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The way we think about how research, policy and practice inform and interact with each other shapes our efforts to improve health and social outcomes. In this paper we describe linear, relationship and systems models with regard to how they approach bridging evidence and policy/practice, or turning knowledge into action. We contribute to the knowledge to action (KTA) systems thinking discussion by highlighting four interconnected aspects of this model we believe merit exploration: evidence and knowledge, leadership, networks and communications. We conclude with the challenge of developing measurement methods for systems research to better understand the KTA process.
There are tradeoffs in knowledge synthesis – for example, between comprehensiveness and timeliness, between generalisability and policy relevance. The tradeoffs are particularly challenging for public health. A growing international community is grappling with building more relevant and useful knowledge bases, to facilitate use of this knowledge in policy and practice. These questions guided a knowledge synthesis using a novel ‘rapid review’ methodology. The synthesis used complex adaptive systems as a theoretical lens, in collaboration with an international expert panel. Findings strengthen the call for a systems paradigm in public health, extending theoretical propositions to empirical studies of knowledge generation and use.
Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.
Incremental approaches to introducing change in Canada’s health systems have not sufficiently improved the quality of services and outcomes. Further progress requires ‘large system transformation’, considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on ongoing dialogue relating to transformation, and examines transformative efforts in the Saskatchewan health system. We aim to build a shared understanding of systems thinking in the context of transformation, and to outline examples of how systems thinking perspectives, with an emphasis on the role of evidence, may inform strategy for complex change initiatives.
