Anne Brice National Library for Health Lead, NHS Choices Programme

1. Reform, choice and well-being: implications of knowledge transfer on the roles of 21st century knowledge workers Anne Brice National Library for Health Lead, NHS Choices Programme Head of Knowledge & Information Sciences, Public Health Resource Unit, Oxford

2. Positioning librarians in the modern world • Context - what is the agenda? • Can knowledge make a difference • What is being done in England - the NKS, NLH & NSF • What librarians need to know and do • Understanding content and quality • Service delivery reform - driven by users • Understanding networks and communities • Health, well-being and choice

3. Facing the challenges • Increasing need as a result of • Population ageing • New technologies • Increasing demand because of rising expectations • Failure of resources to grow as quickly as need and demand

4. Based on one to one paper communication with occasional face to face meetings Have multiple paper records for one patient Do not have a common core of knowledge, relying on memory and the cascade of paper documents c20th Clinical Communities

5. 2 million consultations & 10 million clinical decisions daily in the UK Decisions Decisions Made by made by Clinicians Patients Shared Decisions Consultation time

6. What problems do clinicians face ? • Time • External pressures • Lost notes • Missing data • Welter of paper and websites • Poor access to knowledge at work • Managers/policy makers who have not experienced clinical decision making • Complexity of care • Fragmentation of support

7. An Afternoon Clinic’s Records

9. Choosing Health: Making Healthier Choices Easier ‘The White Paper is about making a difference to the choices people make’ ‘It aims to inform and encourage people as individuals, and to help shape the commercial and cultural environment we live in so that it is easier to choose a healthy lifestyle’ ‘changes need to be based on choices’

10. Priorities • Reducing the number of people who smoke • Reducing obesity and improving diet and nutrition • Increasing physical activity • Encouraging and supporting sensible drinking • Improving sexual health • Improving mental health

11. Delivery mechanisms • Better information for the public (including “marketing health”) • More effective working with children and young people • More effective working with local communities • Increased support to individuals to help them make healthy choices • A re-balancing of the NHS investment • More working with employers to promote healthy lifestyles at work, including the NHS • Spearhead Primary Care Trusts

12. Better information, better choices, better health: Putting information at the centre of health ‘Modern public services are built on effective partnerships’ ‘Easy, equitable access to high quality information lays the foundation for such partnerships to flourish’

13. Key concepts • Generalised and personalised information • Information embedded as an integral part of delivering healthcare • New channels of delivery • A single approach to information • Make information more effective

14. Specific areas • Translation and interpreting services • Community based navigators • NHS Digital TV • Access to health records • Health search engine • Information prescriptions • Reaching the public

15. Our health, our care, our say: a new direction for community services • Better prevention services with earlier interventions • “Life Check” • Health Direct • More choice and louder voice for patients • Tackling inequalities and access • Supporting long term needs

16. Why do we need a National Knowledge Service “The application of what we know can prevent and minimise the seven ubiquitous healthcare problems” • Errors and mistakes • Poor quality healthcare • Waste • Unknowing variations in policy and practice • Poor patient experience • Overenthusiastic adoption of interventions of low value • Failure to get new evidence into practice

17. The mission of the National Knowledge Service is to support the decisions and actions of NHS professionals and patients by organising, mobilising, and delivering best current knowledge when and where it is needed

18. National Knowledge Service The National Knowledge Service will achieve its aim by supporting and facilitating the collaboration of all those involved in generating, organising, mobilising or supporting the use of knowledge for professionals and patients Generation Organisation Mobilisation Localisation Better Consultations, Better Decisions, Better Systems of Care

19. National Knowledge Service Generation Organisation Localisation Mobilisation Utilisation Co-ordinated procurement National Library for Health NHS Direct Online Social Care onLine Map of Medicine NHS Care Record Service Patient & professional education Question Answering Service Better Consultations, Better Decisions, Better Communication

20. A National Library for Health • A modern integrated, hybrid, network based library service for the NHS, providing seamless access to high quality knowledge • Built to ensure that clinicians and patients have easy access to best current knowledge wherever and whenever it is needed • Comprises NHS funded services across the country and a digital hub, plus commissioned information services and products.

21. Reform in libraries • NLH is both an operational service with around 1 million customers a month, and a change programme committed to modernising existing NHS funded library services. The NLH is transforming a service characterised by dispersed provision of variable quality, governed by postcode, bringing services together to create a knowledge service fit for purpose in the 21st century. • Local knowledge services are fundamental to this vision. Knowledge services must be delivered at the point of care and in the workplace, they must support the objectives of their parent/host organisations and they must offer services tailored to the needs of different groups.

22. A National Service Framework “The national service framework will be developed to provide direction for library service development, focusing on the delivery of local services to support the needs and expectations of the customer, within the context of partnership with local and national service providers, with quality of content and service a priority”. National Library For Health Strategic Plan 2005-2008

23. Framework Core Service Areas The service areas define what is required from library and information services • Customer focused service • Resource management • Role of library and information staff • Knowledge Management • Patient and Public • Quality • Information-handling skills • Partnership • Information Technology The list of core service areas may expand or reduce after consultation

24. Framework Core Service Areas Service areaDefinition Core Specification (123) The core specification describes the level of service which is acceptable and which must be universal. Many of the core specifications are based on existing service and reflect requirements defined in accreditation standards. Meeting the core specification is not optional. Developmental Specification (34) The developmental specification describes areas for development and once developed will become part of the core specification.

25. Key results from Phase 1 consultation • Core components were accepted without change by the majority (acceptance ranged from 29% - 64%) • Core component d (knowledge management) gained the least acceptance at 29% • All other core components gained acceptance between 55% and 64%. • Support for development components was less, with a range between 42% and 49% acceptance

26. What do health librarians need to know and do? • Organisational know-how • The state of the market place • Understand what an evidence-based culture in health care means • Understand networks and communities • Negotiation, teaching and facilitation skills

27. What else? • Content and quality • Health care interfaces • Community services • Common languages/taxonomy • Common technical standards and interface • Structured management – evaluative frameworks, governance issues, programme management

28. Content & Quality

29. Evidence-based ? • How many decisions that you make are based on sound research? • Where do you go to find evidence to inform your decisions? • Would you be able to assess the validity, reliability and relevance of a study to inform your practice ?

30. Evidence-based practice “EBLIP involves asking answerable questions, finding, critically appraising and then utilising research evidence from relevant disciplines in daily practice. It thus attempts to integrate user-reported, practitioner-observed and research-derived evidence as an explicit basis for decision-making”. (Booth, 2006)

31. A community knowledge service, part of the National Knowledge Service but tailored,using tool, such as the Map of Medicine, for each community A single digital patient record A common core of knowledge, regularly updated and universally available eMail and shared webspace for virtual, as well as, face to face meetings c21st clinical communities will have

32. c21st healthcare organisations will need to have …. • A culture that manages knowledge with as much energy as it manages finance, and one which values librarians!! • systems for importing and distributing knowledge so that all staff, including agency staff, and patients have the knowledge they need for safe and effective practice; the NCRS • structures to create the culture, develop the systems ,and promote the skills to manage evidence eg a Chief Knowledge Officer at board level and knowledge managers in every unit

33. Knowledge transfer

34. Choice, reform and well-being • Not an option • PEST • Can use EBP and KM as tools to create flexibility and impact

35. What will transform knowledge management in health care, is the patient of the 21st Century

36. and finally …. “Librarians of the world unite …. ….you have nothing to lose but your shelves!” (Professor Sir Muir Gray c2004)

37. Thank you