Among the Knowledge Mobilisation papers I’ve found useful is one by Paul R Carlile called “Transferring, Translating, and Transforming: An Integrative Framework for Managing Knowledge Across Boundaries”. Carlile is a management scholar and this paper was published in Organization Science but although it is focused on product development on a fictional car manufacturing company, its broader theme of managing knowledge across boundaries is relevant to health and other sectors.
As the title indicates, in this paper Carlile discusses the differences between, and challenges posed by, three ways of managing knowledge across boundaries: transferring, translating, and transforming. These relate to three levels of complexity in communication – syntactic (transfer), sementic (translation), and pragmatic (transformation) – and to the increasing level of novelty implicated as we move from transfer towards transformation.
Carlile identifies crossing syntactic boundaries as common when the idea of knowledge transfer is prominent. He says that when there is a common lexicon on each side of a boundary that can adequately deal with the “differences and dependencies of consequence” present then transferring knowledge across that boundary should be relatively unproblematic. He notes that a common lexicon is necessary, though not always sufficient, to share and assess knowledge across a boundary.
When a semantic boundary is involved, creating common meanings to share and assess knowledge may require knowledge translation and the creation of new agreements. This can occur when differences or dependencies are unclear or when meanings are ambiguous. Shared meanings can emerge when communities of practice develop or when knowledge brokers or translators are involved – the challenge is typically one of making tacit knowledge explicit.
Finally, when pragmatic boundaries are present it means that the knowledge to be changed is “at stake” and the interests of individuals or groups are challenged by it or face costs in resolving the differences uncovered. To achieve chance in such circumstances knowledge transformation is often necessary; Carlile suggests the use of boundary objects like drawings and prototypes (which makes sense in terms of car manufacturing) to assist in such negotiations.
I don’t find it too hard to think of examples of each of these boundaries. A colleague recently described to me the efforts of a patient who was keen to get to grips with the evidence behind treatments for her condition. She starting asking health professionals where they found the evidence they used to inform their practice but her repeated question “So what magazines do you read?” brought her bemused looks. Of course it wasn’t a major step for her to realise that she should be asking about journals rather than magazines (“Did you see the results of that RCT reported in Marie Claire?”) and so to come closer to having a common lexicon with those to whom she was speaking – this would be a (very simple) example of something enabling knowledge transfer across a syntactic boundary.
Knowledge translation was necessary for me when I, as a public health practitioner, started working with social-care colleagues. I realised after a while that what I meant when I spoke about prevention (roughly speaking, stopping people from developing health problems) was not the same thing that they meant when they said prevention (making sure people didn’t reach a position where they need to receive statutory services). Our conversations on this topic became easier when I had realised this difference in meanings. This is a simple example of knowledge translation and the situation will be more difficult when it’s not just a single word that is involved.
Finally, I had experience of (unsuccessful) knowledge transformation when I was asked to review a service provided by a partner organisation. To make life easy for me, or so I thought, someone had just completed a PhD that was partly based on an evaluation of the service in question. They had found that the service was ineffective – in fact, that some of the people enrolled in the service seemed to have poorer outcomes than people who were not enrolled. I reviewed the published literature and found little evidence anywhere to support services of this type. I wrote a brief report and sat back, waiting for the service to be closed and savings to be made; but it wasn’t, and they weren’t. The matter was less clear-cut than that and it took me a while to realise what had happened. In effect, the knowledge that I had put together – negative evaluation outcomes, no evidence of effectiveness – presented a challenge to the knowledge of those commissioning and running the service – that people liked the service, that they were personally and politically invested in the service, that they didn’t like the way the evaluation had been conducted. They had knowledge that was put at stake by my knowledge (which was also challenged by their knowledge). I failed in my attempt at knowledge transformation and in this instance the practical boundary was not crossed.
Carlile puts these elements together in an integrative framework as part of a much longer and richer paper in which he considers ways of tackling the problems identified. Considering even these simple elements, though, helps me think about some of the challenges central to knowledge mobilization in healthcare: the need to take knowledge across boundaries of different kinds, the importance of thinking of the differences involved, and the political and practical challenges involved in successful knowledge sharing.
Carlile, PR. Transferring, Translating, and Transforming: An Integrative Framework for Managing Knowledge Across Boundaries. Organization Science. Vol. 15, No. 5, September–October 2004, pp. 555–568. Non-final version available from institutional repository: http://dspace.mit.edu/bitstream/handle/1721.1/3959/EEL_3T.pdf or at http://pubsonline.informs.org/doi/pdf/10.1287/orsc.1040.0094