Knowledge Sharing Through Networks

Evaluating the TREKK (Translating Emergency Knowledge for Kids) Knowledge Mobilization Network

By Leah Crockett

In a previous post, we discussed networks for knowledge translation, their functions, and potential ways to evaluate their effectiveness. In this post, we share highlights from a 2018 article produced by the team at TREKK (Translating Emergency Knowledge for Kids), which evaluates knowledge sharing patterns within their network. If you haven’t heard about TREKK before, it is a national network aimed at improving emergency care for kids by increasing collaboration between general and pediatric emergency departments. In this study, we looked to identify connections within the TREKK network, as well as any barriers and facilitators network members face when it comes to finding information and training about pediatric emergency medicine.

Given that healthcare professionals rely heavily on social connections to obtain information and make clinical judgements, networks like TREKK have enormous potential to enhance learning, efficiency of sharing resources, reduce duplication, and facilitate rapid diffusion and reach of new evidence — all of which improve the capacity of the network to mobilize knowledge. However, measuring the impact of networks can be difficult. One useful measure of impact is the social network analysis (SNA) — a quantitative evaluation technique that evaluates connections using network theory. Two previous SNAs of the TREKK network gave us information about the structure of the TREKK network and identified a reduction in the number of ‘isolated’ sites (community hospitals without a connection to a pediatric centre). In this study, we use a qualitative approach to build on this information and gain a more in-depth understanding of TREKK network processes and context.

What We Did

In this study, we interviewed 22 healthcare professionals who work in general emergency departments across Canada. This included physicians (59%) and nurses (41%) from 18 non-pediatric emergency departments. Our sampling strategy was based on a previous social network analysis to ensure representation from previously identified connected and disconnected sites. We used these findings and paired them with the information gained through qualitative interviews to enhance the richness and depth of information about the network and its sites.

What We Found

Theme 1 — Patterns of knowledge acquisition and sharing

Healthcare professionals sought information about pediatric care in a number of ways. Knowledge was typically gathered from guidelines, online resources, or from talking to colleagues. Compared to physicians, nurses reported using more informal methods of finding information. Sources of information included local or off-site pediatric emergency experts, and pediatric-specific professional development opportunities — both of which the TREKK network has worked to improve access to, suggesting that the purpose of the network (to better connect general and pediatric emergency departments), is being fulfilled.

Theme 2 — Barriers and facilitators

The interviews uncovered organizational, personal, and system-level barriers for members in reaching their desired level of pediatric knowledge and education. At the organizational level, barriers included things like infrequent exposure to training sessions, challenges with disseminating resources to staff, and geographical barriers, among others. At a systemic level, policy-level decisions were at times ‘at odds’ with the views of staff. At the personal level, reported barriers included time (i.e. competing clinical priorities), costs (out-of-pocket or using vacation days to attend training), and not seeing a large volume of pediatric patients at their site.

Theme 3 — Opportunities to enhance capacity

Several successful strategies to enhance the use of the latest research and best practices were noted. Some of these included embedding resources into local systems, enhancing their visibility at the point of care (electronically or in print), use of clinical nurse liaisons, and development of relationships early on in medical training — for example, by promoting TREKK in medical school or incorporating education into orientation sessions. Opportunities to improve dissemination and implementation were readily offered by participants. Notably, nurses reported having to actively seek out information, the critical role of nurse educators in facilitating educational opportunities, and the need for standardization of training and financial support for nurses to attend educational sessions.

Theme 4 — Benefits of network affiliation

Though not directly asked, benefits of belonging to the TREKK network emerged from the analysis. These included greater ease in obtaining pediatric information and training, as well as more connections to the nearest children’s hospital. Benefits were especially strong for physicians working in rural areas, resulting in improved promotion of standards of care in emergency medicine, and closing KT gaps — an umbrella term used to describe multiple activities involved in moving evidence into care.

Why This Is Important

As previously mentioned, evaluating networks can be challenging. This study allowed us to gain insight on how network members were accessing information and/or training, barriers and facilitators to doing so, potential opportunities to leverage as a network, and network impacts. By pairing it with a social network analysis, we are able to better understand both network structure and process and hear from sites with differing levels of connection. As we know, successful knowledge translation requires understanding and attending to the multidimensional barriers and facilitators that influence knowledge-to-practice gaps (as described in the Knowledge-to-Action Framework). However, barriers are dynamic, reinforcing the importance of evaluation over time to ensure that network strategies continue to be appropriate and relevant to end-users.

Read the Article

For more details on the results of this study, read our paper here (note that a subscription may be required).

What are your thoughts on evaluating knowledge mobilization networks? What kind of impacts are important to consider for network sites? Let us know in the comments or via Twitter @KnowledgeNudge

About the Author

Leah Crockett is a doctoral student in the Department of Community Health Sciences at the University of Manitoba. Find her on Twitter: @leahkcrockett.