The need for systems change: reflections on knowledge translation and organizational change

The need for systems change: reflections on knowledge translation and organizational change. Despite over 40 years' work on general systems theory, informed by critical social science, there is a mismatch between the theories used to explain and influence clinical practice in nursing and the way in which transferring new knowledge into practice is articulated. The analysis and emerging propositions were based on a critique of seminal texts published in English up to 2008 covering critical social science, action science, diffusion of innovations, practice development and the management of innovations. There is an implicit adherence to the world view that healthcare systems operate like machines, and much of the science generated around knowledge translation research tends to be logico-deductive. This is in direct contrast to the prevailing arguments of general systems theorists, who view the system more as an organism. Five propositions are posited: knowledge translation is a necessary but not sufficient mechanism to transform systems; the 'system-as-machine' metaphor is profoundly unhelpful to knowledge translation; the healthcare system is best viewed as a complex entity; successful innovation is a function of the level of local autonomy experienced by individuals, teams and the unit involved; innovation is most effective when it involves key stakeholders. The purposeful integration of systems theory with knowledge translation theories and models may enable the application of research and new knowledge to practice to be speeded up.