An Interactive Integrative Approach to Translating Knowledge and Building a "Learning Organization" in Health Services management/Approche Integrative et Interactive Pour la Mise En Pratique Des Connaissances et la Mise En Place D'une « Organisation De L'apprentissage » Dans Les Services De sante/Metodo Integrador E Interactivo Para Trasladar Los Conocimientos Y Crear Una « Organizacion De Aprendizaje

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Knowledge normally leads to one or more of three possible outcomes: better understanding of the world around us, useful products or technologies or a guide to making decisions, such as a policy, professional practice or information on how to manage organizations. WHO emphasized the importance of using knowledge for health development (bridging the know-do gap) (1) after the use of evidence-based medicine gained ground among health-care professionals two decades earlier. (2,3) Generally, the emphasis on evidence refers to evidence generated by research studies. Concerns have been expressed about the fact that most decision-makers, health professionals, policy-makers and managers do not make use of evidence or knowledge generated by good quality research but rather use their "personal knowledge"--derived from their own experiences and trusted sources--to guide their decisions.

If we define knowledge more broadly than findings from research, (4) it follows naturally that few decisions are made without the use of some sort of knowledge, particularly knowledge from personal experiences. From a knowledge-management point of view, knowledge that is derived from experience and trusted sources is considered "tacit knowledge" as opposed to "explicit" knowledge, which comes from documented sources. (5) The current interest in knowledge translation stems from concerns that relevant and useful research findings could be better used to guide decision-making. (6,7) Knowledge translation is an attempt by those who have scientifically sound and useful knowledge to try to find more effective ways of moving their knowledge from research into decision-making processes in order to improve people's health. However it would be naive to expect that relevant and useful research findings will be sought out and used by decision-makers. (8) In order to make knowledge translation more effective, it is important to bear in mind that knowledge translation is context specific rather than context free.

Much can be learned from the use of knowledge translation in drug development, where biomedical knowledge is translated during various stages of the process--from discovery to approval for use and then to the marketing of new products. (9,10) In the process of drug development, it takes great effort and resources to generate and translate the various sets of knowledge along the knowledge-value chain. Drug regulatory authorities specify how many steps are needed before a drug will be approved for use; additionally, the various types of knowledge and quality standards needed to move from one step to another along the knowledge chain are also specified. A knowledge-translation chain is relatively better defined than a chain dealing with decisions made in an organization about policies or management. The translation from knowledge to action is not a simple linear process but rather a complex and often unclear value chain. The translation processes that lead to decisions are often so complex that they have been referred to as "black boxes". (11,12) Knowledge translation in drug development may be relatively less complex than knowledge translation in other areas, particularly health services management; this may be due to the fact that drug development is about technology and thus knowledge-translation chains used by regulatory agencies have to be clearly defined and standardized to ensure the quality and safety of technologies derived from the processes. When decisions about policy and services management are made, the end-points (health improvement or more effective delivery of services) are more difficult to define and involve more complex processes that are difficult to standardize. The areas of policy and service management make use of various types of knowledge, not necessarily those generated by research, and non-linear processes lead from one step to the next. Policy decisions and health services management are often criticized for not making use of objective or scientific evidence. …


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