Abstract
Bridging the ‘know-do’ gap is not new but considerably greater attention is being focused on the issue as
governments and research funders seek to demonstrate value for money and impact on policy and practice.
Initiatives like the Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship are
therefore both timely and welcome. However, they confront major obstacles which, unless addressed, will result
in such schemes remaining the exception and having limited impact. Context is everything and as long as
universities and research funders privilege peer-reviewed journal papers and traditional measures of academic
performance and success, novel schemes seeking to break down barriers between researchers and end users are
likely to have limited appeal. Indeed, for some academics they risk being career limiting. The onus should be on
universities to welcome greater diversity and nurture and value a range of academic researchers with different
skills matched to the needs of applied health system research. One size does not fit all and adopting a horses
for courses approach would go a long way to solving the conundrum facing higher education institutions. At
the same time, researchers need to show greater humility and acknowledge that scientific evidence is only one
factor shaping policy and practice. To help overcome a risk of ideology and opinion triumphing over evidence,
attention should be devoted to encouraging citizens to get actively involved in research. Research funders also
need to give higher priority to how policy can be made to stick if the ‘know-do’ gap is to be closed.