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

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

3. 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

4. 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

5. 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

6. 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

7. 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)

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

9. 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

10. 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

11. 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

12. Knowledge into Action Review

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

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

16. 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.

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

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

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

20. 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

21. “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

22. 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

23. Actionable knowledge

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

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

26. 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

27. 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.

28. 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.

29. 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.

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