How do we know stuff and what do we do with it? From evidence-based practice to troublesome spaces.

True or false?

Research creates data that becomes evidence that turns into knowledge that informs policy and strategy which improves how the world is organised – including services that people access – which increases health and social outcomes. 

If only it were that simple!

In an uncomplicated world a straightforward, if linear and potentially dull, relationship between research, policy and practice might exist. But despite evidence based practice, initially a contested practice in itself, the emphasis in the last decade or so on better understanding knowledge and its creation and origins, indicates that this is not, and could not be, the case.

For the Glasgow Centre for Population Health, set up to create new knowledge spaces to support national and local developments addressing health inequalities, these issues are increasingly pertinent. With Scottish Government commitment in place to fund Phase 3 of our work (until 2015 in the first instance) the Centre is looking ahead to completing our first decade – one in which policy-makers, researchers and practitioners have begun to think very differently about how they work together, and how best to allocate increasingly scarce resources.

Phase 3 of the Centre’s work will focus even more on using translational methodologies to build on knowledge that we have been involved in creating and facilitating, and to support our partners – NHS Greater Glasgow and Clyde, Glasgow City Council and the University of Glasgow, as well as the Government – and others in realising a healthier future for Scotland’s population. 

The Centre has been learning from some of those who have been developing key concepts around knowledge mobilisation and knowledge utilisation. This is a dynamic environment where new meanings are constantly being proposed and discussed. As part of this work, at the end of January 2012, Professor Huw Davies from the University of St Andrews and one of the leading thinkers in this area, spent time with Centre staff and some of our collaborators.

In his engaging presentation, Professor Davies made clear that this way of thinking is fundamentally about engaging supply and demand, and using research and knowledge more efficiently and effectively. For health research, this means recognising that a linear model that moves from the creation of knowledge to the seamless adoption by its recipients is not feasible. Population health, and the NHS as an organisation, are parts of significantly complex systems and do not fit such a construct. One thing does not automatically lead to another.

As Plsek and Greenhalgh said, ‘to cope with escalating complexity in health care we must abandon linear models, accept unpredictability, respect (and utilise) autonomy and creativity, and respond flexibly to emerging patterns and opportunities’ (Plsek and Greenhalgh, 2001). This means thinking differently about where research originates, within what context, who is involved, and how it is employed as well as fully grasping that the environment in which it is situated is multi-layered and multi-dimensional.

As Professor Davies reminded us, in many circumstances findings from systematic reviews and randomised control trials genuinely improve health outcomes, but these are instrumentalist and about choices that can be summarised and assessed. With a research spectrum that ranges from quantitative scientific methods to qualitative approaches concerned with meaning, there is still a need to articulate the context.

Part of that context is values, and understanding their influence on research – why things matter and how that affects practice – is essential. At all parts of the research-policy-practice matrix, values operate, and along with beliefs and vision, ‘permeate every fibre of the organisation’ (Keene, 2000) whether a research team, commissioners, government policy-makers, NHS managers or local authority practitioners.

Taking this notion on board means repositioning the research-into-action pathway and to see that this is not just about knowledge transfer, this is about something more sophisticated which may challenge existing paradigms and ways of working. It may also interrogate self-held attitudes and practices within disciplines and organisations. As Professor Davies said, unlearning knowledge, in the sense of jettisoning previous and outdated ideas that have no utility in a new environment, is part of new forms of knowledge creation. 

‘Unlearning knowledge’ has been proposed by Zygmunt Bauman as necessary in a post-modern liquid world, where nothing is stable and where traditional notions, boundaries and practices hold little authority. When much of 21^st century thinking about the development and use of knowledge within health and social care is located within partnerships and integrated working, there is a need therefore to genuinely create new places for engagement where power is acknowledged and where disciplines and silos are permeable.

 As a recent book about refreshing the academic learning environment (Saven-Baden, 2007) suggested, there are a variety of spaces – writing spaces, dialogical spaces, reflective spaces, digital spaces, troublesome spaces and boundary spaces – that contribute environments in which new learning can happen and old learning decoupled. As Professor Davies concluded this is not about bridging disciplines or moving from one place to another but about dialogical exchange, interaction and co-production.

As the Glasgow Centre for Population Health takes up the new challenge of Phase 3, we are invigorated by the opportunity this offers to expand further the repertoire that we use, to question who we are and what we bring, to think more about who we know and what they know, and to understand and interrogate further the context in which we all operate.