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

  • Knowledge management inmental health services: therole of NHS librariesCatherine EbenezerCISPBSeptember 13th 2002
  • What is KM?A re-working /re-thinking offamiliar concepts: Information management The “learning organisation” “info-mapping” Resourced-based theories of theorganisationetc.(Corrall 1999)
  • 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)
  • 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)
  • Definitions of KM (2)• “Knowledge managementinvolves efficiently connectingthose who need to know, andconverting personal knowledgeinto organisational knowledge”(Godbolt 2002, after Yankee Group 2000)
  • Definitions of KM (3)“Knowledge management is thetask of developing andexploiting an organisation’stangible and intangibleknowledge assets”(DH 2001)
  • …but…“People who define knowledgemanagement are charlatans andcarpetbaggers”David Snowden, IBM Global Services
  • Aspects of knowledge (1) Data Information Knowledge Wisdom…with apologies to T S Eliot
  • 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
  • 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)
  • 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)
  • Aspects of KM (1) Content Infrastructure Skills Culture(Haines 2001)
  • Aspects of KM (2)Two different emphases: Codification Accessing and re-using existingknowledge Personalisation Capturing tacit knowledge
  • Aspects of KM andtechnology enablers
  • Basic KM technologies Intranets Relational databases Groupware (e.g. Lotus Notes) Document management systems Data mining/data warehousingwww.billinmon.com
  • 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)
  • 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)
  • 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)
  • 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)
  • 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
  • The “bad old days” (2)Major disadvantages: Involved time away from theclinical area A poor use of a busyclinician’s time
  • 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”
  • 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)
  • 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
  • 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
  • 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?
  • 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
  • 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…..
  • 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
  • The National electronicLibrary for Health (NeLH) Knowledge Cochrane Library etc. Know-howExplicit Clinical guidelinesTacit (development process) Knowledge managementwww.nelh.nhs.uk
  • 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
  • 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
  • NeLH home page
  • NeLMH home page
  • 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
  • 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
  • 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
  • The clinical intranet: futuredevelopments? How can clinical intranetsprovide context-sensitive linkingto external information sources? How useful are decision supportsystems (DSS)??
  • 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)
  • Roles of the librarian insupporting EBP Evidencelocator Educator Disseminator Criticalappraiser Resourceprovider Quality filterAfter Booth (2000)
  • 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
  • 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
  • Library intranet:home page
  • Library intranet:web subject guides
  • Library intranet:health statistics
  • Library intranet pages:list of electronic journals
  • Knowledgesharehome page www.knowledgeshare.nhs.uk
  • Knowledgesharenewsletter
  • 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/
  • 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
  • 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