Introduction: Dave Kindig and Steph Robert

John LavisJohn Lavis

The Health & Society Scholars program was a fellowship sponsored by the Robert Wood Johnson Foundation at six university sites around the country. The program’s goal was to train leaders in the field of interdisciplinary population health research. Each year, postdoctoral or early faculty scholars came together from diverse disciplines such as sociology, public health, psychology, economics, and biology to investigate the multiple determinants of health and to explore strategies to improve health at the population level. One of the sites that hosted the program was the University of Wisconsin at Madison. The program’s site directors were Dave Kindig (Emeritus Professor of Population Health Sciences, Emeritus Vice-Chancellor for Health Sciences), John Mullahy (Professor of Population Health Sciences and Research Associate at the National Bureau of Economic Research), and Stephanie Robert (Director of the School of Social Work). Here, Kindig and Robert discuss UW-Madison’s knowledge exchange program, a unique feature of their site in which scholars teamed up with nonacademic partners to tackle important health problems in the community.

How did the knowledge exchange program start?

Robert: We and the Foundation wanted the scholars to gain experience with policy and practice, in addition to research. In particular, we wanted them to be able to develop questions of interest to the field. Dave was really the early driver.

Kindig: My whole career has been back and forth between public and private management and academic work, so I’ve been sensitive to how evidence and policy are related from the beginning. I’m fairly confident that one of the reasons why we were selected as a site by the Foundation was because our focus on knowledge exchange was strong and different from the other institutions that were invited to apply.

Knowledge Exchange:
a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to strengthen the health system.

How did the program work?

Kindig: Originally we proposed that each scholar would have two mentors, one academic mentor and one practice mentor. But we quickly realized that this wouldn’t work for everyone. Many scholars were willing to learn about knowledge exchange, but not make it a major focus of their precious 2 years. So we tailored the knowledge exchange experience to each individual, taking cues from scholars about what works for them in the course of their 2-year experience.

Robert: We learned pretty quickly that it was unrealistic to expect all of the scholars to be equally engaged in knowledge exchange in a very deep way. We pulled back very early on from having everybody have a mentor in knowledge exchange, and instead we included content in our seminars on knowledge exchange. We looked at how you develop a relationship with folks, how policymakers use evidence, if at all, and how you develop relationships with them so they can take up your research more quickly.

The strongest approach is one in which organizations have questions of policy or managerial importance and often have data, but need academic partners to analyze and interpret the data. 

Kindig: In our seminar, we have three or four sessions a year where we do readings or bring in outside experts like John Lavis [an expert on the use of research evidence in health policymaking from McMaster University]. We use John Lavis’s knowledge exchange model, featuring push, pull, and exchange components; the third and strongest approach is one in which organizations have questions of policy or managerial importance and often have data, but need academic partners to analyze and interpret the data.

We would often also bring in people from Wisconsin, policymakers in the public or private sector. We’d have the secretary of the State Health Department or the Hospital Association and ask, “What have been your interactions with researchers in the past? What’s been helpful, what’s not been helpful? How do we make that relationship a better one?”

In the last several years we’ve required everybody to do one small knowledge exchange project, as little as it might be, like writing an op-ed or something more substantial in the “exchange relationship” mode. At the beginning of the semester we ask the scholars what their goals are for the year and how their knowledge exchange project fits in.

Robert: I’m so glad we moved to requiring a knowledge exchange project. Being more explicit about it, really forcing people to commit to a particular thing rather than keeping it loose—I think it was good. Because we allow for a whole range of what the projects could be, I think it’s been fine. Not only fine, but excellent. I wish we’d done that a little bit earlier. We have helped scholars come up with a knowledge exchange project that is fun for them but pushes them a little bit.

How did you help scholars develop projects?

Policy is not just public policy like government, but private sector policy as well, nonprofits or hospitals or businesses. Knowledge exchange has a broad set of policy targets that anybody can work with depending on the nature of their work.

Kindig: Sometimes it gets a little intimidating, particularly for new scholars who think, “Oh no, they expect me to go out and change the world or interact with legislators or CEOs.” Occasionally that happens, but you can learn knowledge exchange in many ways. Policy is not just public policy like government—we always emphasize that—but it’s private sector policy as well, nonprofits or hospitals or businesses. Knowledge exchange has a broad set of policy targets that anybody can work with depending on the nature of their work.

Robert: There are only certain types of relationships and projects that scholars can do. Some projects would take too much relationship building for anybody to do during the postdoctoral time. We tried to be mindful of that as we set people up with different projects or heard their ideas and determined whether they were feasible or not.

Kindig: We helped them connect with partners. We would say, “We know the people in the Medicaid office or at United Way, no problem, but let us know if you’d rather do something else. We’ll find those people for you.”

Karen Timberlake, the current director of our Population Health Institute, is a Harvard-trained lawyer and the former secretary of our State Health Department. She has become the knowledge exchange mentor for the program. She organizes one or two of the introductory academic knowledge exchange sessions for us and then meets with everybody individually. She is extremely well connected with government, nonprofit, and private sector leaders, so through her, the scholars are able to connect with the leaders of whatever sector or organization they want to work with.

Our hope was that scholars would go beyond what their previous training was to actually think about how to use the science they produced in new ways.

Robert: Our hope was that scholars would go beyond what their previous training was to actually think about how to use the science they produced in new ways. Some of them took on the task more deeply than others, some of them spending time at the state and doing other projects that were deep in the knowledge exchange dimension. And others were at least exposed to thinking about knowledge exchange.

Kindig: We want to focus not only on the scholars for whom it was a major part of their experience but also on those who just wanted to learn about it and dip their toes into it in an introductory way. In the stories that follow, you will see how it became a significant part of their work as well, though secondary to traditional scholarship.