Spring 2018 (Volume 28, Number 1)

Knowledge Translation and Implementation

By Alexander Lo, MD, FRCPC; Shirley Chow, MD, FRCPC; Natasha Gakhal, MD, FRCPC; and Linda Li, BSc(PT), MSc, PhD

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Knowledge Translation (KT) is of critical importance to health research, as it has become clear that the creation of new knowledge often does not, on its own, lead to widespread implementation or impacts on health. KT is important in bridging the gap between research and practice so that patients can benefit optimally from advances in research evidence.

There exist various theories, approaches and models of KT. The Knowledge-to-Action Process Framework1 is one model. Knowledge application is an important component that represents the "action" phase of the framework, which involves tailoring the knowledge product/tool for implementation, dissemination and quality improvement (QI).

The Model for Improvement is a practical QI approach that can be used to implement the Inflammatory Arthritis or Osteoarthritis Models of Care (MOCs) at the front line of clinical care. According to this model, sequential Plan-Do-Study-Act (PDSA) cycles are executed to guide specific improvement activities. By following a few step-by-step principles, health care providers can apply a QI assessment in their own clinical setting. These steps include performing a gap analysis of the current state to identify ways an individual’s practice could be improved to better reflect a MOC.

The second step is to engage stakeholders and conduct a root cause analysis to understand the reasons for the gap in practice and the barriers to implementing the MOC in an individual setting. To understand the nature of the problem and identify the key drivers of the quality gap, such tools as fishbone diagrams, process maps and Pareto charts can be used. These root causes will be the targets of the QI intervention.

The third step is to implement a change to improve practice and to evaluate the effects of the change to identify what adjustments may be required to refine the process further. Multiple small-scale PDSA cycles are usually necessary to achieve gradual improvements over time.

Dr. Alexander Lo, Physiatrist, Brain and Spinal Cord Program, Toronto
Rehabilitation Institute, Toronto, ON

Dr. Shirley Chow, Assistant Professor, Department of Medicine,
University of Toronto, Toronto, ON

Dr. Natasha Gakhal, Rheumatologist, Women’s College Hospital,
Toronto, ON

Dr. Linda Li, Professor, University of British Columbia; Senior Scientist,
Arthritis Research Canada, Vancouver, BC


1. Graham ID, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006; 26(1):13-24.

2. Chow SL, Shojania K. “Rheum to improve”: quality improvement in outpatient rheumatology. J Rheumatol 2017; 44(9):1304-10.

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