Transcript: The little engine that could - implementation science and art

Podcast Episode: The little engine that could - implementation science and art

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KD - Katharine Dill

Dr Katharine Dill, lecturer at Queens University Belfast and founding executive director of PART (Practice and Research Together), spoke at Iriss’s 6th annual AGM on the 27th of November 2013. Her presentation was entitled ‘The Little Engine That Could’, creating, building and sustaining a Canadian based knowledge exchange programme. In this programme, Dr Katharine Dill, talks about the science and the art of implementing evidence informed practice.

KD Alison asked me to talk about implementation science and that’s a really good question and we didn’t get into this a lot when we were talking with the staff team today, but what is implementation of science, and I think I have been thinking about this a lot. There is a really big popular movement right now to look at this whole notion of implementing research programmes … implementing research studies with fidelity and rigour, and that there is a fairly prescribe way of looking at doing this, and there’s actually a huge, huge movement, I think particularly in America around this whole notion around implementation of science, and we had a lot of debates about this when we were running the part programme, because what … you know, how do you implement something from an evidence based perspective, how do you still incorporate the art within the science? And one of the things that I think is really challenging about implementation of science, is that it’s focused exclusively on evidence based practice. It really is focused on that paradigm around knowledge is here, academics are up here, evidence is seen to be … there’s sort of a rope way of implementing. And I think the journey that I have learned running PART and if I could write another paper about this, which I probably will since now I am in this world of publishing or perishing, but I will get to that, is this whole notion of .. you know, how do we implement and is it an easy path? And I know for the Iriss team, you are probably really challenged with, you know, I tried to implement something, it didn’t actually work, or service users are implementing a project, what got off the rails, how do we evaluate that? And so there’s a real debate, I think, that needs to happen around, what is the role of evidence informed practice in terms of implementation science. It is a fairly nebulous concept and I could go on a lot about it, but it’s really about implementing evidence based practices with fidelity, rigour and I am very much glossing over it, but there’s a real groundswell to really focus on prescribed ways of implementing these practices. What I think it’s missing, and we were talking about this with the team today, is we were talking about this great model where you are actually cultivating people to do programme evaluations on their own and one of the things that we were talking about today was what are the challenges, how do we get people to do programme evaluation, but get people engaged? And I was talking about this in Canada, they actually are doing a whole programme using implementation science, and they are actually getting people to use fidelity, rigour, structured ways at implementing evidence based practices. But do you know what’s happening in the organisations? People are pushing back, they don’t want to do it. Any idea why? They don’t understand … why am I doing this, what is this for, maybe I am implementing an evidence based practice but how is that going to benefit me, I don’t have the time for this and I don’t get how this data is going to make my life any different. And so what was missing, I think, in the implementation science debate is this whole issue around organisational and systemic change. We can’t expect people to use and create evidence unless we motive them and help them to understand how it will make a difference for them and the people that they are serving. And that, I think, is the missing paradigm in the debate which does not come up, and I have been at the Washington conference a couple of times and I think it’s dismally missing. So it’s really focusing on … it’s missing the element around organisational and systemic change. So what ended up happening was, practitioners were coming to PART, to get wisdom from us about ‘how do you create an environment in an organisation where people actually want to use evidence, how do you do that, how do you create that?’ And that’s, I think, the really challenging debate.

Context is really important and I think culture is hugely important, I mean I think the interplay between context and implementation, I think, is very important. I mean I can tell you that organisations, in and of themselves, each organisation, social service organisation that you are working with also has it’s own culture, it’s own way of operating, it’s own way of engaging evidence, leadership is incredibly important, and that’s where, I think, the implementation of science debate falls down because it doesn’t always look at context.

Art and culture and poetry and language, you know, just having … using art as a sophisticated way of actually engaging people to come and talk about evidence, you know … ‘how do we use .. how do we promote evidence in creative ways?’ And ‘if we lose the sense of the art and only focus on the science, we miss the discussion about how to engage people in that. Engage practitioners, they really have to own the work, I mean when I was talking about one of the sites that we engage, PART was originally embedded in one of the organisations East of Toronto, they were an organisation that didn’t use evidence, they just .. I just kept trying and trying and trying, and finally I made some breakthrough because we actually said to them, “why don’t you create a little team, a planning team and have some fun with this stuff?” So they started actually having these PART parties and they actually had film festivals, so they would show the webinar art archives the same week as the Toronto international film festival, so they had a lot of fun with it, they would have little t-shirts, they would have door prizes, man the uptake. And I think that’s one of the things, the lessons I learned, was … does knowledge have to be something really boring and removed from the work that we do? It shouldn’t be, it should be engaging, it should be fun, it should be creative. So I think that’s one of the things that we tried.

I don’t know if any of you know Eileen Gambro, but she is a real powerhouse of a woman, she started the whole movement around Evidence Based Practice in child welfare, and she is at Berkeley and she came up and did some work with our system around Critical Thinking, and she always said, I think her best message ever was ‘just be courageous, try and do something that not everybody is going to agree with you doing.’ So when I first came to Northern Ireland, Cathy had … Catherine Higgins, here at the front, did a great event celebrating 18 years of the work that she had done leading her research centre at Queens for work with children and families, and they did some really extraordinary, courageous things, having a BBC journalist interview the leaders who had led the unit etc, did some story boards, you know I think those ideas were … the impetus was from Iriss, but I think one of the things that we really learned was being courageous, trying something different and that sometimes means that you are going to fail and it sometimes means that you are going to have people say “what are you thinking?”, so it’s really about just trying different things. Where I think the social service sector falls down, is that we don’t try enough to fail, to make mistakes … we learned so much more from the mistakes that we make we tend not to be courageous, and I think in a really risk averse society we have become so, so mired by administrative minutia rules etc, that we forget to think outside of the box. So that is certainly one of the challenges.

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