Making Library & Knowledge Services Business critical
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UHMLG Spring Forum March 2017
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Making Library & Knowledge Services Business critical
- 1. Making library and knowledge services Business critical Anne Gray UHMLG Spring Forum 24 March 2017
- 2. Becoming Business Critical…. HLG conference 2016
- 3. What is business critical? – Department of Health – 27 agencies & public bodies;17 overarching policies – NHS England mandate 2017/18 • Objectives - reducing inequalities; improving quality of care; balance the books; prevention; meet core standards of care; improving out of hospital care; support research, innovation and growth • Translates into - STPs, Five Year Forward View, seven day NHS, Carter Review, Francis report, NHS Operational Planning and Contracting Guidance 2017-9, CQUINs – Your Trust?
- 4. The business of health [Health Foundation 2016]
- 5. Know your customer • What is business critical in your trust? • Understand national and local drivers • Speak the language Provide a tailored service
- 6. Managers’ behaviour Research around managers behaviours – What they need – Where they look – How they use evidence Virtually all managers see information use as important [Edwards 2013] Commissioners appear to be well intentioned but ad hoc users of research [Wilson 2017]
- 7. Evidence based decision making “For commissioners, the word ‘evidence’ often meant any source of information other than personal experience and anecdotes.” [Wye 2015a] ‘Evidence-based policy-making’ usually meant pragmatic selection of ‘evidence’ such as best practice guidance, clinicians’ and users’ views of services and innovations from elsewhere. “ [Wye 2014]
- 8. Managers’ evidence questions • How can we improve this service/pathway? • What does “good” look like? • How have others done it? • Outcomes – intelligence / KPIs • Can we reduce the cost? • How do we compare with others - benchmarking • New models of care • What is the government saying? • Keep me up to date
- 9. Searching habits • Difficult to find commissioning/management evidence either through lack of time, information overload, or not knowing where to find it. • Look for themselves or rely on colleagues • Like email discussion lists & alerts • NHS sources are constantly changing and confusing (want a “one stop shop”) • Don’t ask the library unless they have had previous contact • Library staff also found it difficult
- 10. Where do managers look? The five most frequently used sources (weekly/daily) • views/experiences of colleagues • search engines • front-line staff • NHS websites • email discussion lists and alerts [Edwards 2013]
- 11. Using the evidence “Evidence is context-dependent – “Local processes and professional and microsystem considerations played a significant role in adoption and implementation” “evidence is not ‘taken up’ in practice…Rather, it is co- produced…and becomes a prosthetic device that equips managers, and other actors, in their pursuit of decisions and practical ends… evidence becomes meaningful as a tool for knowing in practice.” “Evidence was continuously interpreted and (re)constructed by professional identity, organisational role, team membership, audience and organisational goals.” [Swann 2012, Kyratsis 2014]
- 12. Using the evidence • CEOs seek information and use knowledge all the time, for three main purposes: – making decisions – accounting for decisions already made – making sense [Nicolini 2014]
- 13. Learning from the research • A different understanding of “evidence” – local and generic • Managers want “high quality” evidence but there is too much of it, it is difficult to access and takes too long • What is happening locally is key • Colleague/team discussions are critical to decision making – “in the room” • Evidence is reconstructed as part of the decision making process • Will use local library services with encouragement
- 14. Librarians and knowledge managers as knowledge mobilizers • “very heavy use of services by some managers who had established close working relationships with their librarians. However, libraries are often seen primarily as repositories of clinical or research based information.” • “Being set apart from the organisation (physically or in terms of involvement in organisational processes) may impede [librarians’] ability to be more proactive in the services they offer to managers.” • “generic technical search skills, while useful, do not guide users to management sources or assist them in critically evaluating the usefulness of the information found” [Edwards 2013]
- 15. A “plurality” of sources [Swan 2012]
- 16. Sourcing the evidence Health Serv Deliv Res
- 17. Mobilising the evidence I like reports, presentations and easy read data. I get frustrated … …if there is no exec summary/findings up front. …if the report is not really getting to the point quickly. It can lay the findings behind this, but tell me quickly what’s the purpose, outcomes. CCG commissioner
- 18. Presenting the evidence Bullet points Summary Sources • Don’t lose the locality detail • Document where you looked • Don’t go beyond your competence • Ensure people can link to the original evidence easily • Client deadline • How long did it take? – tell the client
- 19. Going forward.. Think about • A service model to help my customer • Searching skills to identify the plurality of evidence • Report formats to meet the business need
- 20. BibliographyKnowledge for Healthcare Becoming Business Critical…. Making it happen. Presentation at HLG conference Sept 2016 http://www.cilip.org.uk/sites/default/files/documents/louisegoswamipatrickmitchell.compressed.pdf Edwards 2013 Explaining Health Managers’ Information Seeking Behaviour and Use. Final report. NIHR Service Delivery and Organisation programme; 2013) http://www.nets.nihr.ac.uk/projects/hsdr/081808243 Health Foundation, 2016 Simpler, clearer, more stable: Integrated accountability for integrated care. http://www.health.org.uk/publication/simpler-clearer-more-stable Kyratsis 2014 Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in health care. Health Services and Delivery Research. http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-6#abstract Nicolini 2014 Keeping knowledgeable: how NHS chief executive officers mobilise knowledge and information in their daily work. Health Serv Deliv Res 2014;2(26). http://www.journalslibrary.nihr.ac.uk/hsdr/volume-2/issue-26 Swan 2012 Evidence in Management Decisions ( EMD ) - Advancing Knowledge Utilization in Healthcare Management. http://www.nets.nihr.ac.uk/projects/hsdr/081808244 Wilson et al. 2017 Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: a controlled before-and-after study. Health Serv Deliv Res2017;5(5) https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr05050#/abstract Wye 2014 Evidence based policy making and the ‘art’ of commissioning – how English healthcare commissioners access and use information and academic research in ‘real life’ decision-making: an empirical qualitative study. BMC Health Services Research (2015) 15:430. http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015- 1091-x Wye 2015 Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011–14. Health Serv Deliv Res 2015;3(19) http://www.journalslibrary.nihr.ac.uk/hsdr/volume- 3/issue-19#table-of-contents
Editor's Notes
- A bit of background I joined a PCT as Commissioning Librarian in 2008 and supported it through the hiatus of the Health and Social Care Act to a CCG and subsequent changes. In 2013 I as TUPEd over to a Commissioning Support Unit, but carried over my evidence support role, but for a larger footprint including many CCGs and the CSU itself. In the PCT/CCG I provided an embedded evidence service supporting service redesign and CCG authorisation through alerting services, team support and ad hoc searches. Critical here is embedded – I was part of project teams, attending meetings and submitting reports to the team in the same way a clinical librarian attends ward rounds and responding, both to verbalised requests but also proactively as well as guiding my alerting services. This activity has been highlighted by the KfH framework
- Title taken from HLG plenary presentation from Patrick Mitchell HEE Regional Director, South of England “Knowledge for Healthcare Becoming Business Critical…. Making it happen” http://www.cilip.org.uk/sites/default/files/documents/louisegoswamipatrickmitchell.compressed.pdf He emphasised the importance of evidence from bedside to boardroom, but we tend to shy away from the boardroom. LKS clearly have a role to support evidence based clinical education and practice, and research, but there is an increasing discussion about evidence based policy and management decisions. Some LKS have been actively supporting management and commissioning decision making, but the profile of LKS support for EBP has been raised by the KfH framework. So I want to tell you something of the key research and learning supporting the development of library services for managers, my experiences, how LKS can learn from it.
- The NHS is a business – first thing I was told at an induction course when I joined NHS. A business with a financial envelope and political masters. DH sets the agenda and budget - 17 policies including health and social care integration, NHS efficiency, LTC, public health, Cancer research and treatment, patient safety 27 agencies and ALBs – one of which is NHS England, NHS Digital, CQC, HEE, NHS Improvement NHS E mandate which sets the direction for the NHS and financial envelope for the following year. NHS England 2017/18 mandate there are 7 over riding objectives some of which will depend on development of STPs, with cross organisational boundaries. This translates into a range of business critical initiatives for NHSE the most important being STPs and Five year Forward View. But also seven day NHS, Carter Review, Francis report, and the “must dos” in the NHS Operational Planning and Contracting Guidance 2017-9. Just waiting for NHS E Business/ Delivery plan – due next week - to give direction for the Five Year forward View. These determine what is in the managers inbox over the next year. What are the key business activities in your trust? – Vanguards, IT initiatives, specialised commissioning, cancer treatment?
- The person in the centre of NHS business is the manager – from the CEO to the project manager looking at reorganising or commissioning a service. Understand who is in the boardroom from the CEO to patient/public representatives
- Find out what is business critical Specific issues eg A&E, services under development, CQUINs, co-commissioning, NHS Improvement, Keogh, vanguards, PACS, MDT, Carter, QIPP; HRG; 2WW; CCG, CSU, JSNA So if you are asked you understand the issues and ask sensible questions and tailor your services
- With the activity around STPs and the disappearance of the commissioner/provider split LKS need to think about service development in the widest sense, including commissioning and service development.
- We have to understand what managers mean by evidence. The research indicates that what we find runs counter to our training. Clinical research and practice is based on well established protocols of RCTs but how the service is organised on the ground which is determined by many factors - staffing levels, estates, number of patients, other available services, political pressures as well as finances.
- So what are the questions - in my language A lot of work going on about developing services across traditional boundaries – in particular taking work out of acute into primary care, care closer to home, hospital at home, virtual wards, extended use of outpatients, wider use of consultants (outside acute).
- Managers not usually trained in finding evidence – exceptions public health and clinicians. But in my experience GPs take their EBP hat off when they enter the boardroom. The research into info seeking behaviour always highlights how difficult it is to find the evidence. It is not conveniently placed or organised. Clearly commissioners rely heavily on colleagues and personal experience. Informal sharing is an important part of the commissioning process. They look for the evidence themselves and that means google and all of its pitfalls, but judicious use of google is a good way to get some of the evidence they need. Mailing lists / alerts – keeping ahead of the curve/horizon scanning are important NHS sources are constantly changing – think of NeLH, Specialist Collections, NHS Improvement (the old one), NHS III and the DH website itself. The exception is public health trained staff who have had training in finding and appraising evidence. But since the HSC Act and their move to LA they are one step removed from the informal commissioning discussions which does affect their influence. Most managers don’t think to ask libraries for this type of evidence, unless they have had previous contact with the library – a training course, induction etc. Finally- librarians too find it difficult to locate evidence for commissioners and managers.
- The analysis of health managers’ information behaviour and use - replies from 2,092 managers in a survey 2009. Before any thoughts of Health & Social Care Act, reconfiguration of the NHS Librarians/Inf Specialists Daily/weekly 10%; Yearly or less 46% Trust libraries/electronic resources Daily/weekly 29%; Yearly or less 28%
- How the evidence is used follows from what we have found about how it is gathered. No nice clean pipeline of development, or PDSA cycle. Very much agrees with my experience in a commissioning environment. Decisions are not made in a single step. May decide on specific components based on the evidence but these are batted around and reinterpreted according to new discussions. There is no Right or Wrong, just Better or Worse and the variables are wide ranging – cost, workforce requirements, geography, patient experience.
- Some of the research around how managers use the evidence once they have it. Consider the work by Gabbay around Mindlines.
- Need to change the view of library services – in the same way that clinical librarians/outreach librarians have revolutionised library services. Get out of the library – be “in the room”. Does not mean literally in the boardroom, but you need to build the relationship with managers in the same way clinicians, so that you can be part of the corridor conversations. Training is of limited value. If librarians find this difficult with our searching skills, why would we expect managers to be able to do this. Our job is to make finding relevant evidence as easy as possible and easily digestible. In my view that means presenting it on a plate (within our competencies).
- So if managers’ evidence needs are different to clinicians’ – what do they need? A study by Swann surveyed 345 individuals across 11 PCTs in 2010. - Demonstrated a plurality of evidence Clinical evidence we would all recognize, guidelines, clinical research, Royal Colleges, professional peer groups. Non clinical evidence – supporting evidence in terms of policies, toolkits, intelligence , benchmarking. Implementation Narrative resources –Include opinions, advice, stories, case studies. While clinical research usually aims to eliminate confounders and variables, these variables of setting are critical to understanding the workings of health services across different geographies. For example service availability, distances, workforce, and demography. You rarely get this level of detail when people describe services in research. Therefore case studies or talking to people may be the best way to understand the “evidence” behind a service. It is because of this spread of resources that LKS are not usually considered when looking for this type of evidence. LKS are linked to clinical journals, textbooks etc, not this “grey” literature. There is work to change that – Stockport Grey literature http://allcatsrgrey.org.uk/wp/
- How are you going to find this evidence? HSJ (no print after next year). The key news resource Most commissioners/managers will get the daily news alerts. Their comms people should be keeping them abreast of the news and media stuff. Dig down to find the documents behind the story eg CCG board paper, report etc. Also helps up keep up to date with what is going on National policies -NHS E/ CQC /PHE/ NHS Improvement/ Public Accounts committee Expert bodies eg KF, Nuffield, Royal Colleges etc. Bibliographic resources Frontline research Magazines/board papers/ NHS Fab stuff – to find case studies Google – a key resource to dig into board papers and reports, much better than search engines on websites. Become a google expert.
- Research says that for day to day business they want business style reports. And preferably before they know they need it. Managers want evidence presented in such a way that they can pick up the key points at a glance, can read a little more if it is interesting then look further using any links they are given. Look at Kings Fund reports – headlines in the form of bullet points, an executive summary and then the full report with references. Very different to clinical research reports.
- Ranges from a single link to a fully synthesised report. Output format depends on the question and timescales.