Knowledge-to-Action Framework

The Knowledge-to-Action (KTA) framework was originally developed in 2006 by Dr. Ian Graham and colleagues and is based on more than 30 change theories. It provides a structured approach for making change, including a seven-phase action cycle that moves knowledge into practice. The KTA framework has two main parts: The knowledge creation process and the action cycle.

kta framework with logos

The knowledge creation process

The creation funnel:

The knowledge creation process is what researchers and guideline developers use to create a knowledge product or tool, such as an RNAO best practice guideline, a decision aid or a clinical pathway. This process is shown in the centre of the diagram. It looks like a funnel because it gathers all the knowledge and research available on a specific topic, summarizes the knowledge, and creates a tool that can be used to improve health care.

knowledge creation big

The action cycle

The action cycle includes the following phases:

The action cycle includes the following phases:

  1. Identify the problem, determine the know/do gap, and identify, review, select knowledge 
  2. Adapt knowledge to local context
  3. Assess barriers/facilitators to knowledge use
  4. Select, tailor, implement interventions 
  5. Monitor knowledge use
  6. Evaluate outcomes
  7. Sustain knowledge use

The seven phases of the KTA action cycle don’t necessarily need to be completed in order, but all need to be addressed. Sometimes, you can go back and forth from one phase to another or work on phases simultaneously. 

action cycle big


KTA Framework - By Journey: Planning for change

Get started with change by integrating three action cycle phases: “Identify the problem”, “Adapt to local context” and “Assess barriers and facilitators to knowledge use”.     

Knowledge-to-Action Framework

Identifying the problem to achieve excellence in care

Cardioinfantil Foundation of Cardiology Institute is an acute care facility with a goal of achieving excellence in care in the prioritized areas of fall prevention and wound care. 

Bogotá, Colombia
Fundacion Cardioinfantil
Knowledge-to-Action Framework

Adapting BPG recommendations to a public health context

Toronto Public Health – a Best Practice Spotlight Organization® (BPSO®) - has adapted several RNAO best practice guidelines (BPGs) to align with a population health approach. 

Toronto Public Health
Toronto public health logo
Knowledge-to-Action Framework

Facilitating an evidence-based culture

Unity Health Toronto - St. Michael’s Hospital, a Best Practice Spotlight Organization® (BPSO®) has embedded evidence-based practices into its culture and daily work processes as part of its corporate strategy. 

Unity Health Toronto - St. Michael's Hospital
Unity Health Toronto

KTA Framework - By Journey: Making change happen

Achieve evidence uptake through the integration of the KTA action cycle phases “Select, tailor implement interventions” and “Monitor knowledge use”

Knowledge-to-Action Framework

Implementing effective interventions for drug and alcohol use using SBIRT

Evidence-based interventions to support the development of a screening, brief intervention and referral to treatment (SBIRT) for persons who use drugs and alcohol. 

Implementing effective interventions for drug and alcohol use using SBIRT
Knowledge-to-Action Framework

Leveraging innovative quality monitoring

Humber River Hospital is an acute care facility that has used continuous monitoring to determine the impact of BPG implementation and staff performance. 

Humber River Hospital
Humber River Hospital

KTA Framework - By Journey: Sustaining change 

Sustain best practices through knowledge and strategies to routinize the change by integrating the action cycle phases “Evaluate outcomes” and “Sustain knowledge use”.

Knowledge-to-Action Framework

Evaluating the impact of implementing the Person- and Family-Centred Care BPG

Spectrum Health Care, a Best Practice Spotlight Organization® (BPSO®) and home health organization, evaluated care outcomes after implementing the Person- and Family-Centred best practice guideline (BPG). 

Spectrum Health Care
Spectrum Health Care
Knowledge-to-Action Framework

Sustaining best practices across multiple sites

The Region of Peel, a Best Practice Spotlight Organization® (BPSO®), has sustained the implementation of the Assessment and Management of Pain best practice guideline (BPG) for almost a decade. 

Region of Peel
Region of Peel

Implementation tools

Downloadable tips and tools to give you and your change team the know-how to effectively sustain a practice change including valid and reliable tools, and implementation tools (checklists, resource pages and worksheets).

Case Studies

Demonstrates usage of components of one of the frameworks or the journey process

Implementation Tools

Checklists, Worksheets, and Resources to aid discussions, decision-making and planning for change    

KTA Tools

Tools to aid discussions, decision-making and planning for change