1. Getting Knowledge into Action to Improve Healthcare Quality Progress Update on National Review of Knowledge Services and the Librarian Role 11 th November 2011

2. 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.

3. Meeting guide Mute phones when not speaking One person speaks at a time Give name when speak Use of Chat – demo

4. “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.

5. 12 million + resources 30-40% of UK healthcare NOT based on available scientific evidence (Grol and Grimshaw, 2003) From Accessing Information to Applying Knowledge

6. 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

7. 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

8. What Works? - in getting knowledge into action to improve quality of care?

9. Knowledge into Action Model (Draft) AIM

10. Example Know-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.

11. 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?

12. 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

13. 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.

14. Examples (2) Knowledge uptake interventions Specific 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”

15. 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

16. Examples (4) Organisational capacity and capability Workforce knowledge management skills Knowledge management roles Defined knowledge management strategy and policy

17. 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?

18. Current state of NHS Scotland Knowledge Services Survey Summer 2011

19. Our resources Library staff are NHS Scotland’s chief knowledge asset 116 library staff in total 84 qualified library staff

20. Workforce distribution Library staff as percentage of workforce in each NHS Board Inconsistency and inequity across NHS Scotland

21. Literature searches Dec 2010-May 2011 BoardTotalAppraisal NHS A&A242No NHS Borders71No NHS D&G-- NHS Fife34No NHS Forth Valley-- NHS GG&C322Yes NHS GG&C PH24- NHS Highland94No NHS Lanarkshire136No NHS Lothian19No NHS Orkney-- NHS Shetland-- NHS Tayside18No BoardTotalAppraisal NHS Western Isles6No NES-- NHS Health Scot.83No HM library1200No HPS Library-- Central legal Office-- ISD Library0Yes Waiting Times cen-- HIS library85? NHS2428No Ambulance service-- State Hospital42No

22. Interpretation Variation Inconsistency Inequity Likelihood of Duplication

23. Types of search Advanced searches are common.

24. Purpose of search CPD is most common reason for searches, followed by direct patient care and service improvement

25. Managing new types of knowledge Clinical DigestManagerial Digest Evidence or Care BundleClinical Guideline Clinical PathwayBest practice statements Often110000 Sometimes000000 Seldom331211 Never1112151415 Performance and outcomes Audits/Surve y data Interviews / focus groupsStorytelling sessions Discussion/ forumsWikis/blogs Often001010 Sometimes000001 Seldom111221 Never15 1415 Evidence synthesis/creating actionable knowledge Managing data and tacit knowledge Small beginnings – opportunity for growth

26. Training sessions Summary TableDecJanFebMarAprilMayTotal Literature Search Sessions5573114939295522 Literature Search Attendees92177196136119141861 Critical Appraisal Sessions1110115 Critical Appraisl Attendees1314120131062 Synthesis Session0000000 Synthesis Attendees0000000 Impact? Duplication? Training individuals primarily.

27. 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?

28. Reports from Review Workstrands Physical Library Resource Evidence Search and Synthesis Social Use of Knowledge

29. Knowledge into Action Review The Physical Resource Working Group

30. To build upon the work done via the Library questionnaire, and the ‘Knowledge Space’ model developed and presented on the 12 th 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)

31. Aims of the Group There 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

32. Key Dates so far 14 th November – the group convenes to discuss remit, priorities, outcomes, tasks, timescales, and responsibilities 12 th December – the group convenes for Lean methodology training and application to the physical resource 24 th January – the group convenes to discuss the outcomes and recommendations

33. Search and Synthesis Working Group

34. 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.

35. 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.

36. Membership Confirmed to date: Margaret Theaker, Ayrshire and Arran Seona Hamilton and Kirsty Coltart, GGC Jenny Harbour and Alison Winning, Healthcare Improvement Scotland

37. 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

38. Social Use of Knowledge Working Group

39. 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

40. 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

41. Test of Change Projects

42. Aims of test of change projects Engagement in K2A developments Understanding of new K2A approaches Building capability – learning by doing Collaborative working

43. 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

44. 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.

45. Next steps Leadership 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.

46. 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 teams Need 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.

47. Final questions?

48. Getting Knowledge into Action to Improve Healthcare Quality Progress Update on National Review of Knowledge Services and the Librarian Role 11 th November 2011