Feedback loops as a core driver: rethinking organizational readiness for knowledge translation in Iranian medical universities

Bridging the gap between research evidence and healthcare decision-making, knowledge translation (KT) is a critical process. However, despite advances in research production, many universities in low- and middle-income countries face significant challenges in implementing KT due to a lack of organizational readiness. While existing frameworks often position monitoring as a subsequent implementation step, this study investigates whether feedback loops and oversight mechanisms are core drivers of organizational readiness at Iran's leading medical universities. Employing a qualitative design, this study constitutes the second phase of a sequential explanatory mixed-method project. We used inductive content analysis following the Elo and Kyngäs (J Adv Nurs 62(1):107–115, 2008) framework. Twenty-one experts, including faculty members, senior administrators, and KT specialists, were recruited via snowball sampling from 11 Type I medical universities. Semistructured interviews (45–90 min each) were conducted between February and August 2023. Data were analysed using open coding, categorization, and abstraction using ATLAS.ti. Rigor was ensured through member checking, peer debriefing, and audit trails. Inter-coder reliability was assessed using Cohen's Kappa ( κ = 0.82). The study was conducted in accordance with the Declaration of Helsinki. Analysis identified five overarching dimensions crucial for organizational KT readiness: (1) organizational culture and research climate; (2) human resource development and training; (3) knowledge production and sharing; (4) evidence-based policy and strategy; and (5) monitoring and evaluation mechanisms. Notably, “feedback loops” have emerged as the core driver enabling, sustaining, and interconnecting the other four dimensions. Analysis of interrelationships revealed that feedback mechanisms serve as the “nervous system” of KT readiness, creating organizational capacity for learning and adaptation. Key challenges included siloed communication, limited incentives for the use of evidence, lack of managerial commitment, insufficient capacity-building structures, and weak research-practice linkages. Enhancing organizational readiness for KT in Iranian medical universities requires a multifaceted approach that strengthens cultural, structural, and leadership capacities. Establishing structured feedback mechanisms must be viewed as the core driver—not an afterthought—for sustainable KT implementation. However, these findings identify enabling conditions for KT rather than providing direct evidence of improved health outcomes. By addressing these readiness factors, medical universities can enhance their role in evidence-informed policy and practice.