Sticking points and systems thinking

Recently, I was talking with my Dad and trying to explain what I do for a living. I got the sense that he sees the field of medicine and health as single entity rather than the many micro-ecosystems that is the current reality. His view is, that as one, big, cohesive group those working in medicine and health should automatically learn from each other, as soon as a new solution is created, with a sense of ease and immediacy.

I wondered if his view of how the health sector works is also the view of the majority of the population? When I broke the news that it takes an average of 17 years for medical research to be implemented into practice¹, he expressed his disbelief.

I have been studying the movement and application of knowledge within the health system for more than 10 years, starting with a PhD and then further research in how to implement clinical practice guidelines within the hospital system.  

I have learnt during this time that the health sector is mostly made up of silos. Often these are based on specialties including general medicine, specialist medicine, public health, preventive health, health promotion, hospital-based care, community-based care, public and private care, public policy … the list goes on. In fact, there are so many silos in health, that it can be like many different countries trying to communicate with each other and experiencing language and culture barriers.

Health-related knowledge, when it is developed through research or clinical experience is often created within and for only one of these silos. The knowledge is created within the context and language peculiar to that silo and is not always perceived to be relevant outside. Or, as some explain, knowledge has ‘sticking points’ at the boundaries of the organisations it was created in², it doesn’t move freely between those organisations.

Moving between these silos can also be a challenge. In Australia for example, we drive on the left side of the road, it can be difficult when you visit other countries, to drive on the wrong side of the road. While not impossible, it does not come easily or naturally, and it helps if you have someone to navigate for you. It can be the same between fields or disciplines in health, where new knowledge needs to be intentionally guided through the system.

This is where the concept of knowledge mobilisation becomes important. If we do not want to wait 17 years between knowledge being produced and implemented, we need to have evidence-based strategies that translate and facilitate its uptake and use.

I joined the Prevention Centre just under 18 months ago as the Knowledge Mobilisation Lead. It has been refreshing to join a collaboration dedicated to the co-production of knowledge and supporting its use in policy settings.

In this role, I collaborate with investigators and stakeholders to understand each context and develop strategies to enhance how research knowledge is used within the chronic disease prevention system. In the social and political area of public health policy, the movement of knowledge is rarely a liner process; it is rather a complex web of multiple influences, such as political, economic and resources, that interplay and develop over time.

I am learning to deal with this complexity by becoming more of a systems thinker, which can sometimes be challenging! This involved making a concerted effort to immerse myself in the systems thinking literature, as well as talking to the many and varied experts that make up our collaborative network.

Systems thinking acknowledges that ‘wicked’ or complex problems are difficult to solve because of the many interdependent factors that influence the outcome. Systems thinking affords a vantage point where all parts of the system can be seen, as well as the ways in which they interact. Changes within one part may cause unintended consequences in other parts of the system. Attempting to understand the system and how it might react to change is a method for gathering the information needed to create systems change.³

I am finding that developing an understanding of the system within which knowledge needs to move is key to designing knowledge mobilisation strategies and identifying the leverage points within the system. This is an important step that is sometimes forgotten in the busyness of conducting research. 

A good place to start is to document the system you are targeting, articulate what you want to change, and how you want to use the knowledge you have created. It is important to determine who the main stakeholders and power brokers are in this process and to create a map of how they interact. From here it will be clearer where the opportunities and sticking points may exist.

We are all working collectively at solving the complexity of chronic disease prevention and what has become clear to me is that we all need to be working together, across disciplines to make this happen. It may just be the systems approach that helps to get us there, so that one day my dad will be right after all.

References

1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: Understanding time lags in translational research. J R Soc Med. 2011:104;510 –520. doi: 10.1258/jrsm.2011.110180
2. Tell F, Berggren C, Brusoni S, Van De Ven A. Managing knowledge across boundaries. 2017, Oxford University Press, United Kingdom.
3. Foster-Fishman PG, Nowell B, Yang H. Putting the system back into systems change: A framework for understanding and changing organizational and community systems. Am J Commun Psychol. 2007;39(3-4):197-215.