Academic journal article Bulletin of the World Health Organization

The Knowledge-Value Chain: A Conceptual Framework for Knowledge Translation in health/La Chaine De Valeur Des Connaissances En Sante: Un Cadre Conceptuel Pour la Mise En Pratique Des connaissances/La Cadena De Revalorizacion De Los Conocimientos: Un Marco Conceptual Para la Traslacion De Conocimientos En Materia De Salud

Academic journal article Bulletin of the World Health Organization

The Knowledge-Value Chain: A Conceptual Framework for Knowledge Translation in health/La Chaine De Valeur Des Connaissances En Sante: Un Cadre Conceptuel Pour la Mise En Pratique Des connaissances/La Cadena De Revalorizacion De Los Conocimientos: Un Marco Conceptual Para la Traslacion De Conocimientos En Materia De Salud

Article excerpt

Introduction

The golden era of modern research, which started after the Second World War, was a period during which research findings outside strategic government projects were published (1) and passive diffusion followed. The 1970s saw the birth of evidence-based medicine, which used a "push strategy" of both active dissemination of practice guidelines and education for their local interpretation and adaptation; technology assessment also emerged at a time when private industry took over most of the research and development of products. At the time, conceptual frameworks derived from the social theory of the diffusion of innovation included those of research transfer and research utilization; the private sector developed value-chain models and marketing strategies. The success of evidence-based medicine, however, plateaued in the 1990s and the new millennium dawned bringing flesh thinking to this old frontier. In Canada, for example, as the institutions were reorganized or created, the term "knowledge translation" was coined and it emphasized models of linkage and exchange. (2)

The concept of knowledge translation (KT) is developing at a time when unprecedented global investments in health research have generated a vast pool of knowledge that is underused and not translated rapidly enough into new or improved health policies, products, services and outcomes. KT comes at a time when the gap between what is known and what gets done (the know-do gap) is highlighted by shortfalls in equity (for example, as underscored by the Millennium Development Goals) (3) and quality (resulting in the development of the patient safety movement) in health services. However, there is a limited interpretation of KT as a linear transaction between research "producers" and "users" who trade knowledge as a commodity. Knowledge can be created without science and KT is not research: it moves from responding to curiosity to focusing on purpose and problem solving. It is defined as "the synthesis, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people's health". (4) More concretely, KT is about creating, transferring and transforming knowledge from one social or organizational unit to another in a value-creating chain: it is a complex interactive process that depends on human beings and their context. The transfer of knowledge from one community or organizational unit to another usually faces five problems: knowledge access, knowledge incompleteness, knowledge asymmetry, knowledge valuation and knowledge incompatibility (Box 1). (5-8)

Box 1. Knowledge translation problems

Knowledge access

At its root, KT is often pre-empted by basic access to key information
and expertise. This applies both to the ability to learn of the
existence of knowledge and the ability to retrieve it in a timely
and usable form. The end results are wasted opportunities and
reinventing of wheels. The sheer volume of information available is
itself a challenge, as are the digital divide and the exclusionary
nature of expensive intellectual property. Indexes, search engines,
expertise locators and social networks are making it much easier
today, as are various public and private efforts to facilitate
affordable access to premier information and know-how.

Knowledge incompleteness

When the attributes of the knowledge in a given transfer transaction
are not completely specified, knowledge incompleteness happens.
Research knowledge represents abstract principles dealing
with fundamental relations between causes and effects. There might
be a gap between these abstract principles and their concrete
application in new or improved products and services. Proof that
abstract principles work is frequently not provided to the
recipients of knowledge transfer. The probability that recipients of
knowledge transfer receive usable technical solutions decreases as
research knowledge becomes more complex. … 
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