Getting Knowledge into Action to

Improve Healthcare Quality

Progress Update on National Review of Knowledge Services and the Librarian Role

11th November 2011

WebEx aims

1. Confirm shared understanding of Knowledge into Action Review aims and methods.

2. Update on progress to date.3. Explore key outputs and consider implications

for future service:– Knowledge into Action model– Evidence base - what works in getting knowledge into

action.– Survey of current status of knowledge services– Workstrands – physical resources, evidence search

and synthesis, social use of knowledge.– Test of change projects.

Meeting guide

• Mute phones when not speaking• One person speaks at a time• Give name when speak• Use of Chat – demo

“The NHS is….. not good at capturing, using and sharing information. Lots of data, a lot less information and even less knowledge, and that's bad for patients and their families, it's bad for clinicians, bad for managers, bad for regulators and bad for policy-makers.”

Ann Abraham, Parliamentary and Health Service Ombudsman, reporting on Mid-Staffordshire Inquiry.

• 12 million + resources

• 30-40% of UK healthcare NOT based on available scientific evidence (Grol and Grimshaw, 2003)

From Accessing Information to Applying Knowledge

Define a new knowledge management model and implementation plan which builds on local and international best practice to:

* Help practitioners to apply knowledge to practice. This goes beyond the current focus on organising and accessing knowledge.

* Align use of knowledge with quality improvement, to deliver measurable outcomes in terms of safe, effective, person-centred care, and efficient use of resource.

Aims of Knowledge into Action Review

How? Process and Methods

1) Review available models and the evidence base and for what works in getting knowledge into action.

2) Gap analysis – compare with current state

3) Tests of change aligned with Quality Outcomes

4) Stakeholder engagement, strategic sponsorship.

5) Deliver model and implementation plan for consultation end of March 2012

What Works?

- in getting knowledge into action to improve quality of care?

Knowledge into Action Model(Draft) AIM

ExampleKnow-what:A mental health team leader identifies from readmissions data and complaints a

need to improve cross-agency communication in care of schizophrenia patients on discharge from hospital. He asks the knowledge manager to carry out a systematic search of the research evidence on interventions to improve cross-agency communication in care of schizophrenia patients discharged from hospital.

Know-how and know-who:After the literature search, the knowledge manager identifies published case

studies illustrating such communication in other services, in Scotland and other parts of the UK. She also captures key points from a few interviews with exemplars of good practice in this area. She works with the mental health team leader to organise a WebEx peer assist event to share expertise and experience from leaders in this area.

The knowledge manager works with the mental health team leader to create a checklist with prompts and reminders for use by NHS, voluntary agency and social services staff (actionable knowledge).

Outcomes:The mental health team agree the changes they will make and ask the

knowledge manager to carry out a search of the evidence around effective measures which can be used to assess impact on care process and outcomes.

Discussion

1. What do the model and example mean to you?

2. Will they help you understand how new knowledge management approaches help to improve frontline practice?

3. How could the model be improved?

Evidence Base

What approaches help to get knowledge into action to improve quality of care?

• Inquiry and synthesis• Knowledge uptake interventions• Social use of knowledge• Building organisational culture and capacity

Examples (1)

Inquiry and synthesis

• Problem definition• Expert searches• Rapid evidence reviews• Capture tacit/experiential knowledge – case

studies, stories, social networking• Partner with information analysts to combined

data and research evidence.

Examples (2)

Knowledge uptake interventionsSpecific evidence expressed as calls to action; designed for

use at point of clinical need.

• Pathways• Evidence bundles• Checklists• Prompts and reminders• Decision aids/decision support • Mobile apps• “Actionable knowledge”

Examples (3)

Social use of knowledge• Communities of practice• One to one knowledge transfer (clinical

detailing)• Champions, opinion leaders• Interactive education• Social network mapping• Social networking and social media tools

Examples (4)

Organisational capacity and capability

• Workforce knowledge management skills• Knowledge management roles• Defined knowledge management strategy

and policy

Discussion

1. Which of these approaches are you already using?

2. Can you see your team adopting some new approaches in future?

3. Which approaches are particularly challenging?

Current state of NHS Scotland Knowledge Services

Survey Summer 2011

Our resources

Library staff are NHS Scotland’s chief knowledge asset

• 116 library staff in total

• 84 qualified library staff

KS Costs/Budget

£0.00£500,000.00

£1,000,000.00

£1,500,000.00£2,000,000.00£2,500,000.00£3,000,000.00

£3,500,000.00£4,000,000.00

1

Staff

Journals

Books

ILL

SLA

Workforce distribution

0.00%

0.02%

0.04%

0.06%

0.08%

0.10%

0.12%

Library staff as percentage of workforce in each NHS Board

Inconsistency and inequity across NHS Scotland

Literature searches Dec 2010-May 2011

Board Total Appraisal

NHS A&A 242 No

NHS Borders 71 No

NHS D&G - -

NHS Fife 34 No

NHS Forth Valley - -

NHS GG&C 322 Yes

NHS GG&C PH 24 -

NHS Highland 94 No

NHS Lanarkshire 136 No

NHS Lothian 19 No

NHS Orkney - -

NHS Shetland - -

NHS Tayside 18 No

Board Total Appraisal

NHS Western Isles 6 No

NES - -

NHS Health Scot. 83 No

HM library 1200 No

HPS Library - -

Central legal Office - -

ISD Library 0 Yes

Waiting Times cen - -

HIS library 85 ?

NHS24 28 No

Ambulance service - -

State Hospital 42 No

Interpretation

• Variation• Inconsistency • Inequity• Likelihood of Duplication

Types of search

Basic search Mediated search Advanced search0

2

4

6

8

10

12

Often Sometimes Seldom Never

Advanced searches are common.

Purpose of searchA

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CP

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Ca

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Dir

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atie

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Gu

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/pro

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tan

da

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lop

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Imp

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alth

Le

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ica

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nt

Se

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pro

ve

me

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rev

iew

Org

an

isa

tion

al d

ev

elo

pm

en

t

0

2

4

6

8

10

Often Sometimes Seldom Never

CPD is most common reason for searches, followed by direct patient care and service improvement

Managing new types of knowledge

Clinical Digest

Managerial Digest

Evidence or Care Bundle

Clinical Guideline

Clinical Pathway

Best practice statements

Often 1 1 0 0 0 0

Sometimes 0 0 0 0 0 0

Seldom 3 3 1 2 1 1

Never 11 12 15 14 15 15

 Performance and

outcomes

Audits/Survey data

Interviews / focus groups

Storytelling sessions

Discussion/ forums Wikis/blogs

Often 0 0 1 0 1 0

Sometimes 0 0 0 0 0 1

Seldom 1 1 1 2 2 1

Never 15 15 15 15 14 15

Evidence synthesis/creating actionable knowledge

Managing data and tacit knowledge

Small beginnings – opportunity for growth

Training sessions

Summary Table Dec Jan Feb Mar April May Total

Literature Search Sessions 55 73 114 93 92 95 522

Literature Search Attendees 92 177 196 136 119 141 861

Critical Appraisal Sessions 1 1 1 0 1 1 5

Critical Appraisl Attendees 13 14 12 0 13 10 62

Synthesis Session 0 0 0 0 0 0 0

Synthesis Attendees 0 0 0 0 0 0 0

Impact? Duplication? Training individuals primarily.

Discussion

1. Where are the main strengths of knowledge services at present?

2. Where are the gaps, and how can we address these to have highest impact?

Reports from Review Workstrands

Physical Library Resource

Evidence Search and Synthesis

Social Use of Knowledge

Knowledge into Action Review

The Physical Resource Working Group

The Physical Resource Working Group

• To build upon the work done via the Library questionnaire, and the ‘Knowledge Space’ model developed and presented on the 12th of August

• Membership by invitation – representation sought from a variety of boards (territorial and national) as well as partners: SHINe and HE.

• Short and intense working group (Nov –Jan)

Aims of the GroupThere are 4 aims which have been prioritised as follows:

Priority 1: To develop a single Document Delivery Service model for NHS Scotland

Priority 2: To recommend a physical archive solution for NHS Scotland

Priority 3: To develop the ‘Knowledge Space’ model and make recommendations to NHS to put it into action

Priority 4: To consider the long term future of the print book, and make short term efficiency recommendations

Key Dates so far

• 14th November – the group convenes to discuss remit, priorities, outcomes, tasks, timescales, and responsibilities

• 12th December – the group convenes for Lean methodology training and application to the physical resource

• 24th January – the group convenes to discuss the outcomes and recommendations

Search and Synthesis Working Group

Remit

• To propose models for search and synthesis service delivery across NHS Scotland based on evidence, stakeholder consultation, cost-benefit analysis and consensus from the Knowledge Services Community.

Key Tasks

• Summarise the collective evidence from literature, current providers and demonstrator sites within the K2A review regarding models of delivery, service procedures and impact of search and synthesis services

• Define potential service models for delivery of search and synthesis services in the light of the evidence

• Co-ordinate and deliver a workshop to appraise and further develop these models

• Present a final report recommending approaches to search and synthesis services based on the summarised evidence and workshop feedback.

Membership

• Confirmed to date:• Margaret Theaker, Ayrshire and Arran• Seona Hamilton and Kirsty Coltart, GGC• Jenny Harbour and Alison Winning,

Healthcare Improvement Scotland

Timelines

• November:– Lit Review – Initial Meeting of group

• December:– Perform experience and practice interviews – Collate demonstrator data– Summarise Findings– Model planning – Workshop Planning

• January:– Workshop Delivery

• February:– Final report

Social Use of KnowledgeWorking Group

Scope

The group will • review and prioritise a list tools• define approaches for implementing the

top priority tools • gather feedback• identify challenges and opportunities for

librarians and knowledge managers to support the social use of knowledge

Plan

• Identify more volunteers to join the group• To conduct two online meetings using WebEx

with interested volunteers – to investigate the challenges and opportunities for

librarians and knowledge managers – Discuss and propose case studies and examples of

use

• Organise a workshop or online session for librarians to discuss findings

Test of Change Projects

Aims of test of change projects

• Engagement in K2A developments• Understanding of new K2A approaches• Building capability – learning by doing• Collaborative working

Overview

• 23 projects• 6 special boards, including State Hospital• 5 territorial boards• K2A areas:

– Expert search– Create and use knowledge uptake

interventions/actionable knowledge– decision support, pathways, bundles etc.

– Close interaction with clinical and programme teams (social use of knowledge)

– Coordinated KM teams

Examples

• Rapid search and synthesis for decision support in clinical settings. Virtual clinical librarian.

• Knowledge bundle to support perioperative care of diabetes patients

• Development of knowledge broker role for practice educators.

• Coordinating KM in different functions to support alcohol team.

Next stepsLeadership and engagement• Professor Kevin Rooney appointed as national clinical lead for Knowledge into Action• Clinical Champions for Knowledge into Action in each NHS Board.

Defining future state• Engagement and consultation with clinicians and clinical educators, including a focus

on primary care. • Videoconference workshop for remote and rural stakeholders.• Analysis of the evidence base for knowledge management for person-centred care,

focus groups with Quality Councils and frontline nurses.• Key informant interviews to define ICT support for knowledge into action.

Initiating change; defining strategy• Evaluation of test of change projects.• Using quality improvement approaches to define new service models for search and

synthesis, physical library resource and social use of knowledge workstrands.• Roundtable event with Knowledge Management Executive Leads to scope the new

service model.• Consultation event at review closure with Knowledge Management Executive Leads,

clinical champions, knowledge management and quality improvement leads, to consolidate new service model and begin to plan implementation.

Summing up

Seeing the shape of things to come….• Moving out of physical library resource• Emphasis on expert search, interaction with practitioner

teams – clinical and health improvement.• Creating and sharing new knowledge products• Working as part of cross-functional KM teamsNeed more focus on:• Dissemination and social use of knowledge• Building capability within organisation• Linking with KM Exec Leads and Quality Improvement

Leads to strengthen strategic engagement.

Final questions?

Getting Knowledge into Action to

Improve Healthcare Quality

Progress Update on National Review of Knowledge Services and the Librarian Role

11th November 2011