February 10 th , 2011 KT Canada Seminar Series

1. Required versus inspired partnerships:Report on a survey of researchers and knowledge-users holding integrated KT grantsJacqueline M TetroeSenior AdvisorKnowledge Translation and Public Outreach PortfolioCanadian Institutes of Health Research February 10th, 2011 KT Canada Seminar Series

2. Learning Objectives • To briefly describe the literature on researcher/knowledge-user partnerships • To describe the nature of the partnerships required by CIHR in its integrated knowledge translation (iKT) funding opportunities • To discuss the impact and sustainability of CIHR-funded iKT partnerships

3. Background CIHR – is the Canadian Institutes of Health Research Canada’s national health research funding agency - supports 13,000 researchers and trainees Our mandate: To excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system. One mechanism for translating knowledge and increasing the impact of what we fund is through integrated knowledge translation funding opportunities

4. Background Integrated knowledge translation means researchers and knowledge-users working together to: • shape the research questions • interpret the study findings and craft messaging around them • move the research results into practice In theory, this should increase the chance that the research will be moved into practice and actually have an impact Our integrated knowledge translation grants require researchers and knowledge-users to be co-applicants We wanted to know how these required (rather than inspired) partnerships are working out

5. Basic idea behind our study Purpose: Explore the nature of researcher-knowledge-user partnerships in health research and address the gap in understanding the nature of these partnerships and their impact on the KT process. Objectives: • Gain an in-depth understanding of partnerships • Explore current partnership relationships • Improve CIHR partnership practices and support mechanisms

6. The 3 iKT funding opportunities under investigation Knowledge Synthesis To increase the uptake/application of synthesized knowledge in decision-making by supporting partnerships between researchers and knowledge users to produce scoping reviews and syntheses that respond to the information needs of knowledge users in all areas of health Knowledge to Action To accelerate translation of knowledge by linking researchers and knowledge-users to bridge a knowledge to action gap, and increase the understanding of knowledge application through the process Partnerships for Health System Improvement To support teams of researchers and decision makers interested in conducting applied health services and policy research that will be useful to health system managers and/or decision makers.

7. The study in a nutshell Literature search on partnerships conducted by a CIHR-CHSRF post doctoral fellow (Shannon Sibbald) Surveys developed based on literature search and in collaboration with Shannon Survey posted on-line and full Dillman methodology used to encourage researchers and knowledge-users to respond Semi-structured interviews conducted with 50 survey respondants

8. Search Methodology • Initial Searching: keywords such as knowledge translation and cooperative behavior, partnership(s), collaboration, and research yielded few useful (or new) articles.  • Hand Searching of exemplar article bibliographies (Mitchell, 2009, and Jansson et al., 2009) • Reference Mining & Citation Snowballing* • Forward Searching • Searches within Databases: (Medline, Embase, Science Direct, and CINAHL) • Grey Literature Search • Found 82 articles, 48 of which dealt specifically with researcher/knowledge-user partnerships

9. Cultural differences Time commitments and constraints Contextual issues Resource commitment Concerns about quality of research Competing agendas Academic incentives/reward structure Relationship building issues Staff turnover Lack of skills Power imbalance Barriers identified in the literature

10. Understanding of decision-making environment Enhanced research process Increase trust and mutual understanding New skills (spin-off benefits) Long-term knowledge understanding Enhanced relevance Access to resources Access to data Use of research findings Unique perspective Contextualization Common language Learning opportunities Advancing evidence based decision making Benefits identified in the literature

11. Sustainable partnerships… “reach beyond specific individuals in either setting” (Jansson, 2009, p. 7) are built at institutional level help to increase capacity building, factual learning and research skills support users to test and implement research findings encourage collaborative reflection beyond knowledge creation, on the research use process

12. The Survey Questions created from the literature review just described 41 questions in 8 categories • Partnership details • Study Design • Partnership Outcomes (impact) • Required Partnerships • Partnership Process(barriers) • Information Sharing • Next Steps (for the partnership) (sustainability) • Facilitating partnerships

13. Survey response rate Population: every funded iKT grant from 2005 to September 2009 (224 grants) Includes: Partnerships for Health System Improvement (83) Knowledge to Action (40) Knowledge Synthesis (101) Knowledge-users • Received by 161 • Completed by 110: RR= roughly 68% Researchers • Received by 203 • Completed by 173: RR= roughly 85%

14. Interview questions • What was your experience being a co investigator on this iKT grant – particularly the partnership aspect? • The literature we examined prior to conducting the survey indicated that the following barriers existed for partnerships between researchers and decision makers (Question 31 from the survey): (list of barriers). Our data indicate that these barriers were not an issue for the majority of our respondents. Why do you think this is the case? Is it something to do with the required nature of the partnership?

15. Interview questions • a) Take me through the process of forming this partnership. How was the partnership nurtured/maintained? b) How can CIHR make it easier for partners to find each other and to work together effectively? • a) Take me through the steps you and your partner(s) went through to create your research project? b) How was this different from non-partnered research that you have participated in? • a) From your experience, do these required partnerships increase impact compared to grants not requiring a partner? b) What could CIHR do to increase the impact of iKT grants?

16. The sample for today’s discussion: 77 “matched sets”

17. Results • Barriers to partnership • Impact of partnership • Sustainability of partnership

18. Barriers To what extent did each of the following affect your ability to complete this study?

19. Barriers To what extent did each of the following affect your ability to complete this study?

20. Barriers To what extent did each of the following affect your ability to complete this study?

21. Making sense of the data • Why did our survey respondents not experience the barriers identified in the literature? • Preliminary interview data suggests that many of the partnerships were not new – the barriers had already been addressed/overcome • In cases when new partnerships were created for the funding opportunity, interviewees reported a less positive overall experience

22. Interview responses – why were these identified barriers not an issue? • expectations managed and roles clearly defined early on … understanding of ongoing collaboration to achieve same end • regular and frequent communication • nothing to do with required nature, but more to do with fact that partnership was positive overall • required nature of partnership means that there is specific attention paid to the barriers • design of iKT grants set up to avoid these barriers

23. Interview responses – why were these identified barriers not an issue? • principles of participatory action- based research makes it a success, not just the required nature of the partnership • KU was a clinician that may have done research differently in the past • fewer barriers because KU involved from outset; history of relationship and trust • experienced researchers apply for these grants; trust, confidence and upfront dealing with barriers important • due to culture change, fewer barriers

24. Interview responses – why were these identified barriers not an issue? • researchers tend to dream big, and KU has feet on ground • having senior members in organizations as knowledge-users can be a facilitator because they don’t have someone higher to report to and can make things happen • major barrier: organizational change, not those identified in literature • “[the project] grew out of an existing relationship that allowed us to do research that was of interest to both parties, so it was very productive and satisfying from my end.”

25. Interview responses – why were these identified barriers not an issue? “If there’s a trusting relationship that each of… the partners knows their role, and is engaged in playing that role well, I don’t think the other barriers or challenges actually need to come about. So foundation is trust.” “… my combined … understanding of institutions enabled me to figure out how to navigate these things… and a huge amount depends on personal relationships.”

26. Impact of partnership

27. Did being in a partnership increase the uptake of the study results? • Many respondents reported it was too soon to see any impact (overall, 73% were not finished) • Researchers and knowledge-users gave similar kinds of responses • A few “failures to launch” • “Researcher never produced a usable report to drive/influence decision-making; when it was produced, decisions were already made” • The vast majority of comments were detailed and positive

28. Did being in a partnership increase the uptake of the study results? • success stories – from researchers: • “Given the changes in the provincial health care system, the partnership was critical in ensuring that the project could adapt to the changing circumstances” • “Our knowledge-users have been active in using the findings from the project in their work – they have been champions for the work” • success stories – from knowledge-users: • “I believe our participation opened the doors to a number of government departments being open to the research results and being willing to discuss how it may impact their policies and practices” • “I was able to improve access to service providers”

29. Required versus inspired From your experience, do these required partnerships increase impact compared to grants not requiring a partner? • Yes: connected to community of advocacy organization or policy mechanism; more people engaged- larger audience for results; more investment by KU for uptake of results • Yes: different skill sets of researchers and knowledge-users working on common problem • Working from start to finish on same issue makes for a greater impact • Impact is to break the boundary between practice as real world and academia as ivory tower

30. Required versus inspired From your experience, do these required partnerships increase impact compared to grants not requiring a partner? • Buy-in from beginning; questions are clinically relevant; KUs have voice and accountability • Helps to focus research questions as relevant to practice/ensures that KT gets right into system- KU feels ownership and obligation to research results • Relationship existed, so required nature of grant did not make big difference • Joint desire to influence practice • Key decision makers high in organizations have a better chance of making an impact

31. How can funding agencies facilitate required partnerships? Most popular survey responses: • More time (longer grants) and/or more money to conduct this type of research • Staff to work with funded teams to facilitate KT

32. How can funding agencies facilitate required partnerships? Some options entered under “other”: • A network to help disseminate clinical research tools developed • Better advance notice of RFAs to allow for teams to prepare grant proposals • More time to develop partnerships - times between calls and application due dates are often short and do not allow for meaningful engagement • Funding for pilot work that develops trust and establishes who the important partners will need to be.

33. What kind of impact did these grants achieve? • Most commented on the fact that it is too soon to expect to have achieved impact (73% were not finished) • Researchers tended to report publications in preparation • “Two papers currently under review by a medical journal” • Knowledge-users focused more on use in their comments • “The results of the research are helping to shape our future responses to victims of domestic violence”

34. What kind of impact did these grants achieve? There were some very frank responses • Researcher: “the project has not had the anticipated impact. Some of the KT materials were developed and have had an impact at a policy level, but have not affected practices amongst the institutions of the partners” • Knowledge-user:“Study finished, no publication; a report that I am not sure of the meaning”

35. Sustainability of partnership Many grants were not yet completed (73%), so the response to the first question is moot – response to second question is encouraging. These seem to be sustainable partnerships

36. What could CIHR do to increase the impact of iKT grants? • Local conferences to bring KUs and Rs together • At the review committee level, give precedence to issue driven partnerships over strictly “partnership research” • Promote awareness of work being done through email summaries to interested researchers • Train people how to do iKT: online training of exemplar programs and training program for researchers on how to facilitate partnerships • Longer grants needed

37. What could CIHR do to increase the impact of iKT grants? • Reduce national/multi-jurisdictional emphasis and reward localized partnerships • CIHR can reach academics and high level KUs but grassroots organizations are not aware of CIHR so Rs have to approach these organizations and explain opportunities to them • Infrastructure funding for KT- ensures sustainability of KT rather than funding one project at a time • More media attention • Longer grants foster longer partnerships, which promotes more research questions coming from KUs

38. What could CIHR do to increase the impact of iKT grants? • Timeline indicating types of input and resources expected from KU at certain points in development of project • Address difficulty of engaging federal government • Increase visibility and promotion of these activities • Peer [merit] review: rather than looking at only expertise to develop content, also look at whether people on team represent all potential user or stakeholder groups

39. What could CIHR do to increase the impact of iKT grants? “… if you want to do something meaningful to the public and something big you need to get the people on side early on, which means that… you need to engage the larger public as early as possible and the easiest way and this is a way that includes the media, and for the individual researchers, I mean time is limited, resources are limited, and you know, frankly we’re not trained in doing media stuff, you either know how to do it or you don’t. So having you know CIHR… as the type of organization that provided funding… help facilitate the dissemination of that information to the Canadian public…. I think that would help improve the impact of the partnered research.”

40. How can CIHR make it easier for partners to find each other and to work together effectively? Administrative level KUs need more incentives to actively engage in research, and need to recognize research projects that arise and know which researchers to contact: • help KUs translate perplexing questions they face on a daily basis into research questions; • cross-index database of research interests that match questions or keywords that KUs formulate Online network to bring partners together; list of topics and KUs interested in those topics and match through CIHR researcher bank; speed-dating service to build partnerships; bring together a forum of funded projects for knowledge sharing

41. How can CIHR make it easier for partners to find each other and to work together effectively? Work on how to support genuine partnerships based on principles of collaboration- not just “tokenism” Identify research niches where institutions would be willing to make long-term investment Problems with KT philosophy: immediate and transferrable outcome expected; national/multi-jurisdictional impact expected, which is not realistic Set funding aside for time of knowledge-users (we do)

42. How can CIHR make it easier for partners to find each other and to work together effectively? Networking to facilitate partnership building: provide local venues for Rs and KUs to showcase their work; fund meetings to bring together variety of partners with common research question Reach out to KUs: get message out for what new research ideas exist; form partnerships by having service providers and policy makers come forward; provide opportunities to meet and present findings to key players in not-for-profit sector Website that provides access to researchers doing work in areas that KUs might be having problems in

43. Some final words about required partnerships “ because [of the grant], more people certainly know that this issue is being studied, than would have if we didn’t have… the XXX as a partner. It increased the impact of… what we were doing as we were doing it. It certainly also increases the complexity of conducting it, but I think the tradeoffs are worth it.”

44. Some final words about required partnerships “I knew when we were applying that the partnerships would help the… program…. When faced with a choice of strengthening the partnership versus sticking to the letter of your research protocol… I got the sense that developing the partnership for its long term benefits was more important than sticking to the project exactly and… that’s what we’ve done…. It’s going to turn out,… quite a few years… after the funding has finished, to have been much more successful than we imagined.”

45. Some final words about required partnerships “…. Initially we had… system level partners, so these would be administrative partners, and we did not have people really on the ground that we were working with, so this allowed a lot more close relationships with people actually on the ground, to get established…. You think you’ve got a hold of something, its been nailed down, they’ve agreed to it, submitted the grant, but then when push comes to shove, dynamics shift and that’s just the nature of it…. The really important principle in terms of doing knowledge to action type of work, is that you do have to be extremely flexible and kind of move with those opportunities where they are.”

46. Conclusions to date • The required partnerships that are integral to our integrated funding opportunities generally work well • The grants provide a means for existing partners to work together (which is a good thing) • Most respondents did not experience the barriers to partnering reported in the literature • Most felt that their study would eventually have an impact and attributed this to the partnership • Most intend to keep on working with their partners and value the “iKT way” – although it is not without its challenges

47. Conclusions to date • Communication with team members was seen to be important – some teams used blogs, WebEx, Wiki pages, etc. • A common theme in successful teams was a strong, energetic team leader with partnership facilitation skills • Despite calls for CIHR to play a matchmaker role, researchers and k-us tended to network within their own professional relationships to find partners • Some suggested that CIHR could support partnerships, not just projects - and perhaps partnerships with organizations, not individuals given the fluidity of the k-u work experience

48. Study limitations • The findings are specific to funding opportunities that require partnerships • The conclusions may not be generalizable to other partnerships between researchers and knowledge-users – but they are helpful to us in assessing how these partnerships work • The survey was not a validated one as we developed it in-house, but was based on a review of the literature • The semi structured interview sample was a purposeful one (N=50), but they provide an in-depth view • It is too soon to assess impact for most of the grants

49. Learning Objectives • To briefly describe the literature on researcher/knowledge-user partnerships • To describe the nature of the partnerships required by CIHR in its integrated knowledge translation (iKT) funding opportunities • To discuss the impact and sustainability of CIHR-funded iKT partnerships

50. Final word on partnerships If we are together nothing is impossible. If we are divided all will fail. Winston Churchill