In 2009, the U.S. government spent $29.263 billion on health research—more than half of all funds committed to research in the United States. This case study is an example of how knowledge management (KM) improved targeting this significant investment in research to maximize social benefit.
In this case, KM enabled researchers to focus on improved diagnostic and treatment approaches for tuberculosis (TB) that are accessible to the poor and other vulnerable groups, and to include policy uptake considerations in the implementation of that research. A senior research team of the federally funded global TB research program TREAT TB advocated that research must consider the "true impact" to the health system and the community, rather than just the efficacy of an intervention. The challenge now was how to reach the wide audience of those involved in health research.
TREAT TB essentially wanted researchers to incorporate two types of analyses in their research design: impact assessment and policy transfer analysis. The impact assessment framework asks researchers to consider who gains from the interventions that research aims to improve; policy transfer analysis asks researchers to integrate appropriate engagement of decision makers who might influence the adoption of useful research outcomes to improve health policies and practice.
The first challenge was how to ensure researchers would understand what was asked of them and why. The second challenge focuses on how to explain the application of these two analyses in a way that enabled researchers to apply them.
Maximizing Reach
The Union North America, the implementing organization of the TREAT TB Initiative, initially communicated the importance of these tools by publishing papers and presentations, but it felt that it was not maximizing its reach. It turned to its strategic KM partner EnCompass for assistance. The initial assessment revealed that there were three main obstacles:
- the methodologies were complex and were perceived as too difficult to implement
- researchers—the main audience—saw these analyses as beyond the scope of research
- researchers who wanted to implement these tools found them difficult to apply.
To address these obstacles, the KM team worked with content experts to develop a promotional e-learning program. The program presented these two complex messages with simplicity and clarity, and tailored its presentation to researchers by offering sufficient guidance so that interested researchers could implement them on their own.
The resulting e-learning program establishes a compelling case to researchers. It states the global investment at stake—"More than $70 billion is spent in health research and development each year." Then it asks the user to imagine how much more cost effective and useful that research could be if research managers directed their research toward development of improved practices intended to benefit greater numbers of patients including those with a lower ability to pay, rather than the wealthy elite minorities (see Figure 1).
The e-learning program also asks the user to imagine how society would derive a greater benefit if research managers collected the evidence needed by policy makers and political leaders to help them accept research findings, and make appropriate changes in policy and programs as a result (see Figure 2).
The e-learning program then allows the user to explore interactively the two analytic tools described. In designing this e-learning tool, the TREAT TB team wanted a product that did not look too slick, but felt like a "technical" product for the "working researcher," that spoke to its audience as a technical source, one that invited independent thinking, rather than a public relations product aiming to manipulate the user into an emotional decision.
The next issue was to disseminate the e-learning tool for maximum reach internationally. This tool is now available online for free, and is integrated in TREAT TB programs for researchers to view and use as they design their research.
The tool is intended for wider dissemination at various health conferences. The TREAT TB team is currently considering other avenues to disseminate this e-learning, and ways to evaluate its impact.
Lessons Learned
Several lessons already reflected in the literature have been confirmed in this KM effort.
KM can significantly improve the effectiveness of government funds and programs. When one considers the tremendous potential benefit from better-targeted health research, and the financial and social cost of failing to mitigate adverse health outcomes (such as potential epidemics due to TB that is resistant to first-line medicines), it is clear that helping researchers reach more people effectively and sustainably is critical. In this case, KM focused on increasing access to better-targeted research, and improved research methods, as well as increasing policy uptake of useful research findings.
KM needs to respect users' voice and culture. Better is not always … better. In addressing researchers, KM needed to use a "scientific voice," emphasize the evidence, and tailor concepts to researcher needs and concerns. A slick, highly interactive KM solution was resisted as potentially engendering mistrust, because it was addressing an audience that values simplicity and scientific validity. The partnership and close collaboration between the KM team and subject matter experts resulted in a tailored and appropriate KM tool.
KM increases our power to understand complex concepts. KM clarified valuable, complex concepts. On paper, both the impact and policy uptake analyses were dense and complex involving many steps in their implementation. By laying out these concepts in multi-step, interactive components, KM facilitated a clearer presentation of these methods, and has now enabled accurate and consistent application of each analysis by large numbers of users, and overtime.
KM products should be placed in users' path. In this case, making the KM tool publically available on a portal where researchers go for other purposes enabled a wide circulation of the tool. Also, it was important to have The Union North America—a trusted and recognized leader organization in TB research—disseminate this KM tool. The importance of "roll out" of a KM product cannot be over-emphasized.
Evaluation will make KM better. Just as careful assessment enabled the team to adopt the right voice and design, periodic evaluation will result in improvement and refinement. This task still remains to be undertaken.
KM is both a solution and an intervention. The technology solution is only part of the puzzle—frequently, in fact, the smaller part; the other part is managing the changes in work processes required to accompany the implementation of that new technology.
When KM experts and program managers work together systematically and with appreciation for each others' expertise and experience, KM solutions are better tailored to the government workplace, and are more easily accepted by public managers. This case study demonstrates that, at its best, KM empowers public managers to improve access to information and cost effectiveness of government organizations and programs.
