Context Matters: Factors that Promote Knowledge Exchange

For someone my age, learning to communicate via a blog or tweeting is a steep curve. My five-year old granddaughter is more adept at downloading apps and searching the internet than I. Besides age, I’m also discovering other important factors that influence knowledge exchange through my research in northern Canada.  The context of a health care work setting is widely considered to be an important influence on the use of best available evidence in practice (Dopson, FitzGerald, Ferlie, Gabbay, & Locock, 2002; Wallin, Estabrooks, Midodzi, & Cummings, 2006). The Promoting Action on Research Implementation in Health Services (PARIHS) framework describes context as including culture (Kitson et al., 1998; McCormack et al., 2002; Rycroft-Malone et al., 2002), leadership (McCormack et al., 2002), evaluation (Kitson et al., 1998), and resources (Rycroft-Malone et al., 2004) as important domains of the work setting that facilitate the use of research evidence in practice. Culture is defined as the forces at work, which give the physical environment a character and feel (Kitson et al., 1998; Rycroft-Malone et al., 2002) and encompasses the prevailing beliefs and values, as well as consistency in these values and a receptivity to change among home care providers (McCormack et al., 2002). Leadership is defined as the “nature of human relationships” (McCormack et al., 2002, p. 98) with strong leadership giving rise to clear roles, effective teamwork and organizational structures, and encouraging involvement in decision making and learning. Evaluation is described as feedback mechanisms (individual and system level), sources, and methods for evaluation (Kitson et al., 1998) and is recommended to occur routinely. Lastly, Rycroft-Malone and colleagues (2004) identified time, equipment, and clinical skills as resources needed to implement research findings. Nurses working in health care settings with a supportive and collaborative culture, strong leadership, and positive evaluation or performance feedback are significantly more likely to report more research utilization, more staff development, and lower rates of patient and staff adverse events than do nurses working in settings where these dimensions of the context are lacking (Cummings, Estabrooks, Midodzi, Wallin & Hayduk, 2007).

My research team and I are discovering that within home care centres in northern Canada, most home care providers positively agree that there is strong leadership, a positive culture (the way things are done in their home care centres), and connections among health care providers within their centres. These dimensions are fundamental to establishing a vibrant workplace where employees actively seek out ways to develop and use their skills, knowledge, and abilities to provide evidence-based quality care. When health care providers collaborate, “the sum becomes greater than the parts, teams and the organization develop capabilities for performance, innovation, and creativity that far surpass what individual members bring to their jobs” (Lowe, 2010, p. 2).  However, innovative strategies are needed that promote collaboration between health care providers who are working with the same clients but from different organizations. Formal linkages that connect rural health care providers with specialists in urban settings will also enhance evidence-based practice in rural home care centres. How data is currently being used to evaluate group/team performance and to achieve outcomes also needs to be further examined as there appears to be a wide range of use of data for evaluation purposes. In addition, for home care providers to apply their capabilities to the fullest, resources such as staff, time, space, and information technology that enable them to collaborate, access, adapt, and apply the best available evidence in their practice are needed. Are there opportunities within your healthcare setting to change the context to promote the exchange of best available evidence?

Cummings, G.G., Estabrooks, C.A., Midodzi, W., Wallin, L., & Hayduk, L. (2007). Influence of organizational characteristics and context on research utilization. Nursing Research, 56(4, Suppl 1), S24-S29.

Dopson, S., FitzGerald, L., Ferlie, E., Gabbay, J., Locock, L. (2002). No magic targets! Changing clinical practice to become more evidence based. Health Care Management Review, 27(3), 35-47.

Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence-based practice: A conceptual framework. Quality and Safety in Health Care, 7(3), 149-158.

Lowe, G. (2010). Creating healthy and sustainable health care organizations. Retrieved from

McCormack, B., Kitson, A., Harvey, G., Rycroft-Malone, J., Titchen, A., & Seers, K. (2002). Getting evidence into practice: The meaning of ‘context’. Journal of Advanced Nursing, 38(1), 94-104.

Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A., McCormack, B., & Titchen, A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13(8), 913-924.

Rycroft-Malone, J., Kitson, A., Harvey, G., McCormack, B., Seers, K., Titchen, A., … Estabrooks, C. (2002). Ingredients for change: Revisiting a conceptual framework. Quality and Safety in Health Care, 11(2), 174-180.

Wallin L., Estabrooks C.A., Midodzi W.K., & Cummings G.G. (2006): Development and validation of a derived measure of research utilization by nurses. Nursing Research, 55(3), 149-160.

Dorothy Forbes


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