Knowledge into Action – to improve quality of care

1. Knowledge into Action –to improve quality of care

2. Overview Why? Drivers and context What? Aims and process of review How? To get knowledge into action What does it mean for me? New stories

3. “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.

4. The challenge for getting knowledge into action….. “Yes, it’s quite a noise – - but are we having any impact?”

5. The Knowledge-Practice Gap Only 55% in US healthcare system receive recommended care McGlynn et al (2003) Estimated 30-40% of care in UK not based on available scientific evidence Grol, R. and Grimshaw, J. (2003) 5 year gap between publication of guidelines and changes in routine practice in Western healthcare systems. Lomas et al (1993)

6. From Accessing to Applying Knowledge • 12 million + resources • How much of this gets used in a meaningful way to improve safe, effective, person-centred care?

7. 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. Knowledge into Action Review

8. Method of Review • Review the evidence base for what works in getting knowledge into action. • Gap analysis • 3) Tests of change • 4) Stakeholder engagement, strategic sponsorship.

9. What works in getting knowledge into action?

10. A Strong Knowledge Infrastructure

11. Evidence that knowledge works • McMaster Hospitals 1990’s • “The Evidence Cart” Sackett et al JAMA 1998 • Teaching EBM skills can change practice Straus et al J Gen Intern Med 2005 • Clinical librarian services for improving patient care Scura et al JAMA 1981 • Positive impact of clinical informaticist on clinical decision making Mulvaney et al J Am Med Inform Assoc 2008

12. 3 Key Approaches 1)Knowledge Uptake Interventions- Use well defined structured items e.g. SIGN, care pathways, evidence bundles, 1-1 knowledge outreach.2) Relational use of knowledge- Sharing knowledge to facilitate 3 C’s3) Organisational / Systems approaches- Barriers and Levers Adapted librarian roles to support all above

13. Examples of Knowledge into Action Approaches

14. Clinical Content Management Actionable knowledge at point of care Standards: metadata, taxonomy, content structure Content creation 12 million resources ONLINE Actionable Knowledge Relevant Evidence All Literature

17. Developing a culture of improvement • Workplace VLE • Communities of Practice Knowledge Flow and Quality Improvement across the Organisation Developing local improvement stories Widening our improvement conversations and networks Improvement Evidence Real time tests of change Profound Knowledge – Know-Hou & Evidence of Standards – Know-what Adopt & Adapt Improvement Tools and Technology Sharing experiences and embedding the improvement culture Harvest and share and enable new ideas Measuring the effectiveness of improvement activities Mesosystem Middle mgrs Macrosystem Policy Microsystem frontline Individual

18. Clinical knowledge content teams-working with communities to create clinical content; package and organise as “actionable knowledge” – bundles, decision support, mobile apps etc.Clinical librarians /informationists– expert search and training/support in clinical setting.Knowledge outreach officers– 1-1 knowledge transfer; facilitating networks and dissemination of knowledge.Knowledge brokers– facilitating knowledge flow to support quality improvement. Knowledge into Action Roles

19. “The application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade.” Sir Muir Gray Director NHS National Knowledge Service & NHS Chief Knowledge Officer

20. Knowledge into Action Stories What can we learn from them and how can we improve?

21. Patient and staff story…. “In April, a 70 year old, independent lady with no previous comorbidities. became a grandmother for the first time and was looking forward to watching her family grow up. She developed a cough & became breathless and presented to her local hospital. She was admitted, and developed severe sepsis & septic shock secondary to her community acquired pneumonia and died within 7 hours. Her sepsis was not recognised, and antibiotics & fluids were not given in a timely manner. The patient’s family and the well-meaning and competent medical and nursing team are devastated.” From patientstories.org.uk

22. The clinical team meet to review the case and discuss what changes they could make to prevent this happening again. They invite their clinical knowledge manager to join the discussion. What knowledge into action approaches could help?

23. Creating a new story… A new set of National Standard Infection Control Policies is being issued. Despite many standards, policies and educational efforts over the years, there is a continuing need to improve practice in infection control in both acute and community care. The Infection Control Nurse in your Board is tasked with managing implementation of the new SIPS and decides to discuss approach with the local knowledge management team.What knowledge into approaches could they consider?

24. Define uptake interventions! Analyse the context! Build relationships! Knowledge into Action: interventions & strategies

25. Create actionable knowledge : Evidence summaries Summary guideline recommendations Risk tables and decision aids Care protocols, plans, ICPs Best practice statements Business process maps Implementation tools linked with evidence Optimise actionable knowledge: Clarity Simplicity Easy to look up, within reach Credibility Support for complex problems Communicate actionable knowledge: Prompts and reminders at key points in workflow – online, paper, people. Clinical Q & A services Online decision support – linked with clinical systems Mobile “apps” for easy access to knowledge Target defined barriers Educational flyers Knowledge into Action Menu Card (1):Knowledge Uptake Interventions The evidence tells us that the following approaches can help to get knowledge into action:

26. Dissemination and dialogue Collaborative feedback and review of practice/outcome data Involve target group in planning dissemination Interprofessional collaboration in planning and implementation Patient-mediated interventions Sharing experience in social networks of care providers – e.g. collaboratives, MCNs. Key figures and opinion leaders Personal advisers and facilitators 1-1 knowledge transfer (“educational outreach”). Research-practice partnerships Educational approaches Communities of Practice Educational courses and conferences Interactive educational workshops Planning education - time period, group composition, needs assessment, customisation to target group. Work-based learning Knowledge into Action Menu Card (2):Share knowledge through social systems The evidence tells us that the following approaches can help to get knowledge into action:

27. Influence the culture and expectations about knowledge: what counts and how it can be used Collaborative leadership Develop staff capabilities as “knowledge workers” Embed use of knowledge in development of organisational policy. Integrate use of knowledge in existing organisational systems and practices. Knowledge into Action Menu Card (3):Analyse organisational context The evidence tells us that the following approaches can help to get knowledge into action:

28. Knowledge into Action –to improve quality of care Ann.wales@nes.scot.nhs.uk Suzanne.wilson@nhs.net