Combining health and social protection measures to reach the ultra ...

Innovation
knowledge – the “know what”. The realm of biotechnology
researchers and evidence-based medicine is dominated by
the intensive use of encoded knowledge. By comparison,
practitioners in the health professions, policy-makers and
managers of health service organizations rely on the use of
complementary types of knowledge in a context where
encoded research knowledge does not usually dominate. We
acknowledge that scientifically generated knowledge enjoys
the highest degree of generalizability and potential for radical
innovations 16 , however, some phenomena do not lend
themselves well to systematic research.
The lesson to derive from the examination of the types of
knowledge is that sound decisions and sound professional
practices must be based on multiple types and pieces of
knowledge that bring complementary contributions to
problem-solving in a progressive, Bayesian way 17 . Various
sources of knowledge, besides that from research, are needed
by various users who range from policy-makers, to
practitioners, to managers and communities. The processes
from generation to utilization of knowledge (value chains) is
therefore dependent on the purpose and on who the
stakeholders might be.
Different types of knowledge are especially important to
perform a particular task and solve problems and manage
change in unique, complex or uncertain circumstances.
Moving from KT conceptual framework to the
knowledge value chain
Knowledge should be used as a resource adding value into
the activities undertaken in the production and delivery
processes of health service organizations. In the management
literature, this idea of value creation is often approached
through the concept of knowledge value chain (KVC) from
strategic planning to implementation.
From an organizational perspective, the KVC is the set of
knowledge creating activities to move from concept up to the
production of new or improved products and services
delivering added value for clients. While some variation is
expected for different problems or settings, we propose that
the knowledge value chain consists of five activities
interrelated by multiple feedback loops from knowledge
exploration to exploitation: acquisition, creation, sharing/
dissemination, utilization/application, and performance
assessment/innovations 18 . In turn, each activity is supported
by specific tools and specific tactics. The mission, vision,
goals and strategies of an organization or social enterprise
drive the KVC. The higher the knowledge performance related
to acquisition, creation, sharing, and use, the higher the value
generated for key stakeholders along the value chain. Value is
created by managing interactions between the strategic,
operational and tactical levels of the KVC as well as between
the different activities of the KVC. This dynamic process
generates feedback loops that amplify or attenuate the
knowledge conversion flows depending on key drivers
(motivation and incentives) and local context and larger
historical forces.
Value chains start and end with a purpose, to solve a
problem and create value through the delivery of key services
and products by orchestrating and navigating social and
organizational processes involving motivation, strategy and
incentives. The research to policy value chain (transferexchange-utilization)
is complex but there is some
experimentation. Diffusion of innovation in clinical practice is
well established although there is room for improvement. The
pharmaceutical R&D value chain is one of the most evolved
and one to learn from. Community interventions, on the other
hand, require major development. Paradoxically, this is the
area where private sector has valuable experience in
marketing a product or service. Nonprofit, social
entrepreneurship thus has lots of potential where government
services and market alone fall short.
Research needs
Knowledge Translation has the potential to bridge the knowdo
gap. The field is a growing one with scarce literature,
although a new journal of implementation science has been
launched recently. WHO, countries and the global community
could be further engaged in efforts to address the know-do
gap through research on KT. There is yet no agreed
conceptual framework and a lack of a general learning
platform to develop and spread good practices. Funding
systems are not supportive and evaluation and accountability
systems are not aligned.
The following are among the research topics/questions that
will contribute to development of KT.
✜ Evidence on impact of evidence-based approaches.
✜ Evidence on impact of interactive approaches, including
demand-driven models.
✜ Increase general knowledge of what works and how –
what key factors contribute to success stories (a
forthcoming issue of the Bulletin is devoted to KT and
should contribute to this issue).
✜ Increase understanding of the processes, including
diffusion of innovation from knowledge generation to its
application-value chains.
✜ National and global assessments of the knowledge
enterprise for health.
There is no clear picture of the knowledge systems in
health in countries, and thus, a global assessment of
knowledge for health is needed in order to landscape the state
of KT in countries and the international space. Such
assessment could highlight the importance of KT in countries,
identify and engage new partners, identify needs and
priorities for action in Member States, draw comparative
lessons and derive best practices, and inform a baseline to
monitor impact and progress over time. ❏
Ariel Pablos-Méndez joined the Rockefeller Foundation as
Managing Director in April 2007. He is an Associate Professor of
Medicine and Public Health at Columbia University in New York.
Previously, Dr Pablos-Méndez served as the Director of
Knowledge Management & Sharing at the World Health
Organization (WHO) in Geneva, working to help bridge the knowdo
gap in public health and advancing the field of e-health.
Dr Pablos-Méndez has returned to the Rockefeller Foundation,
106 ✜ Global Forum Update on Research for Health Volume 4