

Governance practices will reflect federal^T and industry^U standards and clarify and provide oversight for the SHARE ends (understanding why it exists and what impact it should have) and its means (understanding how will it make an impact).
_________

[Footnote T = Corporate Governance in Crown Corporations and Other Public Enterprises – Guidelines http://www.tbs-sct.gc.ca/ccpi-pise/cg/index_e.asp]

[Footnote U = Institute on Governance http://www.iog.ca/]

9.4.7    Management

Management practices will reflect federal^V and industry^W standards and facilitate efficient and effective execution of the SHARE responsibilities.
_________

[Footnote V = Modern Comptrollership http://www.tbs-sct.gc.ca/cmo_mfc/index_e.asp]

[Footnote W = American Management Association http://www.amanet.org/index.htm]

9.4.8    Infrastructure

Availability of the people, processes, practices and structures that support the work of the SHARE must be ensured. These include information technology, human resources, finance, security, facilities, etc. Infrastructure requirements should be captured in the strategic and operational planning cycles.

Projects will be managed in accordance with recognized applied research^X and project management^Y standards to optimize scope, human resources, time, communications, risk, quality, costs, and deliverables. Project management frameworks, best practices, and tools will be maintained and applied with consistency.
_________

[Footnote X = Canadian Health Services Research Foundation http://www.chsrf.ca/home_e.php]

[Footnote Y = Project Management Institute http://www.pmi.org/info/default.asp]

9.4.10  Performance Management

Performance will be assessed in accordance with federal^z and industry standards^AA. Performance measures and related indicators will enable the SHARE to monitor (predict) and adjust client services & products, applied research processes & practices, staff learning & growth, and financial allocations & management activities.
_________

[Footnote Z = Results for Canadian: A Management Framework for the Government of Canada http://www.tbs-sct.gc.ca/res_can/rc_e.asp]

[Footnote AA = Balanced Scorecard Collaborative http://www.bscol.com/]

9.4.11 Outputs

Effective transfer and dissemination will enhance capacity for evidence-based policy-making, decision-making and practices, which will increase the overall performance of the health system and improve overall health outcomes.

The SHARE will promote a culture that thrives on just-in-time knowledge, innovation, and lessons learned. This will help the SHARE to remain agile and responsive and guide its future direction.

Critical success factors describe the key items, issues or activities that will be used to determine whether the knowledge transfer and dissemination activities have been successful. The factors are presented in Table 10, in the following categories: general, knowledge, values, governance, management, culture, clients/stakeholders, application, infrastructure, accountability, performance, measurement, outcomes and value.

APPENDIX B – A SAMPLING OF WEB-BASED RESOURCES        [Back to the Table of Contents]

Client and Stakeholder Engagement

• The Consumer Health Information Consortium (UK)
  http://omni.ac.uk/CHIC/

• INVOLVE – Promoting Public Involvement in NHS, Public Health and Social Care Research (UK)
  http://www.invo.org.uk/
  

• Edgeplace – Complexity Resources for Health Care Professionals
  http://www.plexusinstitute.com/edgeware/archive/index.html
  
• Mountain Quest Institute
  http://www.mountainquestinstitute.com/
  

Health Care – Evidence-based

• Evidence Based Health Care Practitioners Links (Canada)
  http://www-hsl.mcmaster.ca/tomflem/all.html
  
• Evidence Matters (Canada)
  http://evidencematters.com/
  
• Evidence Network (UK)
  http://www.evidencenetwork.org/home.asp
  
• The Canadian Cochrane Network and Centre (Canada)
  http://cochrane.mcmaster.ca/
  
• The Canadian Health Network (Canada)
  http://www.canadian-health-network.ca/servlet/ContentServer?cid=1038611684536&pagename=CHN-RCS%2FPage%2FHomePageTemplate&c=Page&lang=En

• Building the Future (Canada)
  http://www.buildingthefuture.ca/
  
• Canadian Centre for Analysis of Regionalization and Health (Canada)
  http://www.regionalization.org/
  
• Canadian College of Health Service Executives (Canada)
  http://www.cchse.org/
  
• Center for the Study of Healthcare Management (USA)
  http://www.carlsonschool.umn.edu/Page1211.aspx
  
• Center for Health Care Strategies (USA)
  http://www.chcs.org/
  
• Center for Health Program Development and Management (USA)
  http://www.umbc.edu/chpdm/index.php
  
• Health Organization Change (Canada)
  http://www.healthorgchange.com/index.htm
  
• Institute for Health Improvement (USA)
  http://www.ihi.org/
  
• The Manager’s Electronic Resource Guide
  http://erc.msh.org

• Alliance for Health Policy and Systems Research (Global)
  http://www2.alliance-hpsr.org/jahia/Jahia/cache/off
  
• Canadian Policy Research Network
  http://www.cprn.org/en/index.cfm
  
• Duke Health Policy Cyberexchange (USA)
  http://www.hpolicy.duke.edu/cyberexchange/
  
• Getting Research into Policy and Practice (UK)
  http://www.jsiuk-gripp-resources.net/gripp/do/viewPages?pageID=1
  
• Health Policy Monitor (Germany)
  http://www.healthpolicymonitor.org/
  
• Manitoba Centre for Health Policy (Canada)
  http://umanitoba.ca/centres/mchp/
  
• National Health Policy Forum (USA)
  http://www.nhpf.org/
  
• Program in Policy Decision-Making (Canada)
  http://www.researchtopolicy.ca
  
• UCLA Center for health Policy Research
  http://www.healthpolicy.ucla.edu/

• American Health Quality Association (USA)
  http://www.ahqa.org/pub/inside/158_716_2487.CFM?CFID=9916505&CFTOKEN=43447367
  
• Health Quality Council (Canada)
  http://www.hqc.sk.ca/

• Agency for Healthcare Research and Quality (USA)
  http://www.ahrq.gov/
  
• Applied Health Sciences (Canada)
  http://healthy.uwaterloo.ca/
  
• Canadian Consortium for Health Promotion Research (Canada)
  http://www.utoronto.ca/chp/CCHPR/index.htm
  
• Canadian Health Services Research Foundation (Canada)
  http://www.chsrf.ca/home_e.php
  
• Canadian Institutes of Health Research (Canada)
  http://www.cihr-irsc.gc.ca/e/193.shtml
  
• Canadian Research Transfer Network (Canada)
  http://www.research-transfer.org/eng/index.cfm
  
• Center for Health Systems Research and Analysis (USA)
  http://www.chsra.wisc.edu/
  
• Center for the Evaluative Clinical Sciences (USA)
  http://www.dartmouth.edu/~cecs/
  
• Centre for Applied Health Research (Canada)
  http://www.ahs.uwaterloo.ca/~cahr/
  
• Centre for Health Economics (Canada)
  http://www.york.ac.uk/inst/che/
  
• Centre for Health Economics and Policy Analysis (Canada)
  http://www.chepa.org/home/default.asp
  
• Centre for Health Economics Research and Evaluation (Australia)
  http://www.chere.uts.edu.au/
  
• Centre for Health Evaluation and Outcome Sciences (Canada)
  http://www.cheos.ubc.ca/main.html
  
• Centre for Health Services and Policy Research (Canada)
  http://www.chspr.ubc.ca/
  
• Health Organization Change (Canada)
  http://www.healthorgchange.com
  
• Health Research Transfer Network of Alberta
  http://www.ahfmr.ab.ca/rtna/
  
• Health Services Research Projects (USA)
  http://www.academyhealth.org/hsrproj/
  
• Institute for Clinical Evaluation Sciences (Canada)
  http://www.ices.on.ca/
  
• Institute of Health Services and Policy Research (Canada)
  http://www.cihr-irsc.gc.ca/e/institutes/ihspr/13733.shtml
  
• Institute for Work and Health (Canada)
  http://www.iwh.on.ca/
  
• Michael Smith Foundation for Health Research (Canada)
  http://www.msfhr.org/
  
• Monash Institute of Health Services Research (Australia)
  http://203.94.147.62/
  
• National Institute of Nursing Research (USA)
  http://www.nih.gov/ninr/
  
• Newfoundland and Labrador Centre for Applied Health Research (Canada)
  http://www.nlcahr.mun.ca/pages/funding_general_info_1.html
  
• Ottawa Health Research Institute (Canada)
  http://www.ohri.ca/home.asp
  
• Canadian Institute for Advanced Research (Canada)
  http://www.ciar.ca/
  
• Council of Ontario Research Directors (Canada)
  http://www.cordnet.ca/

• Center for Shared Decision Making (USA)
  http://www.hitchcock.org/webpage.cfm?site_id=2&org_id=108&gsec_id=0&sec_id=0&item_id=2486
  
• Foundation for Informed Medical Decision Making (USA)
  http://www.fimdm.org/
  
• Relationship-Centered Care Network (USA)
  http://www.fetzer.org/rcc/
  
• Using Research in Primary Care (Book Web Site)
  http://www.usingresearchinprimarycare.co.uk/

• Centre for Reviews and Dissemination (UK)
  http://www.york.ac.uk/inst/crd/
  
• Guide to Producing Health Information (UK)
  http://www.abdn.ac.uk/hsru/guide/guide.hti
  
• Hi Quality – Guidelines for Health Information Quality
  http://www.hiquality.org.uk/default.htm
  
• National Center for the Dissemination of Disability Research
  http://www.ncddr.org/
  
• Optimizing the Transformation of Knowledge Dissemination - Towards a Canadian Research Strategy (Canada)
  http://www.kdstudy.ca/about.html

• Health Canada - Knowledge Management (Canada)
  http://www.hc-sc.gc.ca/iacb-dgiac/km-gs/english/kmhome.htm
  
• The Interdepartmental Knowledge Management Forum (Government of Canada)
  http://groups.yahoo.com/group/ikmf_figs/
  
• KnowledgeBoard – The European KM Community (Europe)
  http://www.knowledgeboard.com
  
• Knowledge Management - National electronic Library for Health (UK)
  http://www.nelh.nhs.uk/knowledge_management/default.asp
  
• OpenClinical – Knowledge Management for Medical Care (USA)
  http://www.openclinical.org/home.html
  
• Knowledge Management Office – Veterans Administration Healthcare Network – Upstate New York (USA)
  http://www1.va.gov/visns/visn02/is/km/

Knowledge Sharing

• Health Partnership for Knowledge Sharing and Learning in the Americas (Pan American)
  http://www.paho.org/English/DD/PIN/pr031015.htm

• Centre for Knowledge Transfer (Canada)
  http://www.nursing.ualberta.ca/knowledgetransfer/
  
• Knowledge Transfer and Exchange – Institute for Work and Health (Canada)
  http://www.iwh.on.ca/kte/kte.php
  
• Knowledge Transfer – Canadian Health Services Research Foundation (Canada)
  http://www.chsrf.ca/knowledge_transfer/index_e.php
  
• Knowledge Transfer Division – VISN 8 Patient Safety Center of Inquiry – Department of Veterans Affairs (Canada)
  http://www.patientsafetycenter.com/knowledge_transfer.htm
  
• Knowledge Transfer Rounds (Canada)
  http://www.nursing.utoronto.ca/research/ktrounds/

• Partnerships & Knowledge Translation at the Canadian Institutes of Health Research (Canada)
  http://www.cihr-irsc.gc.ca/e/about/2894.shtml
  
• The Knowledge Translation Program (Canada)
  http://www.ktp.utoronto.ca/

  Knowledge Utilization

• Knowledge Utilization Studies in Practice (Canada)
  http://www.nursing.ualberta.ca/kusp/

• The Project Management Institute (USA)
  http://www.pmi.org/info/default.asp

• Canadian Coordinating Office for Health Technology Assessment (Canada)
  http://www.ccohta.ca/entry_e.html
  
• Center for Information Technology – National Institutes of Health (USA)
  http://www.cit.nih.gov/home.asp
  
• Digital 4Sight (Canada)
  http://www.digital4sight.com/healthcare.php
  
• Health Care, Technology, and Place (Canada)
  http://www.hctp.utoronto.ca/Welcome.asp
  
• Open Nurse - The Nursing Open Source Network
  http://www.open-nurse.info/presentations/

APPENDIX C – ABOUT CONTINUOUS INNOVATION AND PETER WEST        
[Back to the Table of Contents]

Clients rely on Continuous Innovation to conduct comprehensive environmental scans on challenging topics, to perform a thorough analysis of the materials retrieved and individuals consulted, to clearly communicate the key findings, to help clients to understand the implications of these findings and to strategically position clients to act on related opportunities (or threats). Clients also depend on Continuous Innovation to translate ideas into comprehensive models or frameworks that function as critical guides for stakeholders and contribute to focused execution. A sampling of clients includes the Canadian Health Services Research Foundation, Veterans Affairs Canada and the National Committee for Canadian Francophonie Human Resource Development.

Continuous Innovation has a strong working relationship with the Mountain Quest Institute – a consulting, research and learning center dedicated to working with individuals, groups and organizations to achieve growth, understanding and high performance in this age of change, uncertainty and complexity. The Mountain Quest Institute is the birthplace of the Intelligent Complex Adaptive System (ICAS) a new model for creating an adaptable, high performing organization in a fast-changing, complex marketplace. Institute professionals are available to perform studies and provide consulting services in areas such as strategic planning, knowledge management, adult learning, and systems and complexity thinking applied to problem solving and decision-making. Institute researchers can also help with leadership and team performance issues.

For more information about Continuous Innovation - http://www.continuousinnovation.ca

For additional information about the Mountain Quest Institute - http://www.mountainquestinstitute.com

Peter West

As a consultant, advisor, manager and researcher, Peter West has built a reputation for the timely delivery of insightful and innovative solutions in both the public and private sectors. Combining strong conceptual, complexity and systems thinking, Peter consistently identifies, represents, diagnoses and solves challenging problems. Among his many successes, he researched and developed an intellectual capital framework for telemedicine, designed a Sustainable Innovation Model that complemented the Government of Canada's Innovation Strategy, and conducted environmental scans on knowledge networks and communities of practice in the healthcare industry. Peter's work approaches serve as the penultimate example of knowledge transfer, dissemination and utilization in a changing world. Professional networking and information retrieval skills enable him to tap the minds of recognized subject matter experts around the world to monitor domain-specific advances, leverage newly published materials, identity and share best practices, and optimize the flow and uptake of knowledge. Strong analytical and communication skills enable him to capture, synthesize and disseminate complex information in both physical and virtual environments using simple, understandable, client-sensitive visual and text-based messages. Combine these unique skillsets with a deep appreciation of the human, organizational and technical dynamics associated with the management of knowledge, learning, innovation and change, and you move into Peter's world. Peter is a Senior Researcher and Associate of the Mountain Quest Institute.

You can reach Peter at 902-569-4870 or peter.west@continuousinnovation.ca.

APPENDIX D – REFERENCES        [Back to the Table of Contents]

1    Thomas Clarke and Christine Rollo (2001)
      Corporate Initiatives in Knowledge Management.
      Education + Training, Vol.43, No. 4/5, p.206-214

2    David J. Snowden (2003)
      Complex Knowledge.
      Presented at the 3rd Annual Gurteen Knowledge Conference – Managing Organizational Complexity