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      Making authentic: exploring boundary objects and bricolage in knowledge mobilisation through National Health Service-university partnerships

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          Abstract

          Background:

          In healthcare, bridging the research-to-practice gap is a top priority. Knowledge mobilisation scholars suggest that this gap can be closed through collaboration between knowledge users and producers. The concept of boundary objects – shared things and ideas that enable communication – has gained popularity across various collaborative work practices, but their potential within knowledge mobilisation in health care is understudied. An ongoing challenge for designers of boundary objects is how to create objects that are valued and shared both in principle and in practice.

          Aims and objectives:

          This paper reports on a study of boundary objects used during knowledge mobilisation through NHS-university partnerships called Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). The distinction is investigated between boundary objects-in-theory and boundary objects-in-use, considering whether the latter possess specific characteristics which make them more effective during knowledge mobilisation.

          Methods:

          A qualitative case study of three CLAHRCs was conducted. Twenty-one people employed as ‘boundary spanners’ were interviewed to explore whether boundary objects played a role in knowledge mobilisation.

          Findings:

          The most effective boundary objects-in-use were co-produced through a process of bricolage. These possessed high levels of meaningfulness and resonance, and reconciled multiple user perspectives. Together these properties contributed to the overall authenticity of boundary objects-in-use.

          Discussion and conclusion:

          This paper helps to explain why designated boundary objects frequently fail in practice, and why there is a need to focus on understanding boundary objects based on symbolic, rather than structural, dimensions.

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          Most cited references46

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          Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

          Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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            Qualitative data analysis for applied policy research

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              Diffusion of innovations in service organizations: systematic review and recommendations.

              This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.
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                Author and article information

                Journal
                Evidence & Policy
                Bristol University Press
                1744-2648
                1744-2656
                November 2020
                November 2020
                : 16
                : 4
                : 517-539
                Affiliations
                [1 ]Bangor University, UK
                [2 ]Lancaster University, UK
                [3 ]Canterbury Christ Church University, UK
                [4 ]University of Stirling, UK
                Article
                10.1332/174426419X15623134271106
                5a550034-100c-4bed-80ef-9da1ffea0273
                © 2020
                History

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