Getting Knowledge into Action in Frontline Care and Improvement Bringing Together Clinicians, Improvement Advisers and Knowledge Brokers Wednesday 30th January 2013 #K2Aevent

Knowledge into Action Frontline Care & Improvement Dr E Watson DME- NHS HIGHLAND 2

The Healthcare Quality Strategy for Scotland Person-Centred Clinically Effective Safe Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times 3

KEY MESSAGES Not ‘just another strategy’ Not top down imposition Integrated rather than additional A development of Better Health Better Care – not a replacement Built on shared values For the whole of the NHS, our partners and for the public 4

What are we trying to accomplish? Scotland as the safest nation in the world with respect to health care injuries Unparalleled capability to improve care with respect to any aim established by social need or community ambition What are we trying to accomplish? This question is intended to help you be clear about the improvements that you would like to make. Being clear about the vision/goal is crucial to your progress. “Get fitter?” You have tried that and it did not work. How about a more specific aim? Climb a Scottish Munro without the aid of oxygen by June. Give it a shot – give out Worksheet for change. Give time to get aim. 5

Knowledge into Action Where are we in healthcare delivery? Patients still come to harm Significant variation continues Waste Failure of prevention Increasing demand Increasing need Financial Constraints Muir Gray And this is just healthcare not beginning to touch on integration 6

Bridging the Knowledge-Practice Gap 45% defect rate in US healthcare system – patients not receiving care as recommended in guidelines. (McGlynn et al,2003) 17 years to get research recommendations into practice. (Balas et al 2000)

Wise words……. “Knowing is not enough; we must apply. Willing is not enough; we must do.” - J.W. Goethe (1749 –1832)

From Accessing to Applying Knowledge in NHS Scotland Knowing 66 libraries 116 library staff 12 million + resources Doing How much of this gets used in a meaningful way to improve safe, effective, person-centred care? There and then at finger tips Bimodal disribution in how we like our knowledge Apps to paper penchallenge Recognition that you may have an ipad still write on it! Journey 9

Today Meet new people Hear how others have used Knowledge into Action Support Learn new ways of accessing or delivering knowledge management locally Use new tools to access knowledge Take away fresh ideas

60 two lines of 30 Opposite colleague introduce yuorself &what you want to achieve and vice versa 15 secs each Then left hand line moves down one a la scottish country dancing! 11

Knowledge into Action Review

Getting Knowledge into Action in Frontline Care and Improvement Bringing Together Clinicians, Improvement Advisers and Knowledge Brokers Wednesday 30th January 2013

Overview Why Knowledge into Action? What is Knowledge into Action? What does it mean for service users and practitioners?

Business Case for Knowledge Services “To benefit patient care through the application of knowledge at point of need.” Business case for formation of NES Knowledge Services, 2004.

Why Knowledge into Action? “Knowledge is a treasure, but practice is the key to it.” Lao Tzu 6th century BC

Knowledge into Action Review What do we need to do differently to get knowledge into frontline care and improvement?

Gap analysis Improving quality needs a new knowledge paradigm. Knowledge is a process, not a product. Knowledge comes in many forms.

Knowledge as process Know-what How can we make it work best Practice Experience Research Know-where Systems Processes Variation Know-what Can this intervention work? How can we make it work best in this context, for this patient? Know-what Journals MEDLINE Cochrane Know-who Service user Practitioner Teams

“The NHS is…. not good at capturing, using and sharing information “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, commenting on Mid-Staffordshire Inquiry. Make link with quality of care experience and patient safety

Knowledge as process Practice Know-where Know-how: Research Actionable Systems Processes Variation Know-how: Actionable Relational Organisational Research Know-what Journals MEDLINE Cochrane Experience Know-who Service user Practitioner Teams

Actionable knowledge

Relational use of knowledge Examples: Communities of practice Storytelling Social networking

Organisational enablers Leadership Change management KM roles Workforce capability in knowledge into action Mainstream Knowledge into Action in Quality Plans.

Knowledge broker network Creating a service Practice Know-where Systems Processes Variation Know-how: Actionable Relational Organisational Research Know-what Journals MEDLINE Cochrane Experience Know-who Service user Practitioner Teams Knowledge broker network

A coordinated, national network of knowledge brokers, supporting clinicians and improvement teams to translate knowledge into action through services for : expert search and synthesis of knowledge from research, practice, and experience delivering actionable knowledge. sharing and disseminating knowledge through people networks. building organisational capacity and workforce capability for using knowledge.

Making it real 17 tests of change Diabetes to palliative care Impact: All improved. stakeholder engagement. Over half showed positive user satisfaction. Most improved stakeholder knowledge and skills. Two demonstrated impact on clinical practice – e.g. in 26% of cases expert evidence searching changed diagnosis or treatment and in 71% of cases the answer was helpful for the patient.

Seeing knowledge services in a new light Knowledge broker service New partnerships - to help practitioners do the right things in the right way, getting better every year.

Getting Knowledge into Action in Frontline Care and Improvement Bringing Together Clinicians, Improvement Advisers and Knowledge Brokers Wednesday 30th January 2013