Preparing the ground for change 

The planning stage of KT is preparation for implementation or evaluation. Here we look at some of the key steps and skills.

When planning for KT strategies the selection of an appropriate model, theory, and/or framework can help. You will need to choose one that provides guidance on the planning process of KT.  Some of the skills you will need to develop include: [1]

  • How to develop a logic model: Be able to describe what outcomes you want to achieve and beginning with the evidence for change, the process you will use to guide this.
  • How to engage in collaboration and teamwork: How to develop working relationships with peers and others.
  • Leadership: Have an ability to scan the context, facilitate stakeholder involvement in evidence-based decision-making, influence skill development and act upon stakeholders’ views and needs.
  • How to foster innovation: Be able to use novel tools and strategies to improve practice or policy, address issues, assess and build service improvement approaches, and evaluate the impact of an innovation.

The first step of planning in KT is to determine the need for change. Once this has been established you can begin to plan what you will do to achieve the desired outcome.

Identifying the need to change

In line with increasing demand for palliative care in Australia, the volume of literature and evidence  has expanded rapidly. [2] There is also an increasing policy focus on the delivery of palliative care given an ageing population and the number of people living with advanced and progressive illnesses. [3] While these factors support the need for change, a more deliberative approach is needed to progress these changes.

In practice the need for change may come from emerging problems. These might be identified through audit, complaints, or care provider experience indicating that better approaches are needed. [4]

The first step is to identify where there are gaps between what is known and what is done. [5] The Australian Health Research Alliance, AHRA, has identified the need to develop and embed evidence-based linkages, pathways and strategies to facilitate use of research evidence to improve healthcare delivery. One of 11 recommendations they make is that efforts be made to ‘Develop and adapt models and methods to optimise knowledge translation, scale-up, implementation, adoption and diffusion of best-evidence practice.’

Major evidence sources and useful resources for palliative care include:

  • Palliative care guidelines
  • Palliative care synopsis of syntheses
  • Palliative care syntheses (systematic reviews)
  • The Rx for Change Interventions Database (Canadian Agency for Drugs and Technologies in Health). A searchable database containing current research evidence about intervention strategies used to alter behaviours of health technology prescribing, practice, and use (Free access but registration is required).

Audit and benchmarking activities in addition to more formal research studies can be used to highlight gaps between practice and evidence or variations across sites or services. Examples include:

Many palliative care services carry out audit activities as part of their ongoing management processes. The Palliative Care Outcomes Collaborative (PCOC) provides another mechanism for services to assess their performance against other services using validated data collection instruments. These data sources can be used to compare performance against the research evidence and to identify any gaps that may need to be investigated.

Planning tools - program logic

Developing a logic model to describe your KT program is a common and effective approach to map out how your program should work. In other words, what you will do to achieve the desired outcomes. The model visually shows the relationships between project resources, activities, outputs, and outcomes. A linear form is often used but there are other approaches you can apply if you want to include more detail for each step or result. As well as for planning implementation, the logic model can be used to develop evaluation strategies. The outputs and outcomes show you what should be measured to demonstrate whether a program has achieved its goals. To learn more visit the resources listed below.

If you include reasoning as to why you think the activities will lead to the desired outcomes then the logic model might be referred to as a ‘theory of change’ diagram. 

  1. Mallidou AA, Atherton P, Chan L, Frisch N, Glegg S, Scarrow G. Core knowledge translation competencies: ascoping review. BMC Health Serv Res. 2018 Jun 27;18(1):502. doi: 10.1186/s12913-018-3314-4.
  2. Khalil H, Downie A, Ristevski E. Mapping palliative and end of care research in Australia (2000-2018). Palliat Support Care. 2020 Dec;18(6):713-721. doi: 10.1017/S1478951519001111.
  3. Davies E, Higginson IJ, editors. Better palliative care for older people (537kb pdf). Copenhagen, DK: World Health Organization; 2004.
  4. Wensing M, Grol R, Grimshaw J, edtiors. Improving Patient Care: The Implementation of Change in Health Care [Internet]. 3rd ed. Wiley–Blackwell; 2020. [cited 2022 May 19].
  5. Buchan H. Gaps between best evidence and practice: causes for concern. Med J Aust. 2004;180(6 Suppl):S48-S49.

Page created 28 March 2022