Benefits of Intermediary Risk Management

Transcription

1 I am a knowledge broker :Exploring the enactment of formalised intermediary roles in an academic/practice collaboration [CLAHRC] Sarah Chew Supervisors: Natalie Armstrong and Graham Martin Department of Health Sciences University of Leicester

2 Overview Part 1:Context CLAHRCs Policy background Knowledge brokering Part 2:Empirical work Rationale,question, methods Findings, future directions.

3 CLAHRCs CLAHRC stands for Collaboration for Leadership in Applied Health Research and Care 9 commissioned by National Institute for Health Research (NIHR); a response to perceived failures to get evidence into practice Experiments to address the 2 nd gap in translation: collaborative partnerships between academic partners, healthcare providers, patients and commissioners [RAND,2011]

4 Cooksey, Cooksey report identified two gaps in translation: T1 or bench to bedside : the movement of knowledge from research into a potential clinical product or tool T2 or 'research into practice : the movement of new tools into healthcare practice, leading to improved patient care [The know-do gap]

5 Knowledge brokering in the health services Knowledge brokering is not a universal panacea. However, the interpersonal linkages it creates are certainly very promising as one of the in-between missing pieces that can bridge the knowdo gap for health services. (Lomas,2006)

6 The title of knowledge broker is not regulated, and there is no knowledge broker certificate or academic program to prepare knowledge brokers for the challenges they face (Robeson et al, 2008)

7 What is knowledge brokering? Five facets Capacity building Facilitating interpersonal linkage Knowledge creation Promoting evidence usage Evaluation

8 Diverse terms Link or connection officers Agents of change Third person Intermediary informers Knowledge brokers Boundary-spanners Gatekeepers Boundary spanning knowledge brokers Sparkplugs, boundroids and collabronauts

9 Knowledge Brokering and Boundary Spanning-a relationship? In the context of human interaction, the spanning of a boundary, social, organisational or otherwise is a necessary condition for knowledge brokerage. Knowledge brokering is a functional property of boundary spanning. Prototypical construct intermediary work / intermediaries.

10 Part 2 Empirical work Rationale, research question Design and method Intermediary roles in CLAHRCS Data and analysis Preliminary findings Conclusions, future directions and questions.

11 Rationale Robeson et al (2008) Knowledge Brokering: Public health managers lack of available resources to support the KB s was particularly challenging and highlighted the importance of regular interaction with the research team to avoid becoming very isolated Singh et al (1994) Boundary Spanning: Customer service representatives Due to its innovative nature and large role set boundary spanners are prone to elevated levels of role stress

12 Question, design and method Question: Given the inherently context dependant nature of intermediary work can experiential commonalities be identified? Design: Multiple case studies of formalised intermediary roles in a CLAHRC Method: Ethnographic

13 Intermediary roles in CLAHRCs The nine CLAHRCS have taken varied approaches to intermediary roles. Diffusion fellows, Locality Leads, Knowledge Transfer Associates, Coordinators Consultant level, managerial level, nonmanagerial level Part time, job shares, full time

14 Data Collection Interviews: key stakeholders and intermediaries Ongoing observations: meetings/activities Collection of organisational documents: minutes of meetings, strategy documents, job descriptions Reflective diaries: Solicited July 2010, instalments of the diaries fed back and used to inform interviews

15 Findings Seven posts, all but one full time Non-managerial, banded at grade 6 Embedded in the trusts [acute, primary and mental health trusts] Jointly managed/supervised by the host trust and CLAHRC Characterised as both knowledge brokers and boundary spanners by the CLAHRC

16 The Intermediaries position in the collaboration Board Executive TRUST CLAHRC INTERMEDIARY

17 Remit of the posts Promoting evidence usage within the host organisations Recruiting personnel to participate in new forms of locally driven knowledge production Facilitating evidence use by tailoring and synthesis Establishing and maintaining interorganisational and interpersonal linkage Intermediaries are the primary link between the CLAHRC and the Trust (2009,Job description) I did think it was a bit ambitious that anybody could fulfil all of the criteria [Intermediary 2]

18 Every trust is so different and we all have a different structure, we re all based in different teams so yeah, we re all classed as intermediaries, but actually what we re doing can be quite different. [Intermediary 3]

19 Experiential commonalities Ambiguity: overarching theme linked to aspects of the roles, e.g. remit, expectations, management, status, and evaluation Association with role stress constructs : role ambiguity and role conflict Experiential change and process of adaptation to ambiguity Three broad components: isolation, reconciliation, and autonomy

20 Ambiguity 1: Remit everyone not only in [host trust] but people within CLAHRC and the trusts appears to have very different views of what an intermediary should do [Intermediary 4] Role ambiguity the degree to which clear information is lacking about the expectations associated with the role.(rizzo et al,1970)

21 Ambiguity 2: Expectations I mean I ve got on the one hand, I ve got the Trust who I want to keep happy and I want to sort of appear useful to and then you know I m trying to keep CLAHRC happy and bring the CLAHRC agenda to the Trust. And you know a lot of the time it feels like one is more, I won t say important but you know one master wants more out of me than the other. [Intermediary 2] Role Conflict: the degree of incompatibility of expectations associated with a role.(rizzo et al,1970)

22 Ambiguity 3 : Managerial I think it is a really difficult role, I think they have a major problem of being put in an organisation but somehow separate from CLAHRC so they re line managed by somebody s who s not CLAHRC and supervised by a manager who is or isn't involved in any of the discussions. [Stakeholder] [it] is difficult to know which way to go for support or in fact where I actually belong. [Intermediary 4]

23 EXPERIENTIAL CHANGE Adaptation: Isolation and uncertainty, Consolidation Tailoring and Autonomy

24 Isolation Expression of negative affect, in particular, loneliness and uncertainty were commonplace in data relating to the early months of the posts. I feel very lonely because I have very little management or very little, sort of, supervision in terms of what I do and I do, I have concerns sometimes and little panics that I m doing things I shouldn't [Intermediary 6]

25 Normative Expectations My previous role was very much micro managed, you weren t allowed to do anything unless, you weren t even allowed to send an unless you put it past your manager. [Intermediary 3] I would normally have my feet under the table in a job at six months. But I m still trying to figure it out. [Intermediary 5]

26 Autonomy I would say I manage myself. I mean most of the time there ll be days where I am, I could be in Spain nobody would even know [laughs] I work very autonomously [Intermediary 3] So I feel that really I ve got to devise my own strategy that straddles CLAHRC and [host organisation] and then try and run with it... But I think that s just how it, how it will be [Intermediary 1]

27 Reconciliation [we ve] realised we can t do one thing in all trusts...how we achieve our aims is going to differ [Intermediary 4] I m doing this, what do you think? Well that's not going to work in my trust Well what have you got that's equivalent and we can have those conversations [Intermediary 1] having others to talk to definitely helps... keeping me calmer and not getting me so frustrated with things [Intermediary 6]

28 Conclusions Problems remain with existing evidence base, not easily applied to practice. Formalised intermediary posts associated with role stressors- inherent to the nature of the roles? To some extent, stress in the early phases of the roles may be exacerbated by normative expectations of organisational roles/moderated by COP? Novel roles, novel management?

29 Future directions How might intermediary roles be better supported and how best to approach researching such roles in order to inform/ this? How might formalised intermediary roles sit in the context of professionalization -can there be such a thing as an intermediary career? In so much as intermediary roles might be said to reflect postmodern roles, what might the consequences of such novel ways of working be for the individual?

30 I acknowledge funding from the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care. The views and opinions expressed in this paper are those of the authors and not necessarily those of the NHS,the NIHR or the Department of Health.

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