Intended for healthcare professionals


The in-between world of knowledge brokering

BMJ 2007; 334 doi: (Published 18 January 2007) Cite this as: BMJ 2007;334:129
  1. Jonathan Lomas, chief executive officer
  1. 1Canadian Health Services Research Foundation
  1. jonathan.lomas{at}
  • Accepted 9 November 2006

“The mere knowledge of a fact is pale; but when you come to realize a fact, it takes on color. It is all the difference of hearing of a man being stabbed to the heart, and seeing it done.”

Mark Twain, A Connecticut Yankee, 1889

The ultimate aim of people engaged in health research is to get the health service's workforce, its employers, and its suppliers to have knowledge of facts (as represented by research results) and to use these facts in their practices, policies, and products. How well organised is research to achieve this aim? And how receptive and oriented are health services to this aim? The answers seem to be “not well organised” and “not very receptive.” The interpersonal connections needed to bridge this know-do gap are not yet in place.1 An emerging role therefore exists for knowledge brokers, supported by knowledge brokering resources and agencies, to fill the gap.

Disconnection between research and health services worlds

The old adage “form follows function” is poorly reflected in the production and use of health research. The research world favours grant acquisition and academic publication over knowledge synthesis and engagement with the health service.2 Researcher to researcher communication about the next study (“more research is needed”) is well organised and all too common;3 4 researcher to practitioner dialogue about implementing findings (“actionable messages”) is poorly organised and all too rare.5

Structures and incentives in the health system do not fare much better. The governance, organisation, and delivery of services reward consensus more than use of research; coordination with stakeholders generally trumps collaboration with researchers; and strategic positioning triumphs over decision making informed by research.6 Indeed, research is often seen as the opposite of action, not the antidote for ignorance.

Exceptions to these generalisations exist—the rise of research based guidance organisations such …

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