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Better Intelligence Boosts Quality. Sir Muir Gray CBE 23 March 2009. The future is not a destination like Cheviot Hills , waiting for our arrival; it is something like Durham Cathedral that we have to imagine, plan and build. The future is here; it is just not evenly distributed.

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Better intelligence boosts quality

Better Intelligence BoostsQuality

Sir Muir Gray CBE

23 March 2009


Better intelligence boosts quality

The future is not a destination like Cheviot Hills, waiting for our arrival; it is something like Durham Cathedral that we have to imagine, plan and build.



Great innovations of the first and second healthcare revolutions
Great innovations of the first and second healthcare revolutions

MRI and CT scanning

Statins

Antibiotics

Coronary artery bypass graft surgery

Hip and knee replacement

Chemotherapy

Radiotherapy

Randomised controlled trials

Systematic reviews

First Second

Broad Street - John Snow

Gower Street - Doll & Hill


21st c health and healthcare problems
21st C health and healthcare problems revolutions

Safety

Errors

Quality

Substandard clinical practice

Poor patient experience

Failure to maximise value

Waste

Overenthusiastic adoption of low value interventions

Failure to get new evidence into practice

Inequalities

Failure to prevent disease


The drivers of the third industrial revolution
The drivers of the third industrial revolution revolutions

Knowledge

I T

Citizens

Manuel Castells


Knowledge
Knowledge revolutions

Generalisable knowledge

Explicit

Tacit

  • From research:

  • evidence

  • From data:

  • statistics or information

  • From experience:

  • casebook


Better intelligence boosts quality

CHOICE revolutions

DECISION

KNOWLEDGE

VALUES

THIS PARTICULAR


Knowledge the enemy of disease
Knowledge: the enemy of disease revolutions

The application of what we know will have

a bigger impact than any drug or technology

likely to be introduced in the next decade


Better intelligence boosts quality

“Evidence from recent trials, no matter how impressive, should be interpreted with caution”Claims made in 45 highly cited reports were subsequently contradicted (n=7) or weakened (n=7) for 14 of the interventions

Ionnidis JPA (2005) Contradicted and initially stronger effects in highly cited clinical research JAMA 294; 218-228


Nice guidance

Research should be interpreted with caution”

reports

NICE

guidance


Who is responsible for
Who is responsible for… should be interpreted with caution”

What a new GP in Hartlepool knows about indications for referral for hoarseness?

What a citizen in Gateshead knows about PSA screening?

What a Year 1 SpR in geriatrics in Darlington knows about fractured neck of femur?

What a teacher of children with learning disability in Newcastle knows about epilepsy?


Better intelligence boosts quality

Someone on the Board of every healthcare organisation, directly responsible to the Chief Executive, will be given the responsibility of acting as Chief Knowledge Officer


Better intelligence boosts quality

Public Health is a knowledge business directly responsible to the Chief Executive, will be given the responsibility of acting as The application of what we know from research, from data analysis and experience, will have a bigger impact on health than any drug or technology


Better intelligence boosts quality

  • Librarians directly responsible to the Chief Executive, will be given the responsibility of acting as

  • Information scientists

  • Chief Knowledge Officers

  • Clinical epidemiologists

  • Public health professionals


Better intelligence boosts quality

“most patients were not given clear information about the survival gain of palliative chemotherapy… in most (26/37) consultations discussion of survival benefit was vague or non-existent”

Audrey S et al (2008) What oncologists tell patients about survival benefit of palliative chemotherapy and implications for informed consent

BMJ 2008; 337;a752


Better intelligence boosts quality

www.bettervaluehealthcare.org survival gain of palliative chemotherapy… in most (26/37) consultations discussion of survival benefit was vague or non-existent”


Informing healthier choices

Box 1 survival gain of palliative chemotherapy… in most (26/37) consultations discussion of survival benefit was vague or non-existent”

Workforce capacity and capability

Better workers

Box 3

Stronger organisations

Stronger teams

Informing Healthier Choices

Box 2

Improved data and information

Cleaner clearer knowledge

Box 4

Health information and intelligence portal and systems

Better pipes


Better intelligence boosts quality

Improving public health information and intelligence skills and capacity across England for all levels of the public health workforce

PH Specialists

PH Practitioners

Wider PH workforce

2 objectives

Developing a career pathway and supporting infrastructure tools

Developing training resources to build competencies for all those using information and intelligence

Box 1

Workforce capacity and capability

Better workers


Better intelligence boosts quality

Box 1 and capacity across England for all levels of the public health workforce

Available now!

Box 1

  • Suite of Job Descriptions and Person Specifications for information and intelligence staff

  • 10 e-learning modules (5 at specialist and 5 at practitioner levels)

  • 13 modules with .ppt slides, tutor notes and workbooks

  • www.healthknowledge.org.uk hosts training resources for all public health competences


Better intelligence boosts quality

  • Centrally and capacity across England for all levels of the public health workforce from provider

  • data eg general practice

  • smoking

  • raised BP

  • Special surveys eg

  • well being

  • dental health

  • exercise levels

  • Surveillance systems eg

  • child health systems

  • disease registers

Box 2

Improved data and information provision

Cleaner, clearer knowledge

Reliable data on key health challenges


Box 2 data workstreams
Box 2 data workstreams and capacity across England for all levels of the public health workforce

Health Profiles 3

Primary care data development

Prevalence modelling

Child height and weight

Dental survey data

Drug misuse data

Nutrition & dietary data

JSNA dataset

Local health surveys

Sexual health data

Other initiatives e.g. basket of health inequalities indicators

Box 2


Chd expected prevalence in people over 16
CHD: and capacity across England for all levels of the public health workforceexpected prevalence in people over 16

Box 2


Chd observed over expected prevalence in over 16s
CHD: and capacity across England for all levels of the public health workforceobserved over expected prevalence in over 16s

Box 2


Better intelligence boosts quality

Competencies for WCC, inc JSNA and capacity across England for all levels of the public health workforce

Skills to use intelligence for Public Health and commissioning

Health Impact Assessment

Government Impact Assessment (national)

Specific proposal impact (regional, local)

Training

Strategic Environmental Assessment

Box 3

Stronger organisations

Stronger teams


Policies for action on wdh
Policies for action on WDH and capacity across England for all levels of the public health workforce


Better intelligence boosts quality

Better presentation and accessibility of data to professional public health people

Better use of information systems and tools by networks of people

web-based

improved ease of use

interactive

Examples and inspiration to promote more productive use of information

Box 4Health information and intelligence portal and systems

Better pipes


Projects
Projects professional public health people

NLPH – online, free to access

APHO, IC, DH, PHAST development work

Data analytic tools

Knowledge management systems

Single portal for accessing PH intelligence

Plus social networking?

Other Web 2.0 resources?

Box 4


Better intelligence boosts quality

Expedites shared learning professional public health people

All public health practitioners must submit 1 (or more) report pa

Reports contain

Outline of problem

Why prioritised

Objective of PH investment

Project impact

Lessons learned

Signpost to full documentation

Contact details

Box 4

Public health casebook proposal


Any thoughts
Any thoughts ? professional public health people

drschiller@email.com

muir.gray@medknox.net

sueatkinsonph@aol.com

Thank you!


Phine meeting
PHINE meeting professional public health people

NLPH – busy online library with monthly newsletter (>7500 hits per month)

National guidelines

Systematic reviews

www.library.nhs.uk/publichealth

National knowledge weeks (synthesised for quality) eg HIV/AIDS Dec 2008, drug misuse Jun 2009


Phine meeting1
PHINE meeting professional public health people

Capacity development: posts and courses

Better understand networks of practitioners, networks of information, networks of quality observatories, relations to wider networks beyond NHS (esp PHOs) eg GOs

Distinct role of PHOs

Commissioning competencies within PCTs esp competency 5 (NEPHO workshops with SHA on knowledge management) All PCTs aiming for level 3 in coming year, using DOAS

CKO group self assessing knowledge management


Phine meeting2
PHINE meeting professional public health people

Comp 5: CEOs across Region have started group led by CEO N Tyne

NE Regional Information Partnership with John Carling leading – good online resource

Centre for Population Research – UKCRC set up 5 centres of excellence. In NE 5 universities collaborate (quoted by CMO)

Has attracted funds for research on 10 important themes (social group – economy environment and mh; lifestyle - tobacco, alcohol, obesity, phys activity; prevention fair and early treatment – provision of healthcare not prioritised in other work stream; life course – early years, good life, good later life, good death


Phine meeting3
PHINE meeting professional public health people

Individual universities tackle specific areas

Feedback from pairs – what can IHC do for you?

ONS birth – gestational age please

ONS website design, hard to find what you want

Rationalise web access

Provide digests (but NLPH does this)

Train CEOs in PH knowledge management – show them the benefits


Feedback from pairs
Feedback from pairs professional public health people

Data from OGDs and IC easier to find

Access for PHOs to PPA data and NHS central registry for GP registrations at a national level – use a single issue to highlight, maybe statins

Promote imp of PH to commissioning – demonstrate risks of not having PH info central to commissioning decisions

Help PH people use media their partners use