The in-between world of knowledge brokering

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Abstract
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 as the National Institute for Health and Clinical Excellence in the United Kingdom, the development of data driven practice organisations such as the Veterans Administration Health System in the United States, or the creation of centralised knowledge transfer and brokerage for the Scottish Executive's health department.7 But the general picture is one of poorly connected worlds lacking knowledge of (and often respect for) each other. The inner workings, implicit rules, cultures, and realities that dominate the day to day lives of people working in the health system and those doing research on that system remain, for the most part, mysteries to people on the other side.

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