A perspective of Knowledge Management in the NHS

Dr Jim Hughes

Head of Knowledge Management

Cheshire and Merseyside SHA

Broad questions

What does the Head of KM in Cheshire and Merseyside SHA do?

A(nother) definition of KM!NHS KM and Connecting for HealthNew role for librarians? 18 week target – using data effectively

What does Head of KM do?

Internal role IT services and Informatics Library service Freedom of Information Knowledge Management – e-filing, effective use

of tools, technology and people to work smarter

Job description – cut down this tree

Tools available

Tools / people required

What does Head of KM do?

External Line manage Health Care Libraries Unit (HCLU) CfH - knowledge management North West VLE (e-learning) Data warehouse PCT Shared services – Information knowledge

management / contract management Public Health ; Dr Foster; TIS

KM in – Practice based Commissioning; Management of Long term Conditions

‘SOFT’ KM

‘HARD’ KM

So much to know, so little time!

A(nother) definition of knowledge management

A healthy mix of:-

Tools Technology Processes People

Organisations Behaviours Culture

A(nother) definition of knowledge management

What do we do with it?

Capture Code Store (organise) Access Disseminate – MOBILISE – collaborate - share

Put it back in!

A(nother) definition of knowledge management

And of course - the management bit

Strategy Implement Monitor Evaluate

Connecting for Health - KM

Directorate of clinical knowledge process and safety led by Sir Muir Gray

http://www.connectingforhealth.nhs.uk/delivery/serviceimplementation/kps/

The following eleven slides are taken from Muir Gray’s presentation on the National Knowledge Service taken from the above public web site.

The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade

Muir Gray (January 2005)

The application of what we know can prevent and minimise the 7 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

Muir Gray (January 2005)

3 types of generalisable knowledge

Knowledge from research - Evidence

Knowledge from measurement of healthcare performance - Statistics

Knowledge from experience - Of patients and clinicians

2 types of particular knowledgeKnowledge about this patient

Knowledge about this serviceMuir Gray (January 2005)

For good health people need pure clear knowledge, just as they need pure clear water

Muir Gray (January 2005)

The knowledge spectrum before the internet

Knows KnowsA little A lot

Patient PrimaryCare

Secondary(hospital)Care

Professor

Muir Gray (January 2005)

The knowledge spectrum after the internet -1

Knows KnowsA little A lot

PatientPrimaryCare

Secondary(hospital)Care

Professor

Muir Gray (January 2005)

The knowledge spectrum after the internet - 2

Knows KnowsA little A lot

PatientPrimaryCare

Secondary(hospital)Care

Professor

Muir Gray (January 2005)

The knowledge spectrum after the internet - 3

Knows KnowsA little A lot

PatientPrimaryCare

Secondary(hospital)Care

Professor

Muir Gray (January 2005)

The mission of the National Knowledge Service is to ensure that all decisions can be based not only on best current knowledge but also on the needs and preferences of the individual patient

Contact Muir Gray- muir.gray@his.ox.ac.uk1/1/2005

Better Consultations, Better Decisions, Better Communication

Generation

Organisation

Localisation

Mobilisation

Utilisation

National Knowledge Service

Co-ordinated procurement &Production (£100M) National Library for Health (£50M)NHS Direct Online

Map of Medicine

NHS Care Records ServiceN3National decision support service

Patient & professional Education & services

QuestionAnsweringService

Muir Gray (January 2005)

Ignorance is like cholera; it cannot be controlled by

the individual alone it requires the organised

efforts of society

Muir Gray (January 2005)

Delivering the benefits from CfH

Key knowledge management principles Making knowledge the enemy of disease Supporting decisions that patients make Supporting decisions in clinical practice Creating and mobilising the knowledge base Using knowledge in the consultation process Integrating knowledge into learning and

decision making

Assessment

Tests

Intervention Diagnosis and Decision

Results

Picture Archiving and Communication

System

Order Communications

1. Existing knowledge

sources

2. New sources

3. Present Knowledge ‘in patient’ context

4. Suggest appropriate decision –

patient specific

Choose and Book

Electronic Transmission of Prescriptions

Care Records Service

A vision of using knowledge in the consultation process

Warranted codified knowledge

KnowledgeDelivery

Disseminate knowledge

through existing local professional

activity

Capture local experience

Capture knowledge from

growing information base

– eg care pathways

Local healthcare professional communities of practice

Knowledge from local innovations

Local learning and dissemination

Knowledge used in the consultation

National learning and dissemination

Disseminate knowledge e.g.

Map of Medicine

KnowledgeAcquisition

National Specialist Groups

A vision of integrating knowledge into learning and decision making

Clinical Knowledge Management

Do Once and Share – developing clinical pathways (Sharing)

Map of Medicine and national clinical guidelines (Evidence)

Communities of clinical practice (People / Experts)

National Library for Health (Resources)Single Search

Environment (Search and Retrieval)

Virtual Learning Environment (Learning)

National care record / Data spine / common IT / common coding (Technology)

And finally from Muir Gray….

“Love your librarian and free her from the library”

Muir Gray (January 2005)

A new role for librarians?

HCLU review outcomes Focus on core business Professional development New roles for new times Improved communication

A new role for librarians?

Do Once and Share50 clinical areas

Developing common care pathways Communities of interest Giving context to the technology

Librarian role active clinical engagement Access to clinical knowledge resources Works alongside clinical team

18 week target – using data effectively

Background NATCANSAT commissioned to develop data

warehouse for SHA HES Clearnet data (CDS) Ambulance A+E Diagnostics

Outputs to assist in development of strategic configuration of services and Monitor diagnostic

18 week target – using data effectively

Most recently to develop models to understand pinch points in the 18-week referral to treatment pathway

NATCANSAT working with DH and pioneer Trusts.

Following slides courtesy of Dr Brian Cottier – Head of National Cancer Services Analysis Team (NATCANSAT) – March 2006

Hospital “X” PAS Data

IP Episodes 331,207OP Episodes 1,010,713AED Episodes 217,756Imaging Procedures 1,172,398Endoscopy Procedures 79,048

ReferralReceived

DateElective Date

Imaging

Endoscopy

Pathology

BookAnotherOP Visit

Admission ProcedureOP Visit(1 to n)

GP Referral

InterConsultant

Referral

AED Referral

Discharge

Discharge

Elective Surgery

Frequency of Procedures

Count Of EPIKEY Trust

Procedure Level 2Aintree Hospitals

NHS TrustDiag.Endo.Exam/Lower Bowel Using Fibreoptic Sigmoidosco 7,086Other Excision of Lesion of Skin 5,876Destruction of Haemorrhoid 3,456Diagnostic Fibreoptic Endoscopic Exam/Upper Gastrointe 3,372Other Operations On Varicose Vein of Leg 3,092Primary Repair of Inguinal Hernia 2,781Excision of Gall Bladder 2,059Diagnostic Endoscopic Examination of Colon 1,468Ligation of Varicose Vein of Leg 1,445Transluminal Operations On Femoral Artery 1,242Injection Into Varicose Vein of Leg 1,037Other Excision of Breast 868Diag.Endo.Exam/Sigmoid Colon Using Rigid Sigmoidoscope 851Block Dissection of Lymph Nodes 619Excision of Haemorrhoid 566Excision of Nail 513Excision of Rectum 491Total Excision of Breast 490

Breast SurgeryElective

Joint ReplacementsHips & Knees

PAS#

RAD Proc Code

RAD Proc Description

RAD Consultant

RAD Cons Spec

RAD Cons Spec Code

RAD Procedure

DateXYZ2134 HIPB Plain TM (ORTHOPAE) 110 11-Jun-03XYZ2134 KNEB Plain TM (ORTHOPAE) 110 18-Sep-03XYZ2134 HIPB Plain TM (ORTHOPAE) 110 18-Sep-03XYZ2134 SCRT NC TM (ORTHOPAE) 110 13-Nov-03

XYZ2134 HIPR Plain TM (ORTHOPAE) 110 13-Nov-03XYZ2134 PEL Plain TM (ORTHOPAE) 110 28-Apr-04XYZ2134 HIPR Plain TM (ORTHOPAE) 110 6-May-04

PAS# Op Date Operation Description (IP)XYZ2134 4-May-04 Total Prosthetic Replacement of Hip Joint Using CementXYZ2134 14-Dec-04 Other Total Prosthetic Replacement of Knee Joint

SHA Analysis

Joint Replacements

Imaging Data

RIS Systems

Mod_Name CT

Count Of uniqueid year_procprocedure 1998 1999 2000 2001 2002 2003 Grand TotalCT BRAIN 2,453 2,528 2,917 2,942 2,873 3,019 16,732CT ABDOMEN GENERAL ENHANCED 717 975 1,343 1,397 1,501 1,548 7,481CT LUNGS ENHANCED 500 750 816 796 915 810 4,587CT LIVER ENHANCED 524 647 744 789 736 691 4,131CT LUNGS 800 725 740 501 489 380 3,635CT AORTA (ABDOMINAL) ENHANCED 235 281 361 307 378 512 2,074CT ABDOMEN GENERAL 462 281 312 277 270 301 1,903CT BRAIN ENHANCED 253 254 323 334 293 392 1,849CT SINUSES 290 211 192 294 284 438 1,709CT PANCREAS ENHANCED 209 328 360 211 219 133 1,460CT KIDNEYS ENHANCED 96 109 148 180 146 149 828CT PELVIS ENHANCED 114 148 152 155 89 61 719CT PELVIS 158 157 103 91 96 112 717CT LIVER 176 122 104 123 69 56 650CT BIOPSY 101 89 115 96 57 54 512CT ABDOMEN COLON ENHANCED 64 166 235 465CT CERVICAL SPINE 49 40 66 58 82 111 406CT KIDNEYS 53 61 62 68 56 61 361

Modality = CTRoyal Liverpool HospitalRadiology Information System Data Extract

Mod_Name CT

Count Of uniqueid year_procSpec_Name 1998 1999 2000 2001 2002 2003 Grand TotalGeneral medicine 2,087 2,096 2,315 1,999 1,749 2,063 12,309General surgery 1,507 1,722 2,145 2,005 2,140 2,557 12,076Accident and emergency (A&E) 415 469 618 879 1,040 1,121 4,542Geriatric medicine 617 718 752 797 757 755 4,396Gastroenterology 327 525 740 703 642 633 3,570Ear, nose and throat (ENT) 535 443 469 501 544 810 3,302clinical Haemotology 345 341 309 492 709 620 2,816Trauma and orthopaedics 288 315 415 368 391 497 2,274

389 416 356 199 180 236 1,776Urology 234 169 220 262 225 352 1,462Anaesthetics 209 176 269 252 237 308 1,451Nephrology 184 196 241 315 253 258 1,447Cardiology 66 107 135 142 115 228 793Cardiothoracic surgery 191 279 137 2 1 3 613Rheumatology 75 62 113 100 90 87 527Ophthalmology 53 72 63 110 113 107 518General Practice 64 64 89 78 70 104 469Clinical pharmacology 32 44 60 67 31 234

Modality = CTRoyal Liverpool HospitalRadiology Information System Data Extract

Lessons from the 18 week exercise

To develop analysis methodologiesInform PAS system developmentEstablish a baseline position

National SHA Trust Specialty

To identify “Pinch Points”

Summary and conclusions

You may now open the Knowledge Management question paper

You have until 2010 to complete all questions

You may begin

Did it all sink in? Any questions?