Knowledge management in mental health services: the role of NHS libraries

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Knowledge management in mental health services: the role of NHS libraries

  1. 1. Knowledge management inmental health services: therole of NHS librariesCatherine EbenezerCISPBSeptember 13th 2002
  2. 2. What is KM?A re-working /re-thinking offamiliar concepts: Information management The “learning organisation” “info-mapping” Resourced-based theories of theorganisationetc.(Corrall 1999)
  3. 3. The roots of KMJapanese management philosophies: Total Quality Management (TQM) Kaizen Just in Timeall rely on Sharing of tacit and explicit knowledge Teamworking Management of change Exploitation of knowledge as a capital assetKeeling, Carole and Lambert, Siân (2000)
  4. 4. Definitions of KM (1)“KM is a strategy employed by anorganisation wherein its collectiveinformation resources, acquiredknowledge and personal talents areshared and managed in order toincrease productivity, create newknowledge and new value, andimprove competitiveness”(Lindsey-King 1998)
  5. 5. Definitions of KM (2)• “Knowledge managementinvolves efficiently connectingthose who need to know, andconverting personal knowledgeinto organisational knowledge”(Godbolt 2002, after Yankee Group 2000)
  6. 6. Definitions of KM (3)“Knowledge management is thetask of developing andexploiting an organisation’stangible and intangibleknowledge assets”(DH 2001)
  7. 7. …but…“People who define knowledgemanagement are charlatans andcarpetbaggers”David Snowden, IBM Global Services
  8. 8. Aspects of knowledge (1) Data Information Knowledge Wisdom…with apologies to T S Eliot
  9. 9. Aspects of knowledge (2) Explicit what we may “know about” via anarticulated and recorded “body ofknowledge” Tacit/implicit acquired through personal learning andexperience reflected in an individual’s capacity foraction could be articulated – but usually isn’t
  10. 10. Aspects of knowledge (3) Knowledge as individual or socialconstruct The organisational environment inwhich people are encouraged tolearn and to share knowledge Aspects of organisational“intelligence” that are amenable toplanning and management processes(Streatfield and Wilson 1999)
  11. 11. A caveat KM concept often associatedparticularly with the adoption ofautomated methods for capturinginformation and making it accessibleBUT – need to understand: representation and organisation ofknowledge behaviour of information usersKM is not solely about IM&T (Perez 1999)
  12. 12. Aspects of KM (1) Content Infrastructure Skills Culture(Haines 2001)
  13. 13. Aspects of KM (2)Two different emphases: Codification Accessing and re-using existingknowledge Personalisation Capturing tacit knowledge
  14. 14. Aspects of KM andtechnology enablers
  15. 15. Basic KM technologies Intranets Relational databases Groupware (e.g. Lotus Notes) Document management systems Data mining/data warehousingwww.billinmon.com
  16. 16. Information retrieval systemdevelopments related to KM Automatic generation of Web pagemetadata (Dublin Core) Relevance ranking Use of “intelligent agents” forsearching and current awareness Automated abstracting and indexing XML (interoperability, dataexchange)
  17. 17. Cf. the (traditional) role of theinformation professional Acquiring and organisinginformation Making it available for use Disseminating it Disposing of it“Librarians have alwaysbeen knowledge managers”(Lindsey-King 1998)
  18. 18. N.B. the information worker’s(tacit) knowledge… The organisational context of apractitioner’s work The patient population What type of information would berelevant How the practitioner works How the information would be used(Fennessy 2001)
  19. 19. NHS “knowledge paradox” Richness in content/poverty ininfrastructureNeLH, guidelines outputcf. access to NHSnet Richness in skillsprogrammes/poverty of KM cultureECDL, CASPcf. lack of organisational development orHR policies to encourage knowledgesharing(after Haines 2001)
  20. 20. The “bad old days” (1)Locating an answer to a clinicalquestion required: A visit in person to the library A literature search using libraryfacilities Locating articles/books within thestacks Placing an ILL request if the itemsnot available locally
  21. 21. The “bad old days” (2)Major disadvantages: Involved time away from theclinical area A poor use of a busyclinician’s time
  22. 22. Mooer’s law“An information retrieval systemwill tend not to be usedwhenever it is more painful andtroublesome for clients toretrieve the information than tolive without it”
  23. 23. The clinician as knowledgeworker Data gathererCapturing and storing data, e.g. admission histories Information userUsing information generated and displayed by a clinicalinformation system Knowledge userUsing sources such as textbooks, research literature, clinical practiceguidelines in interpreting clinical phenomena Knowledge builderGenerating new domain knowledge via clinical research(after Snyder-Halpern 2001)
  24. 24. Factors involved in seekinganswers to clinical questions “Cost” factors (see previous) Urgency of a patient’s problem Expectation that an answer exists KM skillsliterature searchingcritical appraisalbibliographic management-- a major issue
  25. 25. The national policy contextA First Class Service 1997Clinical governance conceptInformation for Health 1998NeLH and VBLsBuilding the Information Core 2001 IM&T implications of NHS PlanHSG(97)47 guidance on libraryservicesMental Health NSF
  26. 26. Role of KM in EBPAs knowledge users, cliniciansand managers have questionsabout: What is best practice? Is it effective? How do interventions compare interms of their relative effectiveness?
  27. 27. Wider KM initiatives inhealth care: (1)Many related to EBP, e.g. Specialised bibliographic databasesDrugScope, HealthPromis Systematic reviews Secondary EBM literatureEffective Health Care, evidence bulletins e.g.Bandolier, abstracting journals e.g. EBMH TRIP guidelines databasewww.tripdatabase.org.uk Clinical trials databases Research gateways e.g. TRIAGE
  28. 28. Wider KM initiatives inhealth care: (2) Centre for Evidence-Based Mental Health –gateway to evidence-based mental healthresources www.psychiatry.ox.ac.uk/cebmh/ Critically Appraised Topics: CATbankwww.jr2.ox.ac.uk/cebm/docs/catbank.html InfoPOEMS clinical awareness systemwww.infopoems.com/index.cfm DIPEX patient experiences databasewww.dipex.org/ CLIP: database of clinical effectivenessinitiativesetc. etc…..
  29. 29. Priorities for information systemand service development…. locate decision support tools as nearas possible to the clinical decisionmaker, so as to reduce the perceivedresource costs provide reliable, high-qualityinformation resources that are user-friendly and convenient integrate information resources withclinical information systems
  30. 30. The National electronicLibrary for Health (NeLH) Knowledge Cochrane Library etc. Know-howExplicit Clinical guidelinesTacit (development process) Knowledge managementwww.nelh.nhs.uk
  31. 31. The National electronicLibrary for Health (NeLH) Main NeLHto integrate with local intranet content Virtual Branch Libraries (VBLs)e.g. NeLMH, NeLLD, NeLKM Professional portalsportals for PAMs and librarians nowavailable-- Link to and support (not replace)existing NHS libraries
  32. 32. NeLH developments1999-2003 Integrating knowledge resources at thepoint of care Access to answers to questions at thepoint of care from with the EHR/EPRwww.nhsia.nhs.uk/nelh/ National Knowledge ServiceFurther integration of NeLH and nationallypurchased information resources with NHSlibraries
  33. 33. NeLH home page
  34. 34. NeLMH home page
  35. 35. Maximising access to explicitknowledge: the clinical intranet Organisational informationgenerated locally – “corporate memory”directories (e.g. services, courses)databases ( e.g. vacancies)documents (e.g.newsletters, policies, protocols)other systems (e.g. IT helpdesk) Training deliverygenerated nationally or internationally Virtual Learning Centre
  36. 36. The clinical intranet: cont’d“Soft” clinical informationgenerated locally, nationally, internationallyBibliographic databasesPubMed, Cochrane Library etc.Other research evidenceBMJ Clinical Evidence, Bandolier etc.Clinical databases e.g. OMIMReference sources e.g. eBNFClinical guidelines e.g. TRIPCare pathwaysPatient information leaflets
  37. 37. The clinical intranet: cont’d “Hard” clinical information:computerised patient recordgenerated locallyClinical intranet providesseamless accesse.g Oxford Clinical IntranetCCS soon to be available via SLAM intranet
  38. 38. The clinical intranet: futuredevelopments? How can clinical intranetsprovide context-sensitive linkingto external information sources? How useful are decision supportsystems (DSS)??
  39. 39. Using and harvesting implicitknowledge Promoting collaborative working in projectteams using networked applications groupware bibliographic management systems Fostering professional networks viacommunication facilities web logs (“blogs”) mailing lists/listservs discussion boards newsgroups Auditing skills/building expertise databases(after Lacey Bryant 2001, Corrall 1999)
  40. 40. Roles of the librarian insupporting EBP Evidencelocator Educator Disseminator Criticalappraiser Resourceprovider Quality filterAfter Booth (2000)
  41. 41. Common health libraryKM activities: (1)Information services need to act asintermediaries between healthpractitioners and the knowledge available Working to improve networked access tothe knowledge base, e.g. by buildingweb/intranet sites Information skills training/outreach:locating and using clinical evidence--access to knowledge does not change clinicianbehaviour by itself Compiling lists of/guides to resources Providing current awareness services
  42. 42. Common health libraryKM activities: (2)Reay House library intranet pagesinclude: Web subject guides Lists of freely-accessible Web databases Presentations on health information topics Links to full text electronic journals andbooks Advice on sources of research information,critical appraisal, PDA use, pay-per-usedocument supply etc. Networked access to indexing/abstractingservices (proposed) e.g. HMIC, EMBASE
  43. 43. Library intranet:home page
  44. 44. Library intranet:web subject guides
  45. 45. Library intranet:health statistics
  46. 46. Library intranet pages:list of electronic journals
  47. 47. Knowledgesharehome page www.knowledgeshare.nhs.uk
  48. 48. Knowledgesharenewsletter
  49. 49. ReferencesBerkman, Eric. (2001) When bad things happen to good ideas.Darwin Online, April. At http://www.darwinmag.com/Bixler, Charlie. KM in ever-changing times. Application DevelopmentTrends October 2001. At http://www.adtmag.comCorrall, Sheila (1999). Are we in the knowledge managementbusiness? Ariadne 18. At www.ariadne.ac.uk/issue 18/Fennessy, Gabby (2001). Knowledge management in evidence-basedhealthcare: issues raised when specialist information services searchfor the evidence. Health Informatics Journal 7 4-7Godbolt, Shane (2002) Knowledge management: a practicalapproach. Presentation given at Research, Evidence and Knowledgein Health conference February 2002. At http://www.londonlinks.ac.uk/
  50. 50. References (cont’d.)Graeber, Stefan and Geib, Dieter. Clinical workstations supportingevidence based medicine. In Hasman, A ed. Medical Infobahn forEurope. IOS 2000; pp. 14-17.Haines, Maggie (2001) Knowledge management in the NHS – platformfor change. Presentation given at NHSIA conference, Birmingham,26/11/01. At http://www.nhsia.nhs.ukKeeling, Carole and Lambert, Siân (2000). Knowledge management inthe NHS: positioning the healthcare librarian at the knowledgeintersection. Health Libraries Review 17 136-143Lacey Bryant, Sue (2001) Putting the knowledge base to work.Clinical Governance Bulletin 2(5) 14-15)Lindsey-King, Cathy. Knowledge management: your link to thefuture. Bibliotheca Medica Canadiana 20(2) 74-75
  51. 51. References (cont’d.)Perez, Ernest (1999). Knowledge management in the library – not.Database 22(2) 75f.Shortliffe, Edward H (1999). The evolution of electronic medical records.Academic Medicine 74(4) 414-419Streatfield, David and Wilson, Tom (1999). Deconstructing„knowledge management‟. Aslib Proceedings 51(3) 67-71Snyder-Halpern, Rita et al. (2001) Developing clinicalpractice environments supporting the knowledge work of nurses.Computers in Nursing 19(1) 17-26

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