JCPSLP Vol 14 No 1 2012

KTA intervention. As an example, Molfenter et al. (2009) clearly identified a gap in dysphagia rehabilitation, whereby clinicians had learnt about a new therapeutic tool ( knowledge creation ), but had failed to translate its use into everyday practice ( knowledge action ). The clinical scenario presented is similar: clients are not able to reap the benefits of trialled and tested interventions. In reality, identifying “the gap” is often the easiest, but most crucial, step in a translation project. Such gaps often make their way quickly on to departmental wish lists or to-do plans; however, finding the time, resources, and sometimes the confidence to address them can be more difficult and the right KTE strategies or frameworks can thus be useful. Use clients as partners and agents for change Another key message to emerge is that the most success­ ful translation projects are those conducted in partnership with clients or consumers (Kagan et al., 2010; Simmons- Mackie et al., 2007). As a profession we need to be creative in how we survey and gather information from our clients about treatment services and service delivery models as satisfaction data can provide a powerful impetus for change. Engaging and empowering our clients also encourages them to participate more actively in their own treatment and demand the highest level of care. The recommendation has been made that more energy should be directed into informing our clients and key stakeholders about current best evidence to enable them to become drivers of knowledge transfer. Kagan et al. (2010, p. 541) highlight the need to identify “credible messengers” who may best contribute to a “tipping point” in ensuring that research is translated into practice. One choice might be a client with aphasia and their families; others could include champions in the field. Finding the right spokesperson may determine the power and capability of a translation project (Kagan et al., 2010). Simmons-Mackie et al. (2007) identified not involving the right spokesperson as a limitation of their research and strongly encourage including consumers or clients in the planning and evaluation of KTA interventions. Identify readiness for and barriers to change Simmons-Mackie et al. (2007) demonstrate the importance of identifying potential barriers to change in the planning (and evaluation) stages of an implementation project. In this study, systems-level change was made in two out of the three facilities involved in the project. While positive changes in attitudes, knowledge, and service were seen in the rehabilitation and long-term care facilities, the outcomes were not as positive in the acute care setting and pervasive systems-level change was not achieved. It is extremely important that such “negative results” are reported and shared with the professional community, providing information about barriers and variables that influence systems change and knowledge translation (Simmons- Mackie et al., 2007). Assessing team readiness for change is another important consideration and once “local barriers” are identified, KTA interventions can be tailored accordingly. KTA models and frameworks guide clinicians through this process, enabling them to adapt knowledge to the local context (Graham et al., 2006). Form partnerships and collaborations as drivers of change Knowledge transfer and exchange are dynamic and interactive processes and strategic partnerships play a critical role. Passive dissemination of research findings

through conferences, publications, and other forms of written material does not work and will not ensure consistent or effective transfer of evidence (Kagan et al., 2010; Sudsawad, 2007). This point was made clear in the Molfenter et al. (2009) study, where didactic teaching was not enough to translate use of a new therapeutic tool into practice. For system change to occur, “interactive engagement” is needed between “those who create the knowledge, those who disseminate it, and those who can use it” (Lomas, cited in Kagan et al., 2010, p. 540). Perhaps not surprisingly, research findings are most likely to be “used in practice” when the clinician (or service) is linked to a study or project from the outset (Kagan et al., 2010). For example, in both the Molfenter et al. (2009) and Simmons- Mackie et al. (2007) studies clinicians were engaged from the planning phase and able to identify their own KTA goals and needs. Their input facilitated engagement and “buy-in” with commitment to KTE. It is only through actively engaging “front-line service providers” and administrators that sustainable, long-term changes to service quality (and policy) can be made (Kagan et al., 2010). Evaluate, measure, and disseminate change It is of critical importance that the outcomes of any implementation project are measured systematically to determine success and to contribute to the evidence base for knowledge transfer. Outcomes should be measured at the level of the health professional (e.g., change in practice, knowledge, or attitudes), the patient or consumer (e.g., improved client satisfaction or outcomes), and/or the service itself (e.g., change in policy, programs, or staffing ratios). Molfenter et al. (2009) and Simmons-Mackie et al. (2007) provide useful examples of ways to measure outcomes. To illustrate, Molfenter and colleagues (2009) used a “blind assessor” not involved in the KTA intervention to interview clinicians and collect feedback about the success of the project. Simmons-Mackie et al. (2007) also conducted interviews and focus groups with their participants to explore changes in knowledge, attitudes, and practices. When working within a KTA framework “sustained knowledge use” is vital and requires inclusion of follow-up measures to ensure that robust changes in practice are made and clearly demonstrated (Molfenter et al., 2009). Kagan et al. (2010) state that sound methodology for evaluating the results and success of knowledge transfer is critical and that a strategy for dissemination of findings should be determined at the outset. Considering the key message of the research, the key stakeholders to engage, and the best ways for sharing the results to support and facilitate further transfer into practice are important, continuing the knowledge action cycle (Graham et al., 2006; Kagan et al., 2010). Ensure continued KTE dialogue between clinicians and researchers The final theme to emerge emphasises that effective knowledge transfer is dependent on effective communication between researchers and “end users”, ensuring appropriate and well targeted use of best evidence in practice (Graham et al., 2006; Kagan et al., 2010; Molfenter et al., 2009). This exchange must be bi- directional, mutually inclusive, and cyclical. Researchers play an important role in ensuring that research findings are synthesised and disseminated in an “accessible format for end users” (Macdonald & Wiseman-Hakes, 2010, p. 486), by adopting “practice-friendly research” (Small, 2005, p. 327). Furthermore, it is important that scientific findings have relevance to situations of practice and address areas

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JCPSLP Volume 14, Number 1 2012

Journal of Clinical Practice in Speech-Language Pathology