Evidence networks: lessons from the redwood tree

‘We make a living by what we get, but we make a life by what we give.’
Winston Churchill
 

In the Muir Woods of Northern California, nature is giving humanity a very crucial lesson: that our real strength is in our willingness to support each other. There is wisdom in understanding this simple universal principle that in giving, we receive. 
 

You would assume that a 100-metre-tall tree that was thousands of years old would need deep roots, but that is not the case at all with the Sequoia sempervirens (redwood tree). Their roots are very shallow, often only 1.5 metres deep. But they make up for it in width, sometimes extending up to 30 metres from the trunk. They intertwine (and sometimes merge) with other redwoods to create an underground network of powerful connections. This is why they thrive in thick groves. Redwoods do not survive alone, ever. They form ‘tribes’ or communities, with their entire system relying on their rooted connections. Each tree is held firm by the strength of the whole community.
 

The redwood analogy tells us that surviving our external environment and sustaining growth only works if you support each other. Like the interlocking root system of redwoods, the success of the global evidence-based healthcare agenda relies on individuals and organisations working together within a functioning evidence ecosystem.
 

When I first heard this analogy, it occurred to me that these rooted networks were much like the JBI Collaboration (JBIC). JBI’s global collaborative evidence network has grown from seven partners at inception to 81 partners across 40 countries in 2022, and it has done this by harnessing the diverse strength of its members and leveraging shared resources and expertise to tackle large and complex global healthcare problems. The JBIC benefits and connects members in ever-changing, innovative ways to empower them to work together to communicate and share knowledge.
 

There have been significant milestones, challenges, successes and lessons learned by JBI and the JBIC in its growth over the past 25 years. Growth has meant that decision-making and operational and governance frameworks have changed considerably, with the transition not always being optimal or able to meet different parties’ needs. There have been longstanding equity and diversity challenges with geographical, socio-economic and language barriers, as well as facilitators to collaboration and participation, meeting key performance indicators, and accessing or receiving benefits. Both JBI and the JBIC have had to navigate issues to do with the financial sustainability of growth and participation, and how to meaningfully support partners and maintain relationships, as well as the social capital required for a strong collaborative evidence network during a pandemic.
 

In this blog, I highlight four ways evidence networks can foster strength through collaboration like a redwood tree, drawing on examples from the JBIC.
 

1.    Health-check existing partnerships
Partnerships change over time: much is taken for granted or not discussed; initial strategies may not be revisited; and partners may have very different perspectives on the partnership. It is important to build in transparent and accountable monitoring, evaluation and feedback mechanisms that enable partners to communicate openly about the partnership itself. The JBIC does this through:

• bi-annual business meetings with dedicated Q&A sessions on the JBIC operational framework, with concrete action items for concerns and suggestions, followed by anonymous surveys;
• remote annual drop-in sessions with JBI Executive Director;
• implementing significant governance changes (such as changes to key membership/activity requirements, decision-making frameworks, funding or resource arrangements), which are co-created with members and piloted (or soft-launched); and
• pausing, when required, to re-evaluate and reflect on current challenges and opportunities (i.e. JBI paused new JBIC applications for 12 months in 2015 to address internal governance and sustainability challenges through a stakeholder analysis, and in 2020 to address external/remote support structures for the network during COVID-19).

In the same way that through the wood wide web of linking roots, trees let their neighbours know when they are in distress and pass along information about unwelcome threats, it is important that partners openly communicate about the health of their partnership.

 

2.    Mentor new partners
Mature redwood trees cooperate with and assist other smaller trees in their vicinity to transfer water, carbon and other resources. In a 2016 TED Talk, forest ecologist Suzanne Simard described this as veteran trees sending messages of wisdom on to the next generation of seedlings.
 

Within the JBIC, this is best embodied by the JBIC mentorship program. Mentorship is a formal activity within the JBIC Matrix Framework and is integral to collectively building support systems; creating learning and development opportunities for new entities; improving efficiency and productivity; and passing on corporate knowledge, leadership (see Figure 1) and feedback from annual mentorship surveys.

 
Fig 1. Strengths of mentoring partnerships reported by mentors and mentees in the JBIC Annual Review 2019
 

‘Our mentor has guided us in how to manage our JBI Affiliated Group effectively, including ideas and practices to increase systematic review capacity at our institution and support with running our Comprehensive Systematic Review Training Program.’
JBIC mentee, 2021
 

‘This mentoring partnership has been very beneficial for both sides and opened more opportunities for collaboration in both synthesis and implementation activities than we imagined in the beginning. It is a good support program that JBI has created, especially between high and low-income countries’
JBIC mentee, 2018
 

Within the JBIC mentorship program, roots continue to be intertwined to form strong, unbreakable bonds.

 

3.    Adapt and focus on equity
Over the past 25 years, JBI and the JBIC have learned the importance of remaining agile and proactively adapting operating, governance and administrative frameworks, policies and procedures to meet the changing needs of members and the external landscape (i.e. during COVID-19).
 

‘Over the past year, we have learned that we can support one another despite what is going on [COVID-19]. We have worked together to complete our systematic reviews and to conduct our clinical audits and have supported each other by being flexible and understanding.’
JBIC Clinical Partnership Engagement Survey, 2021
 

Many changes have come from the ‘health-checking’ mechanisms outlined above. For example, in 2015, the JBIC co-developed the JBIC Matrix Framework in response to the JBI Strategic Business Review that highlighted the inequities of the former operational framework (i.e. the number of activities that were not recognised by JBI, the inequitable criteria and expected output of different partner types [synthesis, transfer, translation], and the criteria for activity funding).
 

A follow-up analysis of JBIC activity outputs and funding, stratified by the World Bank income scale, language and region in 2019, demonstrated that while activity output and funding had increased across the JBIC, partners receiving funding were still largely from high-income, English-speaking countries. Over the past two years, JBI and the JBIC have co-created a new funding model, the JBIC Brighter Futures Grant Program, which aims to provide opportunities for internal and external collaboration, capacity building in low- and middle-income countries, and support for multilingual activities within and across the JBIC to build a more equitable and sustainable network and contribute to a brighter future for all.
 

Like redwoods adapting to their conditions by developing thick bark with tannin and deep grooves to withstand fire, or lateral roots to withstand strong winds, so too do evidence networks need to take proactive, concrete steps to adapt to internal and external change. This includes being open to understanding systemic imbalances within the network and working closely with network members on problem-solving.
 

4.    Think community
Community building enables networks to build shared visions among diverse stakeholders, and cohesive, supportive relationships that encourage participation by increasing transparency and trust. However, actively working to maintain relationships, including support structures, resources and processes to build social capital amongst an evidence network, are crucial to building a community that is able to reach its full potential.
 

The vitality, respect and trust upon which the JBIC is grounded is no accident. The relationships between members of the JBIC (both with each other and with JBI) are multifaceted, ranging from structured, formal relationships with goals and objectives (e.g. collaboration agreements, mentorship, clinical partnerships), to social relationships cultivated over years of shared experiences, with the JBIC often referred to as a ‘global family’.
 

Knowledge development, dissemination and exchange are also key to the function and purpose of evidence communities. This is fostered within and across the JBIC in a multitude of ways, including through synthesis and implementation training courses; participation in 10+ JBI methodology groups; via JBIC regional symposia and meetings; JBI webinars, workshops, colloquia and conferences; and formal JBIC Matrix Activities, including mentorship and clinical partnership engagement (to name a few!). Ultimately, strong evidence networks compensate for resource constraints by fostering collaboration and shared innovation:

‘Knowledge is to be shared - this means no-one really 'owns' it. We are all working for the improvement of healthcare - and we can make a huge difference by working together. JBIC meetings are a prime example- I always walk away feeling inspired and energised, with new EBP tools, perspectives and resources to implement into our work.’
JBIC meeting participant 2019
 

Conclusion
Within a global evidence ecosystem, collaborative evidence networks often fill the gaps that can’t be addressed by conventional systems and structures, because they are creative, innovative places where resources are shared for the common good, and are useful for rapid learning and development and amplifying members’ effectiveness. Participation in these networks enables members to contribute to and draw on collective wisdom and expertise and apply learning in new geographical settings.
 

World Evidence-Based Healthcare Day talks about the importance of human connection, and I firmly believe that, like redwoods, we find strength in our global evidence community through enduring, interconnected evidence networks.
 

Disclaimer
The author of this blog is a World EBHC Day Steering Committee Member.