From its second through to the end of its fifth year of operation, SHRTN stakeholders came to value the role and contribution of the network’s team of KBs, even if the nature of the role seemed elusive. During the network’s fifth year, one SHRTN leader remarked, ‘I think the KBs are essential to our task. They are at the core of knowledge translation, because at the end of the day it is those human relationships that bring about the most dynamic change. You need people with skills to enable groups to come together.’
During the network’s second year, the KB role went through a period of development and clarification. The evidence suggests that the KBs immediately made a useful contribution to at least five CoPs that were active in the network, and a more limited contribution to three other CoPs (the data was unclear on the contribution made to the remaining three CoPs). The KBs noted that they were most successful when supporting CoPs that were new and that were not based on pre-existing groups. During year two the KBs designed and facilitated workshops and knowledge exchange sessions, networked with CoPs and external organizations, conducted needs assessments, attended meetings and conferences to publicize the CoPs, participated in meetings with CoP members, assisted with CoP strategic planning, supported membership growth, developed tools, updated websites, and connected people who were working on similar problems.
The KBs indicated that the most effective way to engage stakeholders was through educational webinars, as well as through networking with decision makers, traditional workshops, focus groups, targeted recruitment of early adopters, and phone contacts. KBs also indicated that how they supported CoP activities depended on the CoP’s stage of development. When a CoP was in the early stages of development, the KB was involved in planning, facilitation, communication, sending invitations, conducting online searches, developing mailing lists, making phone calls to form relationships, and coaching CoP members in the use of online tools. For well-established CoPs, the KB performed fewer administrative tasks, and played more of a mentoring role with CoP leaders.
Most KBs described their primary role as connecting people with other people, information, ideas, and education. Most acknowledged that they also played a coordination role, and some indicated that they spent considerable time supporting the network’s web-based software. The job description for KBs in the network’s second year mentions networking and communication, promotion, management of online tools, identification of evidence, and facilitation. When asked about the importance of these roles, the KBs provided numerous examples of all of these responsibilities, with the exception of ‘identification of evidence.’ Though some KBs helped to identify evidence, most reported that this was a minor role. When asked which role occupied most of their time, KBs indicated that facilitation, networking and communication were their most significant roles.
Facilitation activities that KBs carried out included facilitating discussions and focus groups and chairing teleconferences. Examples of networking and communication activities included connecting with professional groups, attending meetings and conferences, writing articles, publishing newsletters, identifying and meeting with people who could benefit from the CoPs, communicating with members and stakeholders, supporting online knowledge exchange, and collaborating with other KBs.
When asked about her most important role, one KB said ‘Each of the CoPs I work with are in the early stages of development, therefore networking and communication contributed the most to the current successes being accomplished by these groups.’ A second KB suggested that the most important roles were ‘networking, supporting project work, in addition to knowledge brokering by phone and addressing email concerns in a timely manner.’ When looking toward the future of the KB role, one KB said that it was important to ‘continue to support strategies that increase awareness of the [network]; increase potential outcomes; and increase use [of the network].’ A second KB suggested that ‘the knowledge broker CoP needs time to work together and develop our own terms of reference and best practice guidelines related to working with CoPs.’ This latter point referred to the creation of a KB CoP as a way to share challenges and successes and to problem solve together. These statements suggest a focus on bringing people together to experience the value of participating in a CoP and a knowledge network, and on finding ways to support the growth of the CoPs.
During its third year, the network employed six KBs and supported thirteen CoPs. Network membership grew by 1,101, reaching 3,048 by the end of the year, and a total of 183 knowledge exchange events reached an audience of 4,023 participants. The year three evaluation focused more on knowledge exchange and the growth and performance of the CoPs, and less on the KBs. Nonetheless, KBs used a reporting template to share their perspectives, and commented on the continuing evolution of their role. KBs talked about disseminating information to CoP participants, facilitating discussions and meetings, handling logistical setup for meetings, preparing materials for presentations, troubleshooting technical problems, assisting with membership growth, and helping with the preparation of knowledge translation tools. One KB indicated that there was the potential for focusing the KB role on developing new practices and knowledge. Another said that some CoPs appeared to benefit from KB support more than others, and suggested that those CoPs that already had a strong sense of purpose and an action plan were less likely to need KB support.
When asked to share insights on effective ways of moving knowledge into practice, one KB responded, ‘since knowledge transfer in health care is relatively new, knowledge brokers can benefit from using models from the peer-reviewed literature to guide practice.’ The KBs also felt that it was important to be pragmatic and positive, and focus on using knowledge transfer to bring tangible improvements. One KB advised, ‘Keep things small, and celebrate small successes.’ A second suggested ‘placing knowledge transfer activities within the context of a performance improvement model that will help focus resources on closing gaps.’ A third said that knowledge brokering ‘is still a work in progress.’ The KBs emphasized the importance of allowing for interaction through enabling technology. One pointed out that ‘relative isolation and wide geographical dispersion of members makes use of existing SHRTN technology very attractive’ to caregivers, and a second said that the ‘ease of use of [SHRTN’s web-based technology] will greatly facilitate the achievement of objectives.’
In its fourth year, when the network employed five KBs and supported nineteen CoPs, network leaders explicitly sought to understand the KB role and the competencies needed to fill the role. The evaluation team was asked to define knowledge brokering—at least as it was practiced and experienced within this network. They were asked to gather information about the ‘doing’ of knowledge brokering, to catalogue recent KB accomplishments, and to identify the KB’s core skills.
Defining knowledge brokering in SHRTN
SHRTN KBs facilitate processes of learning whereby people are connected with tacit or explicit knowledge sources that will help them to resolve work-related challenges. To make this happen, KBs help CoPs to develop and operate, facilitate exchanges among people with similar concerns and interests, and help groups and individuals to create, explore, and apply knowledge in their practice. The SHRTN experience also suggests that the role is evolving and is difficult to define.
One CoP leader said, ‘A KB is an individual who facilitates a process of dialogue between different parties who possess different knowledge, to find common ground between these parties to allow them to move forward with their collective work.’ Another said, ‘We are trying to promote a more integrated healthcare system. That is ultimately what we are doing. Building bridges, linking people, improving the flow of information to improve practice and to improve integration in the system.’
The ‘doing’ of knowledge brokering
To provide network leaders with a perspective on the core skills of KBs, the evaluation team created four sets of narrative data: interview responses from CoP leaders who were asked to comment on KB activities and accomplishments; interview responses from CoP leaders who were asked to identify the core skills needed by successful KBs; interview responses from CoP leaders who were asked about the ways that KBs facilitate the flow of knowledge through the network; and focus group data from KBs who were asked about their accomplishments. Additional file 3 provides a summary of the key findings from each of these data sets.
When asked what KBs do and what they have accomplished within SHRTN, we received responses that highlight the contextual nature of the role. One CoP leader said ‘Our KB’s manner is conducive to facilitation and coaching. The KB … coaches people and fosters a lot of questions in a supportive way, and comes across as very open minded and supportive.’ Another mentioned a variety of activities and contributions: ‘Culture receptivity, improving readiness, finding the right people, fostering the process by which there is knowledge in the right formats. And cataloguing things that could be useful.’ Others talked about how the KBs ‘Work together to develop new and existing CoP and cross-CoP collaborations,’ and ‘bring information back from the CoPs on needs and barriers to help improve SHRTN.’
SHRTN KBs support their CoPs by providing coordination and administrative support, identifying knowledge resources, linking CoP members to those resources, creating relationships and dialogue, and fostering the growth of new CoPs. They also facilitate the flow of knowledge through the network by engaging in analytical and planning activities, coaching and supporting people, expanding existing networks, translating knowledge so it can be used by specific groups, planning and facilitating meetings and events, and handling administrative functions. SHRTN KBs must also possess excellent verbal and written communication skills, including the ability to influence and persuade others. They must be skilled at working with people and groups (including the ability to collaborate, direct, empower, support, and negotiate). A KB must have subject matter and technical skills (facilitation, project management, organizational change, research, learning, and project management). KBs must also possess personal qualities that equip them to work in ambiguous social environments (including time management, flexibility, and persistence).
KBs and those they support agree that KBs draw on their own experiences, and share their knowledge with each other and with others in SHRTN to promote the development and success of SHRTN CoPs. They also agree that KBs provide important information to SHRTN leaders, so solutions can be developed at a system-wide level, and so important information is available as leaders set a direction for the network.