Getting Knowledge into Action for Best Quality Healthcare
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Getting Knowledge into Action for Best Quality Healthcare

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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 ...

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.

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Getting Knowledge into Action for Best Quality Healthcare Getting Knowledge into Action for Best Quality Healthcare Presentation 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
    • Review the evidence base for what works in getting knowledge into action.
    • 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
  • Content creation Standards: metadata, taxonomy, content structure Actionable knowledge at point of care ONLINE Actionable Knowledge Relevant Evidence All Literature Clinical Content Management
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  • Developing local improvement stories Widening our improvement conversations and networks Profound Knowledge – Know-Hou & Evidence of Standards – Know-what Adopt & Adapt Improvement Tools and Technology Harvest and share and enable new ideas Sharing experiences and embedding the improvement culture Measuring the effectiveness of improvement activities Individual Microsystem frontline Mesosystem Middle mgrs Macrosystem Policy Real time tests of change Improvement Evidence Knowledge Flow and Quality Improvement across the Organisation
    • Workplace VLE
    • Communities of Practice
    Developing a culture of improvement
  • Clinical knowledge content teams- working with communities to create clinical content; package and organise as “actionable knowledge” – bundles, decision support, mobile apps etc. C linical 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 [email_address] [email_address]