Collective knowledge brokering: the model and impact of an embedded team

In: Evidence & policy: a journal of research, debate and practice, Band 16, Heft 3, S. 429-452

Abstract

Background:The Bristol Knowledge Mobilisation (KM) Team was an unusual collective brokering model, consisting of a multi-professional team of four managers and three academics embedded in both local healthcare policymaking (aka commissioning) and academic primary care.
Aims and objectives:They aimed to encourage 'research-informed commissioning' and 'commissioning-informed research'. This paper covers context, structure, processes, advantages, challenges and impact.
Methods:Data sources from brokers included personal logs, reflective essays, exit interviews and a team workshop. These were analysed inductively using constant comparison. To obtain critical distance, three external evaluations were conducted, using interviews, observations and documentation.
Findings:Stable, solvent organisations; senior involvement with good inter-professional relationships; secure funding; and networks of engaged allies in host organisations supported the brokers. Essential elements were two-way embedding, 'buddying up', team leadership, brokers' interpersonal skills, and two-year, part-time contracts. By working collectively, the brokers fostered cross-community interactions and modelled collaborative behaviour, drawing on each other's 'insider' knowledge, networks and experience. Challenges included too many taskmasters, unrealistic expectations and work overload. However, team-brokering provided a safe space to be vulnerable, share learning, and build confidence. As host organisations benefitted most from embedded brokers, both communities noted changes in attitude, knowledge, skills and confidence. The team were more successful in fostering 'commissioning-informed research' with co-produced research grants than 'research-informed commissioning'.
Discussion and conclusions:Although still difficult, the collective support and comradery of an embedded, two-way, multi-professional team made encouraging interactions, and therefore brokering, easier. A team approach modelled collaborative behaviour and created a critical mass to affect cultural change.