There is often a gap in care between research evidence for best practice and its application in a clinical setting. In 2016, Advancing Health’s Aggie Black pioneered the Knowledge Translation (KT) Challenge, an initiative designed to empower health care providers with the tools, mentorship, and resources necessary to effectively implement evidence-based practice changes.
“There is often research available showing what is currently the best standard of practice and care. What is lacking are the resources and support health care providers need to implement those newly confirmed best practices, rather than investing resources into more research projects on certain topics,” said Aggie.
This innovative program recognizes that while many health care professionals possess extensive clinical expertise, they may lack specific knowledge about how to implement best practice changes into a clinical setting, a part of knowledge translation. By offering both financial support and comprehensive training, the KT Challenge helps practitioners use up-to-date research to improve health care policy and practice and enhance the quality of care provided to patients.
Putting research into practice
The KT Challenge is designed to support interdisciplinary clinical teams and is open to anyone interested in implementing changes to improve practice across Providence Health Care, Vancouver Coastal Health, and BC Cancer. This year is also the first year that teams from Northern Health and Fraser Health are welcome to apply. Teams in previous years have included nurse practitioners, physicians, nurses, pharmacists, allied health care workers, peer outreach workers, Indigenous patient navigators, youth care workers, research scientists, and overdose prevention specialists.
“The KT challenge often supports the implementation of information that people are already aware of, such as an updated guideline,” said Aggie, “There isn’t always immediate uptake because people keep doing their work the way they are used to, often due to lack of resources available to adapt to new evidence. The KT Challenge not only provides resources, but also helps identify clinical teams motivated to improve patient care.”
Advancing Health’s Dr. Angela Russolillo, the Director of Mental Health Clinical Research at PHC and UBC School of Nursing Assistant Professor, was excited by the opportunity to get involved with the KT Challenge, alongside clinical nurse specialist Michelle Carter. “We were often looking for opportunities to be able to propel some of our clinical and research findings back into practice, but it’s challenging to do that off the side of your desk. We immediately jumped on the opportunity to have some funds allocated so we could carve out time and be able to support better practice outcomes,” said Dr. Russolillo.
This opportunity ended up leading to the successful implementation of a clozapine clinical toolkit in the psychiatry inpatient program at Providence Health in collaboration with Advancing Health Scientist Dr. Joseph Puyat. This project was published as a case study in a recent paper, with co-authors Dr. Russolillo, Michelle, and Aggie, on advancing evidence-based practice through the KT Challenge.
Teamwork makes the dream work
One of the aspects that the paper highlighted is the importance of the world’s largest health care workforce — nurses. For KT Challenge teams to successfully implement change in practice, it often means involving and collaborating with nurses. In fact, 26 per cent of funded team members are nurses, largely because they work very closely with patients and play an important role in knowledge uptake into clinical practice.
Aggie, an award-winning nursing professional herself, shares that many practicing nurses don’t have strong knowledge translation skills . “I think that’s a huge benefit to the KT Challenge program and to the health care system, because whatever other projects our KT Challenge participants tackle later, the nurses who’ve been involved in a KT project have those skills now.”
However, the largest proportion of KT Challenge team members are allied health providers, people who provide diagnostic, technical, therapeutic, and support services within a clinical setting. This diversity in team members is one of the unique strengths of the KT Challenge because funding opportunities are commonly limited to just those individuals based in academic or research settings. A distinct draw of the Challenge is that it funds health care providers who are working at the point of care.
“We really should be providing clinicians opportunities to be involved in this type of knowledge translation work; it should be part of their regulatory body requirements and supported by their colleges or unions,” emphasizes Dr. Russolillo. “There’s such an opportunity to integrate knowledge translation to sustain a consistently improving and learning health care system.”
Although individual team members may not have experience with knowledge translation, the KT Challenge pairs teams with mentors to help guide research implementation. Mentors are those with research and knowledge translation experience, and can include clinical nurse specialists, professional practice leaders, and academics. Advancing Health’s Drs. Joseph Puyat, Annalijn Conklin, Angela Russolillo, Sarah Munro, Martha Mackay, Eugenia Oviedo-Joekes, Rick Sawatzky. Skye Barbic, Josie Geller, and Nick Bansback have all mentored KT Challenge teams.
“The mentorship role, in my opinion, is often the best because you get to work with people who are really interested in an idea and are super keen and wanting to change practice and improve care. Not only am I able to provide content expertise, but I can also share the reality of what changes could be involved when going through a project itself,” shares Dr. Russolillo. “It’s important to temper expectations a bit while also encouraging people because they’ve spent so much time invested in the evidenced-based change they want to bring to into clinical care.”
Improving care is important, but it has to be important not just to the care team, but to the patients themselves. That’s why all teams for the past three years are required to include a patient or family advisor, who are compensated for their time. There are also patient or family advisors who review the project proposals and provide helpful feedback, including concrete suggestions on what to follow-up on once the project is finished.
In addition to a motivated team, there are a few other key elements to having a successful project.
Features of successful projects
One of the most important features is clear rationale for why this work is important. This can be established evidence of best practice, whether it be a validated screening tool, a clear set of guidelines, or a methodology that has been shown to improve patient outcomes. For example, the clozapine clinical toolkit, was developed in response to extensive evidence citing clozapine as the gold standard for treatment-resistant schizophrenia. Despite its beneficial therapeutic effect, the medication requires regular monitoring of patients’ blood work and vitals in response to increased risks of certain drug-specific adverse effects. Michelle Carter, the mental health clinical nurse specialist recognized this as an opportunity to develop a clozapine treatment toolkit, and together with Dr. Russolillo and their team, collaborated to develop and implement a standardized set of tools for both nurses and physicians to use in practice to effectively monitor patients prescribed clozapine.
Projects can also be informed by reports or other health care-relevant information to improve care. Riley Louie, a Leader of Clinical Projects and Strategic Initiatives at Providence Health Care, who will lead the upcoming 2025 KT Challenge, highlights that it is more than just implementing a strong evidence base.
“Projects can also be born out of multiple considerations to improving care. For example, there was a project focused on providing Indigenous food options for Indigenous patients while in hospital. This speaks to both the In Plain Sight Report and our call to engage in reconciliation, as well as the concept of food as medicine,” he explained. “Projects don’t necessarily have to be as simple as evidence into practice; the KT Challenge really provides a platform for a grassroots change in our health care.”
Implementing change is no easy feat, especially considering that the individuals on these teams are doing their full-time clinical roles while carving out time specifically for their KT project. One of the biggest challenges for KT Challenge teams is underestimating how long things can take. That is why having a mentor to support the process while providing guidance and insight on realistic goals is essential.
But even through all these possible obstacles, there have been several projects which have been successfully implemented to improve care throughout Providence Health and beyond. For example, the clozapine clinical toolkit is not only used throughout B.C. but is also being actively implemented in psychiatric care units across Canada.
Paying it forward
One of the biggest benefits to team members is the education that is provided to all the team members involved in a project. In addition to the insight shared by mentors, participants gain access to several workshops on knowledge translation and implementation practices. This information can be applied throughout a person’s health care career to encourage change and implement best practices wherever they go.
“As an occasional patient myself, I find it encouraging that my clinicians are supported to be curious and innovative and always thinking about how to make care better, because almost all of these projects are rooted in a clinician’s desire to improve the care we offer patients and families,” said Aggie. Working on the KT Challenge enables the health care providers to take additional time and enroll in this initiative and step up to try to make things better.
“I find this encouraging as a patient, as a nurse, and as a health care leader. Providence Health Care has many clinicians who are innovative and hardworking and absolutely committed to making things better, and the KT Challenge gives them some tools to do it.”
Interested in implementing change in your health care practice? Apply to the 2025 KT Challenge!
