ࡱ> `!W(:T_*! 5@STxڭZ lTglBj~BoCRA{@P 14@ F@Z+Xq@%Z(SJM?F*TB@vslp=kn~|x/ ^c  =HzL޺-tgTḦ́~\9+;!EK<={ʅEK{w n;PO_Iq3E[+4e2E鑞.͛\^ Ъ,Gi4R`W}3l>R(zH%grX=lLW[V`hu=E֝ghz(i=n@Rb#4=EhC;lzJZnlLlfVYh~s9+b[Q}جU,E'R& EUB23Eܷrά5fTMs>6a#49Pb.Ԅ H8 "uJv5a 1X^R8*77X\OQ^GP%imLp :M S7z=Y0zIaHJU UbBX[DZb39Sr`8od-{ЫN϶Ki]CH,avZ[C)]Ţ Aocvo +c1l+a jRx^%Z]OocrH8{˅pC ynF(Oh 4"o-FMS]?EkW> v񨾞*Э1±ܳҀ{<#(+ZDseSSQF,UAVG\1 p+>~lӇO)x(6ˆ}ȏm 4Q-2pUHնzj#plUSqT5#P63_q `sP%1qFL>4 ^^` jP٫H϶ߞ.ދfu'}^Gs[4ryq{ W^Dr!ƒ3e uEOIᲆ뷹+,T ]̅\:~A 4P/xh ȤE0J`U@/,0\9?Txpƭ̸ 87VXgp\R+ 6IcY{7@Cw=COy\hWd{~$F,c<6ʅ5]z#WUc\(z6U3j"d9v= 7-g|,X^čR`s-=)#^b_YN<܎zj/#eiɺz+q63i|S6SMxg`E۸z[F<[|9*w9y":6d8'?>`x3r#~-kF܈gd|ro[.o,QQ:gySąWX2 \OB?aW([5NQ6a\56!H7XG tgSq 9ج\b5pn>˃F27Vu oa,qPfatiίlYE譗>JԲPZ6c3#"  # "#"# "  " $#$6$!$$#$>$#$B6* $  ? a16Observations re: KU/T within Health Care Organizations77$What we (seem to) know about  making it happen B. What we don t (seem to) know about  making it happen R0ndnd;1%;%b2JA. What we (seem to) know & (albeit)<&%%%"dThere is no one  inductive or  deductive approach that has been substantiated: There is some evidence re: individual strategies & the need to use multiple strategies Often per Rogers work on innovations (but largely re: individuals) Mostly per research re: physicians, whose  organizational links varyQnsXnd+!!!X!!!T+*1. & no one& approach& .' '<There is a growing body of funded RU/EBP/translation research Interventional: Often,  medical or  interdisciplinary focus; in few cases, with a KU framework; usually project- or condition-focused. Descriptive: In many cases, nursing focused, exploratory, and barrier focused. Effective approaches may be an adaptation/ mix & relate to: Definition of evidence & its strength Nature of evidence-based practice>nd=ndH>#!!z! !!C!=#H ! :HA. What we (seem to) know & (albeit)N%'$%%%There is increasing recognition in research of the potential influence of  context, including leadership and culture, in transfer/utilization: Interventional studies: Often within the perspective of an isolated project, as a correlate/barrier Descriptive studies: Just beginning to be explored in-depth beyond barrier perceptions nsK!!;!!!N!!E!JL'PB. What we don t (seem to) know about & R)%' ' ' Approaches to implementation Association of QI & EBP/KU-T Impact on tailoring/adaptation  Facilitation of implementation efforts Context of implementation Meaning/measurement  RU/EBP exemplar organizations nUgUU4U'$e%!'$'4 % C!1. Approaches to implementation '$hWhat is the association between Quality Improvement Models & KU-T/RU/EBP? Meaning of  EBQI models? Degree/importance of QI function involvement with KU/T/EBP research or projects?JUkB%%%%!%Q!w< >What is the impact of alternative approaches on the tailoring/adaptation of  evidence ? Relation to strength of evidence or nature of evidence/innovation?  Intelligently adapt evidence-based (clinical) interventions (rather than  tailor ) (Goldberg & Horowitz) ~XUCUU0X!C!>!!0 E$ What is the extent, nature, or influence of  facilitation or  researcher change agentry needed for implementation efforts? Within individual ( research /implementation) projects Internal facilitation (content champion or QI role?) External facilitation (researcher role?) Within an EBP organization Role of service-based nurse researcher? A generic facilitation mechanism? nd7HA^K;%%%%#%%7'^#'K # P(2. Organizational Context<'$ '$bWhat is the meaning of context & culture? Variable meanings/variable measures Inconsistent terminology used to describe the context Organizational context of nursing practice Powerful determinant which influences the work in the organization (Hall, 1991). Organizational culture Multitude of definitions Trends in the definition: 1) SHARED; 2) UNIQUE*nd$8$+Q$H$)' $  7  +QHl7'   Organizational research issues Measurement Approaches Who forms the sample Unit of analysis Impact of multiple use of translation solutions m 09F# &Nature of  RU/EBP exemplar organizations or  naturally occurring experiments ? Identifiable Nursing departments (&& ?) Use an RU/EBP Model Focus on both project and departmental level There is a lack of organizational-level research about such departments/organizations: Descriptive or interventional Issue in terms of cost-effective implementation Issue in terms of role of a researcher/facilitatorQndZ'ZBZYZZO%%'%B!Y% ! I%7Organizational Context & KU/T (EBP) at the Macro Level88$jThere is knowledge on organizational change potentially applicable to  routine, cost-effective, sustained, and integrated KU/T There are frameworks that could be evaluated/tested.,5 (Sample Framework)# EBP Organizational Implementation Framework: Leadership Support for an EBP Culture Capacity Building RU Model Infrastructure to Support and Maintainr-8 '-$8#( #$&#(p9GManaging Change in the NHS: Organizational Change(Iles & Sutherland: )2H2""3"  & time is ripe for investigation of& alternative models of organization and management & emerging in service settings Integration of KU/T & EBPDw w   Recommendations:! Multi-site research at the organizational/ departmental level re: KU & Transfer in, at least, Nursing Naturally occurring experiments Interventionalfhnd/HA!!/!!/! [. Collaboration across research projects to refine/create/use standard measurements, at a minimum, for: Culture, as Relevant to EBP Organizational culture Professional practice culture Propensity to innovate (Iles & Sutherland) Organizational (and Project) Capacity Facilitation, internal and external (Kitson et al.; Harvey et al.) Self-audit tool (Lomas) Organizational readiness (Sales et al)fndZHAZ`HAZ&HAZHAZf!#`## # # # F    ) q: Critical Infrastructures: Formal goals/priorities Information systems Roles/expectations  Adaptation, relative to: Strength of evidence Nature of evidence/innovation  Intensity of implementation Character/format of the clinical innovation @AZ?@AZ@AZ4UZMUZ!?!!4!M! u s; Innovative  research /evaluative designs with service-based EBP projects Beyond case studies Multi-site, networking VInd+HAIdI!+!t > Knowledge utilization and transfer and the organization: How to Make It Happen (Routinely)? .&&$Q(/L 6@GJKM N!R#Z'\(c+d,e-m2o3r4t5u6GHF  0` 33PP` 3333` ___MMM` 13` 333fpKNāvI` j@v۩ῑ΂H` Q_{>?" dd@(?n<d@ `7 `2@`7``2 n?" dd@   @@``PR    @ ` ` p>> j b    (     <\J" D   T Jd" D   <ԖJ"U_ D   TDJd">& D   NJ"P D   <J"p D   C xJ?d?"bUv D   6pJ "U J T Click to edit Master title style! !$  0J "  J RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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A lot of research and conceptualizing ahead of us and a lot of different ideas about how to make that happen.. Both pragmatically and relative to the ty0es of research we need.. An with that .. I suspect some of you are dying to challenge our ideas or share additional ideas & 9H  0޽h#6 ? ̙33r0M$]gPH C :k6Fm:@FoC^E0(LqI`ANs2uw"yPyR"{TZ0.}^J.``Yr|~l&#tXFneZgm hi˒A lOh+'0$4 hp, @L l x HSession 2 Knowledge utilization and transfer and the organization Cheryl StetlerLC:\Program Files\Microsoft Office\Templates\Presentation Designs\Blends.pot cmmiller88Microsoft PowerPoint@*V@\@0;IG2g  9Q  y--$xx--'33--$,4 4 ,,--'-::--$ , 5 5 , ,--ff--$ , 5 5 , ,----$ , 55, ,----$,55,,----$,55,,----$,55,,---'--$4<<44--'---$ 3 <<3 3--X--$3<<33--݌--$3<<33----$3<<33----$3<<33----$3<<33----$3<<33---'QA   2( ~~ll[[JJ99%%rraaOO>>--xxffUUDD5678&'() 90123 !"4$9+,-./9&'() *9 !"#$%;  '--$ * = = * *--'---$89988-- --$89988--"""--$89988--$$$--$89 9 88--&&&--$ 8 9 9 8 8--)))--$ 8 9 9 8 8--+++--$ 8 9 9 8 8-------$ 8 998 8--000--$89988--222--$89988--444--$89988--666--$89988--888--$89988--:::--$89988--===--$89988--???--$89988--AAA--$89988--CCC--$89988--EEE--$89988--HHH--$89988--JJJ--$89988--LLL--$89988--NNN--$89988--QQQ--$89988--SSS--$89 9 88--UUU--$ 8 9!9!8 8--WWW--$!8!9"9"8!8--YYY--$"8"9#9#8"8--[[[--$#8#9$9$8#8--]]]--$$8$9%9%8$8--___--$%8%9&9&8%8--aaa--$&8&9'9'8&8--ddd--$'8'9(9(8'8--fff--$(8(9)9)8(8--hhh--$)8)9*9*8)8--jjj--$*8*9+9+8*8--lll--$+8+9,9,8+8--nnn--$,8,9-9-8,8--ppp--$-8-9.9.8-8--sss--$.8.9/9/8.8--uuu--$/8/90908/8--www--$0809191808--zzz--$1819292818--|||--$2829393828--~~~--$3839494838----$4849595848----$5859696858----$6869797868----$7879898878----$8889999888----$9899:9:898----$:8:9;9;8:8----$;8;9<9<8;8----$<8<9=9=8<8----$=8=9>9>8=8----$>8>9?9?8>8----$?8?9@9@8?8----$@8@9A9A8@8----$A8A9B9B8A8----$B8B9C9C8B8----$C8C9D9D8C8----$D8D9E9E8D8----$E8E9G9G8E8----$G8G9H9H8G8----$H8H9I9I8H8----$I8I9J9J8I8----$J8J9K9K8J8----$K8K9L9L8K8----$L8L9M9M8L8----$M8M9N9N8M8----$N8N9O9O8N8----$O8O9P9P8O8----$P8P9Q9Q8P8----$Q8Q9S9S8Q8----$S8S9T9T8S8----$T8T9V9V8T8----$V8V9W9W8V8----$W8W9Y9Y8W8----$Y8Y9Z9Z8Y8----$Z8Z9[9[8Z8----$[8[9]9]8[8----$]8]9^9^8]8----$^8^9`9`8^8----$`8`9a9a8`8----$a8a9c9c8a8----$c8c9d9d8c8----$d8d9f9f8d8----$f8f9h9h8f8----$h8h9j9j8h8----$j8j9l9l8j8----$l8l9n9n8l8----$n8n9p9p8n8----$p8p9r9r8p8----$r8r9t9t8r8----$t8t9w9w8t8----$w8w9y9y8w8----$y8y9{9{8y8----${8{998{8----$89988----$89988----$89988----$89988----$89988----$89988---'@"Tahoma-. 332  Session 2 ."System }-@"Tahoma-. 33 2 9T.-@"Tahoma-. 33.2 ?Knowledge utilization and .-@"Tahoma-. 3332 ('transfer and the organization.-@"Tahoma-. 332 K; Discussants:.-@"Tahoma-. %2 V.Cheryl B. Stetler & .-@"Tahoma-. 2 `& Shannon Scott.-@"Tahoma-.  2 `Y-T.-@"Tahoma-. 2 `\Findlay.-՜.+,0    wOn-screen Showuz Times New RomanTahoma Wingdings Arial NarrowArialBlendsESession 2 Knowledge utilization and transfer and the organization Slide 27Observations re: KU/T within Health Care Organizations&A. What we (seem to) know (albeit)1. no oneapproach%A. What we (seem to) know (albeit))B. What we dont (seem to) know about 1. Approaches to implementationSlide 9 Slide 102. Organizational Context Slide 12 Slide 138Organizational Context & KU/T (EBP) at the Macro Level(Sample Framework)HManaging Change in the NHS: Organizational Change(Iles & Sutherland: ) Recommendations: Slide 18 Slide 19 Slide 20 Knowledge utilization and transfer and the organization: How to Make It Happen (Routinely)?  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