is not as in depth as needed, Kabcenell said. Gaps in knowledge included how to get changes right and how to engage physicians. Making relevant knowledge accessible was identified as a systemic issue. In discussing the information marketplace, the group identified a number of ways to collect information, including the Internet, improvement networks, and social networks.

Execution of spread covered a range of issues, from high-level policy issues to front-line practitioners, with an emphasis on the need to capitalize on opportunities for collaboration. Environments can foster teamwork and tools such as technology, and transparency can enhance data sharing. The group also explored the idea of a renewable organization for improvement, where the expertise and power built for one project could become the basis for future projects. One particular call was to disseminate the knowledge that is already known. Much of what is known already is not widely known or readily available to a broad audience. Competition was also identified as a barrier to collaboration.

The importance of having linkages between the research and implementation communities was highlighted. Implementers could offer researchers the ability to test theories and ideas in real labs, while also providing expertise from an operational perspective. The need for research to have a user-oriented approach was also discussed. Additionally, allowing implementers to provide more input could be beneficial in research design and execution of change. Implementers could also be used a resource for funding.

The group discussed what information implementers wanted from researchers. In particular, core elements or essential ingredients for implementing change were desired, ranging from measures of organizational readiness to context, from the tools available for change to who needs to participate. It was noted that a standard way of communicating across organizations is imperative. Another type of information centered on troubleshooting to help determine why a tool or mechanism did not achieve its desired effects. Although cost data and strength of evidence are necessary, rigorous evaluations also are required to move forward. Reports on failures and successes should ideally be about equal—documentation of failure is as important as documentation of success, although few may want their failures documented. Information is also needed to predict both short-term and long-term returns on investment.



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