getting knowledge into action for best quality healthcare
DESCRIPTION
NHS Education for Scotland and Healthcare Improvement Scotland are working with NHS Boards to define new approaches to implementing and sharing knowledge which support practitioners to get knowledge into action at the frontline. This shift in focus from accessing to applying knowledge will integrate knowledge management more closely with quality improvement. This interactive workshop will use creative knowledge management techniques to challenge the way we apply knowledge in practice.TRANSCRIPT
Knowledge into Action –to improve quality of care
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
“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.
“Yes, it’s quite a noise – - but are we having any impact?”
The challenge for getting knowledge into action…..
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)
• 12 million + resources
• How much of this gets used in a meaningful way to improve safe, effective, person-centred care?
From Accessing to Applying Knowledge
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
Method of Review
1) Review the evidence base for what works in getting knowledge into action.
2) Gap analysis
3) Tests of change
4) Stakeholder engagement, strategic sponsorship.
What works in getting knowledge into action?
A Strong Knowledge Infrastructure
Evidence that knowledge works
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’s
3) Organisational / Systems approaches- Barriers and Levers
Adapted librarian roles to support all above
3 Key Approaches
Examples of Knowledge into Action Approaches
ONLINE
ActionableKnowledge
RelevantEvidence
All Literature
Clinical Content Management
Content creation
Standards: metadata, taxonomy, content structure
Actionable knowledge at point of care
Developing local
improvement stories
Widening our improvement conversations and networks
ProfoundKnowledge – Know-Hou
&Evidence of Standards –
Know-what
Adopt & Adapt Improvement Tools and Technology
Harvest andshare and
enable new ideas
Sharing experiences and embedding the improvement
cultureMeasuring the effectiveness
of improvement activities
Individual Microsystemfrontline
MesosystemMiddle mgrs
Macrosystem Policy
Real time tests of change
Improvement Evidence
• Workplace VLE• Communities of Practice
Developing a culture of
improvement
Knowledge Flow and Quality ImprovementKnowledge Flow and Quality Improvementacross the Organisationacross the Organisation
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
“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
Knowledge into Action Stories
What can we learn from them and how can we improve?
“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.”
Patient and staff story….
From patientstories.org.uk
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?
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?
Creating a new story…
Define uptake interventions!
Build relationships!
Analyse the context!
Knowledge into Action: interventions & strategies
Knowledge into Action Menu Card (1):Knowledge Uptake Interventions
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
The evidence tells us that the following approaches can help to get knowledge into action:
Knowledge into Action Menu Card (2):Share knowledge through social systems
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
The evidence tells us that the following approaches can help to get knowledge into action:
Knowledge into Action Menu Card (3):Analyse organisational context
• 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.
The evidence tells us that the following approaches can help to get knowledge into action:
Knowledge into Action –to improve quality of care