Organizational Learning for Evidence-Based Practice: A 'PAKT' for Success

This article presents a participatory action knowledge translation (PAKT) framework for creating a learning organization to implement and sustain evidence-based practice in health services. Developed and piloted in the home care sector in Ontario, Canada, the PAKT framework inextricably intertwines organizational, team and individual effort in a never-ending cyclical process of refining evidence-based practice, overcoming fragmented, hierarchical bureaucratic functioning by evolving as a learning organization. The process reflects Giddens' (1982, 1984, 1991) structuration theory. Participants combine bottom-up pull in decision-making, organizational leader push toward evidence-based practice and social interaction to create knowledge that integrates research evidence with tacit understanding and experience, thereby refining evidence-based practice. The PAKT approach makes organizational commitment to knowledge translation visible, undoes bureaucratized hierarchical relationships, fragmented work effort and entrenched work patterns, and creates an opportunity for all involved to question the status quo and move toward more evidence-based practice. Managers are positioned to influence the accommodation of externally imposed policies and system trends, as well as internal cultural and structural attributes, resource considerations, policies and priorities. The costs of knowledge translation are accounted as a 'need to have' part of service delivery, rather than 'added-on' staff education. The approach, however, requires time, effort and belief in service providers' ability and willingness to integrate their experiential and tacit knowledge and judgement with research evidence.