title: Spanning the know-do gap: understanding knowledge application and capacity in long-term care homes.
abstract: Using a multiple case study design, this article explores the translation process that emerges within Ontario long-term care (LTC) homes with the adoption and implementation of evidence-based clinical practice guidelines (CPGs). Within-organization knowledge translation is referred to as knowledge application. We conducted 28 semi-structured interviews with a range of administrative and care staff within 7 homes differentiated by size, profit status, chain membership, and rural/urban location. We further undertook 7 focus groups at 5 locations, involving a total of 35 senior clinical staff representing 15 homes not involved in earlier structured interviews. The knowledge application process that emerges across our participant organizations is highly complex, iterative, and reliant upon a facility's knowledge application capacity, or absorptive capacity to effect change through learning. Knowledge application capacity underpins the emergence of the application process and the advancement of knowledge through it. We find that different elements of capacity are important to different stages of the knowledge application process. Capacity can pre-exist, or can be acquired. The majority of the capacity elements required for successful knowledge application in the LTC contexts we studied were organizational. It is essential for managers and practitioners therefore to conceptualize and orchestrate knowledge application initiatives at the organization level; organizational leaders (including clinical leaders) have a vital role to play in the success of knowledge application processes.
authors.affiliation: University of Toronto, Faculty of Medicine, Department of Health Policy, Management and Evaluation, 155 College Street, Suite 425, Toronto, Ontario, Canada M5T 3M6. whit.berta@utoronto.ca
authors.forename: Whitney
authors.initials: W
authors.lastname: Berta
authors.forename: Gary F
authors.initials: GF
authors.lastname: Teare
authors.forename: Erin
authors.initials: E
authors.lastname: Gilbart
authors.forename: Liane S
authors.initials: LS
authors.lastname: Ginsburg
authors.forename: Louise
authors.initials: L
authors.lastname: Lemieux-Charles
authors.forename: Dave
authors.initials: D
authors.lastname: Davis
authors.forename: Susan
authors.initials: S
authors.lastname: Rappolt
mesh_terms: D000368:Aged; D055317:Evidence-Based Practice; D017144:Focus Groups; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care / Q000458:organization & administration*; D009735:Nursing Homes / Q000458:organization & administration*; D009864:Ontario; D009936:Organizational Innovation; D017410:Practice Guidelines as Topic