Librarians and Commissioners

Mike RoddhamHead of Library & Knowledge Services

Why?Ensuring local people get the best quality

health servicesby

Ensuring services are commissioned according to the best available evidence

What?The importance of languageWhere do we fit in the commissioning cycle?What they want and what they don’tThe service model & how it will change usThe importance of relationshipsChallenges and Gains

But not necessarily in that order

http://www.commissioningboard.nhs.uk/2012/02/03/commissioning-intelligence-report/

Whatquestions

do we need toanswer?

8. What are our future plans? 1. How healthy?

2. What’s really happening

in this system?

3. How much?

4. How do we compare?

5. Are my providers delivering what they agreed?

6. How could things be better?

7. What difference

have we made?

4. How do we compare?

Q4.01: Where is there clinical / activity / cost / outcome variation vs

local, national, international, best practice?

Q4.05: How do we compare for value for money,

outcomes and productivity against similar areas / best practice

over time?

Q4.04: Do current pathways reflect evidence-based good practice?

Q4.02: Are we delivering national standards of care

for patient experience, quality and outcomes?

Data

D4.01: Age-sex deprivation standardised comparative data at practice level for commissioned activity

D4.02: Primary care data extracts providing integrated analysis of with acute activity e.g. prevalence rates vs admissions / screeningsD4.03: Comparative benchmarking data (e.g. QOF Data sets, NCHOD, NHS Comparators, NHS Atlas of Variation, Better Care Better Value indicators

D4.05: Benchmarked GP referrals analysis

D4.06: Practice profiles (needing national standards)

D4.07: National guidance, PROMs, utilization reviews

S4.01: Practice-level, regional and national bench-marking of disease prevalence, activity, productivity and costs

Types of service & tools

S4.02: Analysis and presentation of productivity indicators by programme / project

S4.03: Clinical pathway mapping and modelling and cost comparators

S4.04: Providing evidence and information on comparative health outcomesS4.05: Statistical analysis of variation and correlations e.g. Statistical Process Control

Look at the model. Which areas do you think we can contribute to?

Targeting There are areas where we can contribute effectively, e.g.service redesign, pathways, individual funding requests

There are areas where we can’t,e.g, contract compliance

Be realisticTarget your message

Targeting

Be specific, don’t generalise

Concentrate your fire on target areas but don’t miss

Use examples from •Commissioning Handbook,•knowledge4commissioning

an opportunity.

Wordsmithing

Read up – HSJ, reports, DH stuff, NHS Commissioning website

Understand their mindset

Talk their languageKnow their world

Wordsmithing

Literature searchingTrainingLoansBooks & journalsLibrary

•Finding evidence•Create the evidence base•Identify national & international best practice

•Horizon-scanning•Knowledge management•Decision support

Literature searching

Literature searching

Literature searching

Literature searching & reviewing

Current awareness

Organising information

WordsmithingWatch for changed meanings

IntelligenceEvidenceKnowledge management

Analysts and commissioners believe in Safety in Numbers

Data analysis

Wordsmithing

Don’t describe the services you offer

Present the benefits that the commmissioners gainTalk outcomes, not processes

i.e. not literature searches but “confidence in their decisions”

They Don’t Want

Piles of photocopies

Reference lists

To have to come to the library

Bureacracy and form-filling

Don’t offer training!

Our unique selling point – “we find it for you.”

We have professional skills they can exploit to save money and improve patient services

They don’t want it, they won’t use it.

What Do They WantInformation on what works

Information on how others are coping (we can offer not just UK, but international)

Information on what doesn’t work

Reviews, summaries, time-savers

What Do They Want?• Information they can rely on• Information they can base decisions on

• Evidence they can hide behind• Information that enhances what they already have

What do they have? DATADATADATA

DATADATADATADATADATADATADATADATADATADATA

DATADATADATA

DATA

• Always Historical• Somewhat predictive of activity• Says ‘what happened,’ ‘when,’ ‘how many,’ ‘how often’

• Doesn’t say ‘why,’ ‘what else,’ ‘how do we change’

• Not always reliable

Major Change

Get them thinking beyond the data

Examples, stories, vignettes are really important

Relationships• Develop them

• Exploit them

• Use champions

Work through people you know to reach those you don’t

Likely ProspectsBusiness intelligence leads/ directors don’t talk to the analysts

IFR / PIN leads Understand need to justify expenditure

Public health still need library support.

GP members, education committees, clinical effectiveness & research committees

CCG or CSU?

What You Could DoYou might need to loss-lead to show them the benefits

Set it up as a project with option to make permanent

Work together across services if you aren’t co-terminous with a CCG. Use their borders, not yours. Also looks better to customers

Challenges

• Work out of the library – physically and mentally!

• Change your mindset – think like the customer

• Sell your skills not your resources

More Challenges

Summarising and reviewing

Needs better service monitoring

Learn to sell yourselves – exhibitions, marketing materials, publicity, Facebook

Gathering feedback on service impact & activity

More Challenges –A Different Sort of Enquiry

Health Visitor involvement in early interventions for improving children's language development & early communication skills.

The Troubled Families Initiative - any information? On intervention strategies in particular..

Best Practice initiatives to reduce inappropriate GP referrals in planned care:Cardiology, Gastroenterology, Neurology, General Surgery - Upper GI, Colorectal, Breast, Vascular

GP direct access to head CT scanning - any protocols, reasons why if not

Risk stratification for Long Term Conditions; which risk stratification tools work best; any local examples; within the last year; review articles within the last 3 yrs

Is there any new evidence to support revision of the local referral guidelines on hip pain, knee pain and low back pain?

Innovative community ENT services; national examples/best practice; primary care based/community-led

Is peanut allergy in children more prevalent in the UK? If so, why?

Impact of weight management services (Tier 3/4); does engaging in them lead to e.g. reduction in incidence of diabetes, hip/knee replacements, etc.

GainsUnderstanding

Respect

Feel good

New skillsChampions

Secures services

Non-MADEL income

New user groups

Direct contribution to improving local health