Knowledge brokering: An innovative model for supporting evidence-informed practice in respiratory care

WD Reid, PG Camp. Knowledge brokering: An innovative model for supporting evidence-informed practice in respiratory care. Can Respir J 2013;20(4):271-274. The process of adopting research findings in the clinical setting is challeng- ing, regardless of the area of practice. One strategy to facilitate this process is the use of knowledge brokering. Knowledge brokers (KBs) are individu- als who work to bridge the gap between researchers and knowledge users. In the health care setting, KBs work closely with clinicians to facilitate enhanced uptake of research findings into clinical practice. They also work with researchers to ensure research findings are translatable and meaning- ful to clinical practice. The present article discusses a KB’s role in a respiratory care setting. Working closely with both researchers and clinicians, the KB has led teams in the process of conceptualizing, developing, testing, disseminating and evaluating several projects related to respiratory care, including projects related to mobility in critical care settings and acute exacerbations of chronic obstructive pulmonary disease; inspiratory muscle training; and the use of incentive spirometry in postsurgical populations. The KB role has provided an important communication link between researcher and knowledge user that has facilitated evidence-informed practice to improve patient care.

(KB) positions. The KB's role is to 'bridge the gap' between evidence and practice (5)(6), functioning as a 'change agent', catalyst and project leader to link research producers and knowledge users. In a recent review of the literature on KBs, Conklin et al (5) identified seven types of activities that are typically undertaken by KBs and emphasized the 'boundary spanning' component of the role to link researchers, practitioners and decision makers by "fostering relationships and creating operational groups capable of producing tangible results". The KB's ability to promote mutual understanding of the unique environments and cultures of each stakeholder group is crucial to fostering understanding across groups, commitment to the objective(s) of the project and, ultimately, adoption of the desired change. A key component of success is the ability to adapt the knowledge to the local context. Ward et al (6) identified the five key elements to the process undertaken by KBs: identify and communicate the problem; analyze the context; develop and select the knowledge to be transferred; select the appropriate KT interventions; and consider how the knowledge will be used in practice. The steps outlined by Ward et al (6) provide evidence-based direction for teams seeking guidance for their own knowledge translation activities. The process of adopting research findings in the clinical setting is challenging, regardless of the area of practice. One strategy to facilitate this process is the use of knowledge brokering. Knowledge brokers (KBs) are individuals who work to bridge the gap between researchers and knowledge users. In the health care setting, KBs work closely with clinicians to facilitate enhanced uptake of research findings into clinical practice. They also work with researchers to ensure research findings are translatable and meaningful to clinical practice. The present article discusses a KB's role in a respiratory care setting. Working closely with both researchers and clinicians, the KB has led teams in the process of conceptualizing, developing, testing, disseminating and evaluating several projects related to respiratory care, including projects related to mobility in critical care settings and acute exacerbations of chronic obstructive pulmonary disease; inspiratory muscle training; and the use of incentive spirometry in postsurgical populations. The KB role has provided an important communication link between researcher and knowledge user that has facilitated evidence-informed practice to improve patient care.

Key Words: Knowledge broker; Knowledge translation; Respiratory care
Le courtage du savoir : un modèle novateur pour soutenir la pratique fondée sur des données probantes en soins respiratoires Le processus d'adoption des résultats de la recherche en milieu clinique est complexe, quel que soit le secteur de pratique. Le courtage du savoir fait partie des stratégies pour faciliter ce processus. Les courtiers en savoir (CS) sont des personnes qui travaillent à combler les lacunes entre les chercheurs et les utilisateurs du savoir. Dans le milieu de la santé, les CS travaillent en étroite collaboration avec les cliniciens pour qu'ils intègrent les résultats des recherches à la pratique clinique. Ils travaillent également avec les chercheurs pour s'assurer que les résultats de la recherche soient traduisibles et significatifs en pratique clinique. Le présent article porte sur le rôle d'un CS en pneumologie. En étroite collaboration avec les chercheurs et les cliniciens, ce CS a dirigé des équipes dans le processus de conceptualisation, d'élaboration, de mise à l'essai, de diffusion et d'évaluation de divers projets liés aux soins respiratoires, y compris des projets liés à la mobilité en soins intensifs et aux exacerbations aiguës des maladies pulmonaires, à l'entraînement des muscles inspiratoires et à l'utilisation de la spirométrie d'encouragement après une opération. Le CS s'est révélé un lien de communication important entre les chercheurs et les utilisateurs du savoir et a facilité la pratique fondée sur des données probantes pour améliorer les soins aux patients.  , this position has evolved to include multiple interdisciplinary KB projects related to acute and chronic disease, with several specifically focused on respiratory care. The roles and activities of the physical therapy KB are diverse, but can be categorized as activities related to research; development of practice resources; and evidence-informed practice skill development. The KB facilitates research by identifying and facilitating partnerships among academic, education and clinical entities (decision makers and clinicians) in medicine, nursing and the allied health professions including physical therapy. The development of practice resources uses knowledge of the optimal methods to 'translate' the literature into practice-relevant tools and make it accessible and acceptable to stakeholders, including clinicians, researchers, students and decision makers. These practice resources are housed on an array of stakeholder relevant websites enabling broad access. Assessment of web traffic to these KB resources has shown a total of 10,000 hits over four years, and a 230% increase in traffic between year 1 and year 4 of the KB position. To improve health care professionals' critical appraisal skills, the KB developed a journal club series hosted through a webinar platform (and recorded for repeated viewing), enabling health care professionals working throughout the province an ongoing opportunity to develop and refine their skills in reading, critiquing and then applying knowledge to their clinical practice setting. Attendance has increased by 302% between the first and most recent sessions (10 sessions in total) and pre/post evaluations demonstrate a 29% to 43% mean change in confidence in appraisal skills. This position undergoes an annual review of activities and outcomes before renewal of funding. Annual reports of the activities and outcomes of the position are available at <http://physicaltherapy.med.ubc.ca/research/physical-therapyknowledge-broker/>.

SuPPORTING EVIDENCE-INFORmED PRACTICE IN RESPIRATORY CARE
With respect to supporting evidence-informed practice specifically in respiratory care, the KB has been instrumental in facilitating six important projects for British Columbian and Canadian health care providers. Using the five steps outlined by Ward et al (6), Table 1 provides the essential components of each of these KT projects.

OTHER KT RESOuRCES
The recent emphasis on KT is a reflection of the lack of uptake of research findings into clinical practice. The KB role is an increasingly popular method to enhance evidence-informed practice. Although knowledge brokering can be an effective means to link clinicians, decision makers, educators and researchers to improve clinical care,

CONCLuSION
Funding agencies, such as the Canadian Institutes for Health Research, government agencies, such as the Public Health Agency of Canada, nongovernmental organizations, such as the Canadian Lung Association and health care professional societies, such as the Canadian Thoracic Society and the Canadian Respiratory Health Professionals, are united in their support for best evidence-based KT activities. The need for KT in respiratory care is vast, from the requirement of urgent and accurate communication with health care practitioners and patients (eg, in surveillance and identification of disease, such as during the SARS outbreak), to detailed management guidelines for complex chronic diseases (eg, chronic obstructive pulmonary disease, asthma and idiopathic pulmonary fibrosis). However, while most researchers are adept at producing end-of-grant KT items, such as peer-reviewed articles and presentations at conferences, there is less experience and expertise in designing, implementing and evaluating KT activities. Similarly, health care professionals often voice concerns about the time and proficiency required to efficiently access, synthesize, interpret and apply the findings of research articles. The inclusion of the KB role to our health care community provides a vital communication link that has enabled respiratory-related KT activities to expand beyond end-of-grant activities to include a wide variety of evidence-based strategies to improve patient care.