Reflecting on backward design for knowledge translation Comment on “A call for a backward design to knowledge translation”

In a recent Editorial for this journal, El-Jardali and Fadlallah proposed a new framework for Knowledge Translation (KT) in healthcare. Many such frameworks already exist; thus, new entrants to the field must be scrutinized in regard to their unique contributions to advancing understanding and practice. The El-Jardali and Fadlallah framework focuses on policy-level discussions, a relatively under-studied issue to date. Their framework usefully incorporates both priority setting questions at the front-end (which KT efforts get undertaken and which do not) as well as evaluation questions at the back-end (how do we show that more evidence-informed decisions are actually better ones?). Their framework also emphasizes capacity building among both decision-makers and researchers. This is an area worthy of additional attention, particularly because it is likely to be far more challenging than El-Jardali and Fadlallah allow

Sustaining organizational culture change in health systems

Purpose – The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues. Design/methodology/approach – The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts. Findings – Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement. Practical implications – The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application. Originality/value – This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.</p