The structure of the findings follows the five components of KE, including the distinct themes describing the nature of KE. The four questions derived from the knowledge mobilisation framework clarify some of the components. The two questions on whose and what type of knowledge is being mobilised are included under knowledge. The why and how questions on knowledge mobilisation are included in the intervention component.
At several points in time during the KT process, attention was paid to the challenge that the receiving regions chose to address. Two different approaches were designed for carrying out the KT activity.
The first approach was informed by the maturity assessment of the healthcare system using the SCIROCCO tool. The outcomes of the assessment provided insight into the strengths of, and challenges for, integrated care in the region. Hereafter the region chose one domain for improvement. It sought support from another region which had previously demonstrated a significant progress in the corresponding domain (as shown in the outcomes of the maturity assessment). Within the project, two cases (3 and 4) focused on improving a specific domain/aspect of integrated care using the first approach.
In the second approach, the problem identification focused around a strategic interest of a region in one of the GPs which were selected by other regions in the project. After the region expressed their interest, the requirements of that GP, for it to be adopted and transferred, were assessed using the SCIROCCO tool. Then, the receiving region assessed the maturity of the healthcare system for the adoption of the GP using the SCIROCCO tool. After the regions investigated the requirements of the healthcare system to adopt the GP, the twinning and coaching process was initiated. Within the project, a total of three cases (1, 2 and 5) focused on the second approach.
After the regions were matched, they used different approaches to clarify the problem/challenge of the adopting regions before the study visit. One transferring region explicitly indicated to be in contact with the adopting region prior to the visit (case 5). In the other cases, the regions involved did not provide details on how the preparations on clarifying the challenge of the receiving regions was conducted. Participants in case 2 mentioned that the study visit would have benefitted from more preparation.
Clarifying/focussing on the challenges of the regions occurred during the study visits. In the programme of four out of five study visits, explicit time was scheduled to discuss the rationale for the twinning and coaching between the transferring and receiving region(s). The challenges of the adopting and transferring regions were sometimes also mentioned during the focus groups. Some respondents talked about reviewing the challenge experienced by their region, based on the knowledge they had received during the study visit. Quotes are presented in Additional file 2.
In the final step of the KT process, the challenge of the regions was described in the action plans by the regional project leaders of SCIROCCO (details are provided in Additional file 2). For all five cases, the background of the problem was identified as being part of a broader process for change and/or improvement of the health and social care systems. Almost all representatives of regions, acknowledged that the sustainability of their health and social care systems is becoming a challenge. Hereafter, the problem was more focused towards the subject of the KT activity: a short description of these challenges is presented in Additional file 2.
No direct observations were made where the problems in the regions evolved over time. In two cases, however, respondents mentioned that the tool could be used to track progress over time (in case 1 and 3).
Exploring, discovering and revealing contextual characteristics was a central part of the five KT activities within the SCIROCCO project. This activity was supported by using the SCIROCCO tool. In the two study visits (in case 3 and 4), using the first approach, a facilitated discussion was organised that compared the self-assessments of the transferring and receiving region. For each dimension, this included the identified features of the health care system. The features were concrete attributes of the environment that are needed for improvement. The receiving regions explored what they needed to change in the local environment in order to enable the improvement of that domain in their local context. They also considered whether improvement in this specific aspect on integrated care related to other dimensions of the SCIROCCO tool. These aspects were later captured in the relevant action plan.
In the second approach, the KT was informed by the assessment of maturity requirements, first, of a GP for adoption and, second, of the health care system of the receiving region. A maturity requirement is a feature that a GP needs the environment for it to be implemented. In two out of the three study visits, a discussion was facilitated focusing on what would be the requirements of local health care systems to transfer the GP (one did not take place because of lack of time). The outcomes of these discussions informed the development of the action plan.
In Additional file 3, the classification is presented based on the assessment of the extent to which the transfer of knowledge per contextual dimensions was regarded feasible to the local context and the organisational or professional characteristics. The contextual structural characteristics, organisational or professional contextual characteristics, were sometimes indicated by regions, and are also presented in Additional file 3.
SCIROCCO’s KT procedure
The SCIROCCO tool and project activities supported regions in locating the knowledge. The tool and project activities assisted in the matching of regions and the further KT processes. Assessing the relevance and usefulness of knowledge by the experts of the receiving regions occurred during facilitated discussions in six out of the seven study visits. Based on the contextual dimensions and features, the experts assessed whether transferring the learning about the GP or the learning about a dimension was feasible in their region’s context. This was done by indicating whether transferability was feasible (yes or no). When it was considered feasible, this was further assessed by indicating whether this required little or much effort or adaptations.
After looking into the feasibility, a further selection of the knowledge was made. In the action plans, the receiving regions listed a maximum of three prioritised features to be considered for the transferability of learning about a GP, or an improvement in dimension in the receiving regions’ local context. Hereafter, the adopting regions described per listed feature the suggested adaptations to their local context to enable the creation of conditions for the adoption of the learning from the GP or dimension (Additional file 3). The suggested adaptations can be understood as tailoring knowledge.
Type of knowledge
The knowledge shared by the transferring regions came from different sources, including presentations and discussions among the experts from the transferring and receiving regions. In four cases, knowledge also came from practical site visits. Furthermore, the transferring regions provided information in the action plan of the receiving regions. The knowledge shared among the regions came from a mix of “knowledge donors”, who were involved in the KT activities and differed case (Additional file 3). Only one transferring region, case 3, included members of the public who were acting as, or on behalf of, their communities and people in receipt of services (i.e., service users). Furthermore, the type of knowledge which was offered by the transferring regions during the five organised KT activities within the SCIROCCO project varied per case (Additional file 3). In three study visits, scientific/ factual knowledge was shared in the form of data on the performance of the practice shown during presentations or was described in the action plans. Technical knowledge was shared during the presentations in the study visits. The sharing of technical knowledge and practical wisdom were reflected in sharing experiences with the experts of the transferring regions during both the discussions and demonstrations in the site visits.
The participants from the receiving regions, who were regarded as the “knowledge receivers”, included a mix of experts, composed of project members of SCIROCCO and invited regional experts (Additional file 3). In all cases programme and programme developers were involved as experts. Only one receiving region included a member of the public acting as, or on behalf of, the person’s community and people in receipt of services.
With regards to the type of knowledge, the adopting regions described in their action plans per listed feature the suggested adaptations/changes of the features to their local context. The type of knowledge which was of interest for the regions is shown in Additional file 3. The type of knowledge needed categorised as scientific/factual knowledge, were described by two of the receiving regions and included the feature of the SCIROCCO tool entitled Evaluation Methods.
The need for technical knowledge was noted in all the seven receiving regions. Technical knowledge was about developing (implementation) plans/mechanisms (enabling adoption), reforming/developing legislation and embedding learning though education and training and included different “dimensions/features.” The last type of knowledge needed, practical wisdom, was found in five regions. The need for practical wisdom included raising awareness about a new way of working, increasing public awareness, and demonstrating benefits of the GP or improvement in an aspect of integrated care. Features that emerged included Removal of Inhibitors, Citizen Empowerment, Readiness to Change, Innovation Management and Information and eHealth services (these five are among the 12 dimensions that populate the SCIROCCO tool).
For the intervention concept, a distinction is made between the intervention consisting of the SCIROCCO project itself and the priority actions of the adopting regions as described in the action plans. These two sorts of interventions are described separately below.
When focussing on the SCIROCCO project, three types of KT interventions were reflected in the methodology for twinning and coaching sessions. Starting with information management, the SCIROCCO project supported the regions in finding the knowledge in another participating region. Linkage and exchange occurred as the five KT activities organised by SCIROCCO included study visits to bring together the matched regions. All study visits included presentations from the transferring region. Almost all accommodated discussions among the regions based on comparisons of the self-assessments and some involved practical site visits. Finally, capacity building was facilitated by helping the regions to reflect on the possibility to transfer and adopt the learning about the GP or dimensions to local settings, by drawing up an action plan following the study visit. On the negotiating KT roles and responsibilities within the SCIROCCO project, the SCIROCCO local project members were part of the KT activities representing their regions and they invited several types of regional experts to be part of the KT: details on these types of experts are presented in the “knowledge” section. The knowledge mobilisation technique used by SCIROCCO can be categorised as “making connections between knowledge stakeholders and actors by establishing and brokering relationships.”
The participants provided feedback on the SCIROCCO study visits: a short overview of their feedback on these visits is presented here.
The use of the SCIROCCO tool as part of the knowledge transfer activity was considered according to respondents in case 1, 4 and 5 as supportive in focussing/structuring the discussion during the study visit between the regions. Two experts (in cases 1 and 2) suggested to edit or the need to add elements in addition to the tool. Some experts indicated experiencing issues with the language of the tool (in cases 2,4,5). Overall, participants observations covered the usefulness of study visits especially when they including a practical (real life) trip and/or presentations (in cases 1, 2,3); an appreciation of the collaboration and process involved (in cases 1 and 3) and of the role that the site visits played in mutual learning (in case 4). Organisationally, the length of time sometimes spent on a study visit or on its preparation could, in some cases, have been lengthened (in cases 1, 3,5).
Interventions to be used by receiving regions
During the study visits, there was time for the regions to discuss and clarify possible interventions to transfer the learning/knowledge to their local contexts. This means that the adopting regions discussed what changes/improvements were needed to enable the transfer of the GP or the improvement in an aspect of integrated care in their local environments. (This is also reflected in the knowledge needed by the regions as presented under “knowledge” section). Once back home, these processes were further clarified and written down in the regional action plans in the form of priority actions. An iterative process of selecting an intervention by the regions could not be observed. At the end of their action plans, the regions listed the actions proposed to enable conditions for the adoption of learning about GP or to enable conditions for improvement of innovation management in the local context. The actions included objectives, anticipated outcomes, and policy implications. The priority actions of the regions are categorised under the type of intervention to be used and are presented in Additional file 4.
The type of intervention categorised as capacity development was described by all the regions. It involved raising awareness among professionals or citizens when certain improvements are needed. It concerned e.g. engaging professionals or embedding/improving education and training. Strengthening/improving or positioning several roles as part of the intended change were also considered part of capacity development. Linkage, as intervention, emerged as engaging/involving several stakeholders or joining efforts among actors, and encouraging participation and partnership building in the intended change. Decision and implementation support were reflected when receiving regions referred to developing plans or strategies for implementation, extending or scaling-up initiatives, or embedding elements in regulations or policies. Information management came up in a few regions, indicating the collection of data/information on the change and publishing data.
The study team also looked whether the actions could be categorised under the “How mobilise knowledge?” concept. However, since the action plans refer to “proposed” actions and policy “implications”, the actual implementation of these plans was out of the scope of the project. As a result, it was not possible to categorise the “How mobilise knowledge?” concept for these actions.
Attention was paid to negotiating KT roles and responsibilities in the action plan, as the receiving regions were encouraged to think of who would be the (future) responsible actors for the priority actions. Six of the seven regions pointed out the responsible actors (see Additional file 4). Furthermore, the regions indicated policy implications for the intended actions, which can be considered as a form of integrating the intervention/priority action in their local context.
A range of ways of how the knowledge will be used could be retrieved from the action plans (see Additional file 4). The knowledge transferred during the twinning and coaching sessions is expected to be used mainly conceptually (i.e. to change opinions) and politically (i.e., to confirm or challenge policies) by the receiving regions. The receiving regions indicated policy implications for the proposed priority actions. Some regions indicated that they have a range of policies in place supporting the actions, while other regions were in the middle of developing them or opted for expressing the need for policies or strategies to support the action. The policy implications indicated are presented in Additional file 4 under “knowledge used politically.” These policy implications, including the request to think of the responsible actor(s) and anticipated duration of the action, can be considered as SCIROCCO’s way to support the receiving regions to think of sustaining and spreading knowledge.
The receiving regions also indicated the practicalities of knowledge use, as sometimes regions indicated during the assessment of knowledge, that the knowledge would not be feasible to transfer (see ‘’context’’ section). Practicalities are also considered in the action plans, where the adopting regions described the benefits and opportunities of the adoption of the GP or of improving a particular dimension in their region. These are summarised in Additional file 4.
The categories on “why knowledge is being mobilised”, reflected in these practicalities, are also presented in Additional file 4. The reasons for mobilising knowledge between the regions are found mainly to be a mix of “To (further) develop new policies, programmes and/or recommendations”, and “to change practices and behaviours.” Also, a few regions were planning to use the knowledge “To adopt/implement transferring regions ideas on practices and policies.