1. Implementing Knowledge into Action in Scotland’s Health and Social Services A brief overview Masterclass Day 1 18 th March 2014 Dr Ann Wales Programme Director for Knowledge Management Ann.wales@nes.scot.nhs.uk

2. Overview 1.Why Knowledge into Action? 2.What is the model? Types of knowledge Implementation methods 3. How is it making a difference?

3. Why Knowledge into Action? Values: Care that is: Safe Effective Person-Centred

4. Knowledge Service Provide Knowledge Share and Apply Knowledge Connecting to: People’s experience of care. Day to day working lives of healthcare staff.

5. National Knowledge into Action Review (2011-12) Knowing Knowledge Network - 12 million + resources Knowledge products – SIGN, HIS, HPS, NES IRISS, etc as “knowledge broker” organisations. www.knowledge.scot.nhs.uk Doing? How much of this gets used in a meaningful way to improve safe, effective, person- centred care ?

6. Need for a new knowledge paradigm 1.Limitations of research evidence – 15%-20% of clinical issues. Williamson 1979, Sackett, 1995. 2.Information overload- “Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?” Bastian, H. et al 2010 3. Context: Overestimation of impact in research studies compared with real-life contexts. Ioannidis, 2011. 4. Personalisation: Limitations in applying research results and guidelines to individual patients with complex needs. Kent, 2007; Lutgenberg, 2009.

7. Translating Knowledge into Quality Care Research Knowledge MEDLINE, ASSIA, Cochrane etc Know-What Quality Care & Support Doing the right thing Doing it right Care Decisions Improvement Knowledge: Practice, People, Context, System Know-How “Profound Knowledge” Change systems and behaviours Adapted from: Glasziou, P et al. Can evidence-based medicine and clinical quality improvement learn from each other? 2011. BMJ Qual Saf 20 (suppl 1): i13-i17 Embed knowledge in workflow

8. Designing a Knowledge System for Scotland’s Health and Social Services 1. What conceptual knowledge translation frameworks can help us to design a new approach to get knowledge into practice? 2. To inform our action plan, what practical knowledge translation interventions have evidence of improving practice?

9. Conceptual Frameworks 1. Implementational Focus on well-defined, codified knowledge - e.g. clinical guidelines. Planned action theory of change. 2. Interactional Social knowing and learning about how to change practice. Problem solving theory, social learning theory of change. 3. Context and Agency Capability, Capacity, Culture. Organisational / Systems theory of change

10. Implementational Example Knowledge to Action Framework Graham and Logan, 2006

11. Interactional Example Knowledge Transfer Process Model Ward et al 2010

12. Context and Agency Example Normalisation Process Theory: May and Finch 2009

13. Evidence-Based Knowledge into Action Methods 1. Knowledge in actionable formats: Clinical pathways; checklists; bundles; computerised decision support; audit and feedback. 2. Social knowledge approaches: Communities and networks of practice, social networking, interactive learning approaches. 3. Addressing factors in the wider organisational culture Leadership, capabilities, change agents.

14. Congruence of Theory and Practice Conceptual Frameworks Implementational Interactional Context and agency Methods Actionable knowledge Social knowledge Organisation environment

15. Knowledge into Action Model Know-what Journals MEDLINE Cochrane Know-where Systems Processes Variation Know-who Service user Practitioner Teams Practice Experience Research Know-what Can this intervention work? How can we make it work best in this context, for this person? Knowledge broker network Search & synthesis Actionable knowledge Social knowledge Organisational knowledge

16. Methods and Agents Actionable knowledge Decision support Pathways Mobile apps Relational use of knowledge Communities of Practice Social networking Social learning Organisational enablers Backing at national and board level Tests of change to embed approaches Skills development Change Agents: Knowledge Broker Network Search & synthesis Evidence from research, practice and experience Rapid reviews

17. Expertise in: * Evidence search, synthesis. * Presenting knowledge as decision aids * Facilitating sharing of knowledge * Planned dissemination and uptake * Building workforce KM capabilities From librarians to knowledge brokers

18. How is Knowledge into Action Making a Difference? Examples

19. Decision support in SCI-Diabetes

20. Community of Practice – Tailoring Decision Support 1.Reviews audit data to determine impact of decision support on practice. 2.Shares experience of using decision support – e.g. overriding in complex cases with multiple conditions. 3.Refines and adapts implementation approach.

21. Knowledge into action in nursery care Nursery identified need for reminders to implement training on language development recently cascaded to all staff They created a card with a checklist to hang from their security badges. Administrator identified as a knowledge broker; planning knowledge management training with her.

22. Summing up New paradigm for managing knowledge in health and social services. Grounded in theory and evidence. Know-how as important as Know-what Evidence-based implementation methods Operationalised as practical methods and support to improve quality of care.