ABSTRACT
As much as relationships have been developed across nations, and an international “transition management” community may be observed, it must be acknowledged that transition management is largely a European phenomenon. At the same time, there is certainly no shortage of international experiments in the governance and management of system innovation in other countries outside the European Union, including those that have system-level change as a goal. In this chapter, we discuss Canada’s Executive Training for Research Application (EXTRA) program, which can in some ways be seen as a Transition Program avant la lettre. This program is an effort initiated by the Canadian government to build capacity for the creation and explicit application of knowledge to innovate the Canadian health system, in the conviction that this contributes to a more sustainable health system. The system currently has limited capacity to apply, contextualize, generate and translate evidence that may be used by practitioners in their settings. The system innovation, the transition, implies a broader and contextualized use of “evidence” by healthcare professionals and leaders, which in a reflexive manner and a sustained fashion contributes to improving the health system performance – “a culture of evidence-informed decision-making” (EIDM), in the EXTRA parlance. In contrast to evidence-based medicine (EBM), which has often been criticized for creating obstacles for professionals and neglecting the need for contextualization (Clements, 2004; Brown et al., 2005; Pawson, 2002a), the nature of evidence that is taken into account in EIDM emphasizes the generation (and tailoring) of evidence in deliberative interaction among a variety of actors in their work settings (e.g. hospitals), including both research knowledge (e.g. RCTs) and informal, experiential and tacit knowledge. EIDM focuses on processes for the consideration of scientific forms of evidence within an organizational or systems context, as well as building capacity for non-clinical decision-makers (including policy-makers) to know when and how to include and contextualize research in their own decision-making (Clements, 2004; Culyer and Lomas, 2006). The innovation presented and discussed in this chapter thus entails the transformation of 209intervention development and implementation in health organizations, challenging both the “trial-and-error” approach of many health practices as well as the “evidence-based medicine” (EBM) approach of the knowledge production system.
