Do ‘wicked problems’ require ‘wicked knowledge exchange’?

The ATTP define knowledge exchange (KE) as ‘a collaborative, creative endeavour that translates knowledge and research into impact in society and the economy’. This relatively straightforward definition masks a system which is complex in practice.

‘Wicked’ is a concept borrowed by Keith Grint who conceptualises complex problems as ‘wicked’ and requiring multi-faceted approaches by multiple players. How might this complexity increase when knowledge exchange is applied to a sector-level, ‘wicked’ problem, such as healthy ageing? What are the implications for the way we conceptualise knowledge exchange?

Therapeutics that intervene in the biological pathways of ageing to treat, and potentially prevent, the onset of multiple age related conditions, marks a new and emerging direction for the development of innovative medicines. Research England acknowledged the role of knowledge exchange in addressing this problem, in the form of their support, via the Connecting Capability Fund, of UK SPINE. A key component of UK SPINE funding is the interaction of research and knowledge exchange to develop innovative research that has real-world impact. During the course of this research programme, best practices have been developed around how to go about the knowledge exchange to begin to unpick this complex challenge.

Accelerating drug discovery and development to treat multiple long term conditions (or multimorbidity) requires disruptive innovation which challenges the existing ecosystem in more ways than one. A number of shifts are needed, involving different parts of the system. These include, but are not limited to: the design of clinical trials and the identification of clinical endpoints; the definition of disease areas to enable regulatory approaches to approve drugs aimed at multiple conditions; and public dialogue about geroscience and the associated approach to therapeutics. All of these issues contribute to this being a sector-level problem, involving multiple stakeholder groups.

Using Keith Grint’s[1][2] conceptualisation of complex problems, we can view the challenge of developing therapeutics to improve healthspan by intervening in the ageing process, as ‘wicked’. A wicked challenge is complex, caused by many different environmental factors and existing in a system of high uncertainty.

Addressing a wicked problem requires high levels of collaboration and collective decision making, between a diverse set of stakeholders. Each of these groups may hold fundamentally different views on what the solution should be.  For instance, in healthy ageing research, there is debate about whether ageing should be defined as a disease to be treated, or if framing around multiple long term conditions is more helpful. Each of these perspectives comes from different priorities, standards, culture and experiences, and while none of these will be wrong, they must be brought out into open discourse, balancing the needs of academics, clinicians, the public, commercial organisations and policy makers.

One of the critical phases in managing challenges of this type is to ask the right questions, rather than giving the right answers and to encourage people to work together on possible solutions. The role of asking questions and bringing together individuals to consider and discuss this is clearly in the remit of knowledge exchange practitioners. Therefore we can pose the questions - do ‘wicked problems’ require ‘wicked KE’?

It’s clear that the multilateral nature of the problem requires a multilateral approach to knowledge exchange. It requires a strategic effort in bringing together a range of organisations, disciplines, sectors, and perspectives, to challenge, discuss and influence each other.

Conceptualising cross-disciplinary and cross-sectoral collaboration as boundary spanning activity, Michael Hopkins[3] highlights the challenges associated with these interactions, including differences in culture, expectations, practices and difficulties in accessing funding to support such work.

Ways in which these challenges to boundary spanning collaborations can be facilitated include in the pattern for individuals to have multiple roles spanning sectors. For instance, an individual might be an academic researcher but also be involved in entrepreneurial activities; or have a consultant role in an academic institution, but be from an industrial background. There is an important role for professionals in support functions that have cross-sector experience, e.g. individuals trained as scientists with regulatory or policy experience, who can ‘cross-translate’ between seemingly opposing views brought in by different stakeholder groups. In a challenge as wicked as ageing, each professional individual will also have a personal interest or experience, which will bring differing priorities and drivers to tackle the problem.

In addition, work to make boundaries more porous, by building familiarity, understanding, trust and using shared standards and common language also act to facilitate the interactions necessary to address wicked problems. The role of ‘wicked KE’ to solve complex/’wicked’ problems, represents a shift from simpler transactional KE where fewer parties are needed to address specific problems which may be fairly linear in nature, as opposed to challenge-led issues. Wicked KE is challenge-led and proactive, rather than opportunistic and reactive. It not only requires a broader range of stakeholders but also different methods, involving posing questions, rather than coming up with answers, and working towards consensus-building to set the scene for progress.

Knowledge exchange activities are commonly within the remit of university support services and academics, with the aim to drive the economic and societal benefit from research activities. In areas where there is a specific mission oriented challenge, knowledge exchange becomes a broader and more systemic consideration. With the focus of developing therapeutics to increase healthspan, the UK SPINE network and programme of work has demonstrated the need for multiple stakeholders to come together, facilitated by a network of knowledge exchange professionals, to facilitate discussion about the diverse set of issues that need to be addressed.

What does wicked KE look like? Lessons learned from UK SPINE have emphasised the role of organising dedicated events and conferences, bringing together diverse groups of stakeholders and providing a platform to facilitate discussion involving different ideas and perspectives. UK SPINE have done this regularly, in particular incorporating an annual conference into the programme of events. Other approaches that demonstrate ‘wicked KE’ include having a cohesive message and communications plan, across the research programme, giving a public image to the network and its mission.

UK SPINE

UK SPINE Knowledge Exchange aims to improve healthspan (healthy life-years) for patients with multiple age-related conditions. Their mission is to accelerate the discovery, development and testing of new drugs, by better understanding the underlying biology which drives these conditions, and work with patients and the public to consider the regulatory needs for such treatment. This network, driven by six partner institutions throughout the UK, is committed to open sharing of knowledge, research and understanding of age-related illness.

The UK SPINE is funded by Research England’s Connecting Capability Fund (CCF), and places knowledge exchange at the centre of the network. It provides a platform for the geroscience community to share and exchange expertise, perspectives and experience.

The name ‘UK SPINE’ draws on the geographic spread of the founding partner hubs (Universities of Oxford, Dundee, and Birmingham, the Medicines Discovery Catapult at Alderley Park, and the Francis Crick Institute in London), which forms a spine, connecting the locations across the UK.

Philippa Crane (University of Oxford), Stuart Wilkinson (University of Oxford), Harriet Teare (University of Oxford), Jennie Shorley (Manchester Metropolitan University)

[1] Leadership challenges in turbulent times: 1.3 Step 3: Types of leadership challenges: tame, wicked and critical challenges - OpenLearn - Open University

[2] Critical, Tame and Wicked Problems | Art of change making (leadershipcentre.org.uk)

[3] Presented at the UK SPINE annual conference 2022