The messiness of Knowledge Transfer (KT): Evaluating (favorably?) what wasn't planned

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23 Φεβ 2014 (πριν από 2 χρόνια και 9 μήνες)

37 εμφανίσεις

1

Paul Wishart, PhD, MA

Adjunct Assistant Professor,

Department of Surgery

Faculty of Medicine, University of Calgary

pmwishart@shaw.ca

(403) 208
-
3431

Paul Wishart, PhD, MA

Adjunct Assistant Professor

Department of Surgery

Faculty of Medicine,

University of Calgary

E
-
mail:

pmwishart@shaw.ca

Phone:

(403) 208
-
3431


The messiness of

Knowledge Transfer (KT):


Evaluating (favorably?)

what wasn't planned

2

Acknowledgements

Medical Director, Agape Hospice
-

Dr.
David Falk

Alberta Heritage Foundation for Medical
Research

Department of Surgery, University of
Calgary


Dr. John Kortbeek

Geriatric Mental Health, University of
Calgary


Dr. Suparna Madan

Pre
-
Admission Clinic nurses, supervisor,
and manager, Calgary Health Region

3

Overview

Connecting

4
-
7

Where it started;

Delirium and Grounded Theory

8
-
11

Messiness and KT

12
-
17

Making a Difference

18

Evaluating; SUCCESS, Funding,
Dissemination

19


Take
-
Home Message

20

Thank
-
you

21

4

Connecting: A Reminder


It starts with a
story, and a
sense of
humor

5

Walling in and Walling out

Before I built a wall I'd ask to know

What I was walling in or walling out

And to whom I was like to give offence.

Something there is that doesn't love a
wall



Robert Frost, from Mending Walls
1

6

Tapping and Listening
2,3



What “others”
hear

2.5 %



What we want
others to hear

50.0 %

7

Frasier’s Martin and Niles


Tapping & Listening

See:
http://www.youtube.com/watch?v=4zYN2Vpe1pk
; 5:18


8

Where it started:

Delirium & Grounded Theory
4

The study:

Statistical significance

Case finding delirium by nursing staff, post
-
surgery



Clinical relevance
-

stories

Patient relevance


stories

9

Delirium,

A

Medical

Emergency

Delirium

Disturbance of consciousness; Transient,

Fluctuating

Attention, Cognition, Perception, and/or Orientation

disturbed

Complicates

Postoperative course of 5
-
52% of non
-
cardiac

surgical patients

New onset in hospital

Increased length of hospital stay

Greater rates of nursing home placement

Mortality rates approaching 30%


10

Delirium KT:

1.
Recognizing

2.
Treating

3.
Preventing

4.
Evaluating

11

Grounded Theory is …
5

What is the main concern?

How is it (or could it be) resolved?


Connect the two conceptually, through
SUCCE
S
S
2


S
imple,
U
nexpected,
C
oncrete,
C
redible,
(
S
urprising)
,
S
tory


12

KT happening;


I almost missed it

How did I almost miss it?

Follow
-
ups, conversations, clarified
recruiting criteria.

Nursing staff and leadership facilitated
involvement and recruitment; buy
-
in that
research could make a difference.

Messiness was actually the connecting
part, not the obstacle I thought it was.

13

Successful

Suspicion

Need total IDT involvement

Educate staff & family

Increase delirium recognition

Chart audits

Database development


Kindly provided by Dr. David Falk

Hospice’s dealings with Delirium

14

Delirium as a KT metaphor

Messiness

Increased Sensitivity

Disorientation/Disconnection/


Overwhelming

Suspicion

Reorientation

15

Challenges

Establishing a base line

Education
-

Delirium recognition,
treatment, and prevention

Solutions

Establish a baseline

Education
-

Delirium recognition,
treatment, and prevention


PCN, GPs

Long Term

Care

Transition

Services

Surgery

Pre
-

Admission

?

?

?

?

?

Delirium
Knowledge
Transfer
(DeKT)

DeKT

Post
-

Surgery

?

Surgery

Delirium KT Stream
4

Palliative

Hospice

?

16

Surgery

Pre
-

Admission

Pre
-
Admission
Clinic

?

?

Surgery

Post
-

Surgery

Post
-
Surgery

Recovery

?

Baseline

Post
-
Surgery

Delirium
Knowledge
Transfer
(DeKT)

DeKT

Delirium KT Stream:

A Pre
-
Post Scenario

17

Connecting the

Delirium KT Stream

Patient

Family,

Care
-
giver(s)

GPs, Pre
-
surgery,

Post
-
surgery

Discharge, …

18

Making a Difference

Making a difference is an effective
motivator for KT, rather than saving
time and/or energy

Connecting; Delirium & GT, Theory &
Practice, Clinical practice and Patient
perspectives

Further studies

19

Evaluation

Is it a success?

Is it successful? Funding
Dissemination, Support

Is it sustainable? We’ll see

20

Take Home Message

Sometimes it is the
messiness

that
actually facilitates KT; it’s in the
relationships
.

Don’t leave it, or them, out.

Tapping and Listening; we’re doing it;
appreciate it.

SUCCESs, a story of connecting

21

THANK
-
YOU.


Questions, Comments, …

Contact:

Paul Wishart, PhD, MA

Adjunct Assistant Professor,

Department of Surgery

Faculty of Medicine, University of Calgary

E
-
mail:

pmwishart@shaw.ca

Phone:

(403) 208
-
3431


22

References

1. Frost, R. (1967).
The Poetry of Robert Frost
. New York, NY: Holt,
Rinehart, and Winston.


2. Newton, E. (1990). Overconfidence in the communication of intent:
Heard and unheard melodies. PhD thesis: Stanford University,
Stanford, CA.


3. Heath, C. & Heath, D. (2007).
Made to stick: why some ideas survive and
others die
. New York: Random House.


4. Wishart, P. M., Madan, S., Cole, M., McLennan, L., Lemarquand
-
Unich, B.,
Shellenberg, L. et al. (2009). Delirium knowledge transfer: Exploring
the health care knowledge transfer stream. Alberta Heritage for
Medical Research, Edmonton, AB, Request for proposal; Successfully
approved for funding, May.


5. Glaser, B. G. (2001).
The grounded theory perspective: Conceptualization
contrasted with description
. Mill Valley, CA: Sociology Press.