Organizational knowledge translation strategies for allied health professionals in traumatology settings: realist review protocol

Knowledge translation (KT) [1] is an important means of improving health service quality [2]. The science of KT is currently booming [1]. However, most research to date has focused on the upstream stages of the process (e.g., assessing facilitators and barriers or monitoring the use of interventions), and only a limited number of studies have examined the effectiveness of KT strategies [3, 4]. KT effectiveness refers to the ability of the different strategies employed to produce results for users, stakeholders, and the health system [3, 4]. Research on KT strategy effectiveness has primarily dealt with individual strategies, i.e., strategies that directly target the modification of health workers’ knowledge, attitudes, and behaviors [5, 6]. In general, these strategies are moderately effective in changing practices (maximum 10% change) [5]. In this context, it is imperative to consider other KT avenues than those focused on individuals alone in order to continue to improve health service quality.

A promising new avenue for supporting service quality improvement through the translation of evidence-based practices targets changes in organizational contexts (e.g., change readiness, general and specific organizational capacity, organizational routines) [7‐11]. Increased emphasis [12‐14] is being put on the decisive influence that organizational KT strategies could have on evidence-based practice implementation. This influence is now included in the majority of theoretical and conceptual models explaining this phenomenon [15‐17]. Organizational strategies are defined by Wensing et al. [5] as “planned rearrangements of one or more aspects of the organization of patient care.” In contrast to individual strategies, organizational KT strategies focus on the changes in the care and service contexts of organizations, such as redefining professional roles, changing meeting structures, and care protocols. These strategies, in addition to those focused on the individual, have the potential to significantly catalyze health and social service quality improvement. However, their mechanisms of action and effectiveness have been poorly investigated and remain unclear [18]. Recent studies conducted in the Quebec trauma rehabilitation context have highlighted the value of organizational implementation strategies to promote the effective and sustainable implementation of evidence-based practices [19‐22]. For example, changes in disciplinary roles, interprofessional meeting structures, and physical changes to the work environment were reported as facilitating implementation in this particular context. In 2008, Wensing et al. conducted a structured review of systematic reviews of the effectiveness of organizational strategies to improve professional practices and health outcomes for users; their results were equivocal, as none of the documented strategies produced consistent results. In addition, only the effectiveness of these strategies was analyzed, without any attempt to open the “black box” of their functioning. The action mechanisms of these strategies have not been documented, and it is therefore difficult to understand how they may or may not contribute to changing the behaviors of health professionals. Furthermore, in 2012, Flogren et al. conducted a systematic review of the effectiveness of organizational structures in promoting the use of evidence-based practice in nursing; they found only one study with a sufficiently rigorous design that did not conclude on the effectiveness of the strategy used for 3 months post-implementation [23]. As regards our rehabilitation practice context specifically, it is characterized by certain particularities in terms of KT due to the interdisciplinary nature of interventions, on the one hand, and the evolutionary nature of patient pathologies and hence their impact on patients’ capacity and lifestyle, on the other.

A realist review is required to assess the different action mechanisms of organizational KT strategies (how, why, for whom, to what extent, and under what circumstances) and to facilitate the choice of effective strategies that will enable effective and sustainable implementation of evidence-based practice for allied health professionals in traumatology settings. Realist synthesis (or review) is a scientific literature review approach that provides an explanatory analysis of how theories work (or fail to work) in different contexts [24]. It is used to develop an understanding of the implementation chain of interventions by detailing the prerequisites to achieving positive results and avoiding negative outcomes [24]. No research has been done to date on the functioning and effectiveness of organizational KT strategies with allied health professionals in traumatology settings. Focusing on a new organizational target can improve KT effectiveness and service quality. The objective of this study will be to identify why, how, and under what conditions organizational KT strategies have been shown to be effective or ineffective in changing the (a) knowledge, (b) attitudes, and (c) clinical behaviors of allied health professionals in traumatology settings.

Using a systematic and rigorous method, this review will help guide decision-makers and researchers in choosing the best organizational strategies to optimize the implementation of evidence-based practices in the trauma field.

Researchers have explained some of the challenges that are specific to realist reviews. Among other things, making the distinction between mechanism and context can be difficult [32‐34]. Robert and Ride explain that the mechanism (M) in one CMO configuration can be the context (C) of another CMO configuration [34]. Moreover, Pawson et al. mention there is a limit to what can be understood through the available information. Less tangible information such as relationships of influence and power, for example, may not be described in an article [35], hence the importance of opening up the search for information to documents other than primary studies, but this also makes it more difficult to assess the quality of the information. In this context, quality assessment is not necessarily based on formal grids, but mainly on the judgment of the authors of the synthesis with regard to data credibility and its impact on theories [35]. The recommendations based on the synthesis may also be limited. It will be difficult for the authors of the synthesis to claim that they have grasped all the opportunities and constraints associated with interventions and to predict the circumstances under which subsequent projects will be implemented [35]. This limits the scope of the recommendations. It is crucial that future users of the knowledge produced through realist synthesis understand the usefulness, but also the limitations of this approach. This underscores the importance of their participation in the review from the outset. Finally, it is important to remember that the steps described in this protocol will be carried out in an iterative manner. Any amendments made to this protocol when conducting the study will be outlined and reported in the final manuscript.