Implementing Knowledge into Actionin Scotland’s Health and Social Services

A brief overview

Masterclass Day 1 18th March 2014

Dr Ann Wales Programme Director for Knowledge Management Ann.wales@nes.scot.nhs.uk

Overview

1. Why Knowledge into Action?

2. What is the model?• Types of knowledge• Implementation methods

3. How is it making a difference?

Why Knowledge into Action?

Values: Care that is:

• Safe

• Effective

• Person-Centred

Knowledge Service

ProvideKnowledge

Share and Apply KnowledgeConnecting to:

• People’s experience of care.

• Day to day working lives of healthcare staff.

NationalKnowledge into Action Review (2011-12)

Knowing• Knowledge Network -

12 million + resources• Knowledge products –

SIGN, HIS, HPS, NES IRISS, etc as “knowledge broker” organisations.

www.knowledge.scot.nhs.uk

Doing?

How much of this gets used in a meaningful way to improve safe, effective, person-centred care?

Need for a new knowledge paradigm

1. Limitations of research evidence – 15%-20% of clinical issues. Williamson 1979, Sackett, 1995.

2. Information overload- “Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?” Bastian, H. et al 2010

3. Context: Overestimation of impact in research studies compared with real-life contexts.

Ioannidis, 2011.

4. Personalisation: Limitations in applying research results and guidelines to individual patients with complex needs. Kent, 2007; Lutgenberg, 2009.

Translating Knowledge into Quality Care

Research KnowledgeMEDLINE, ASSIA,

Cochrane etc

Know-What

Quality

Care & Support

Doing the right thing

Doing it right

Care

Decisions

Improvement Knowledge:

Practice, People, Context, System

Know-How

“Profound

Knowledge”

Change systems and behaviours

Adapted from: Glasziou, P et al. Can evidence-basedmedicine and clinical quality improvement learn fromeach other? 2011. BMJ Qual Saf 20 (suppl 1): i13-i17

Embed knowledge in

workflow

Designing a Knowledge System for Scotland’s Health and Social Services

1. What conceptual knowledge translation frameworks can help us to design a new approach to get knowledge into practice?

2. To inform our action plan, what practical knowledge translation interventions have evidence of improving practice?

Conceptual Frameworks1. Implementational • Focus on well-defined, codified knowledge - e.g. clinical

guidelines. • Planned action theory of change.

2. Interactional • Social knowing and learning about how to change

practice . • Problem solving theory, social learning theory of change.

3. Context and Agency• Capability, Capacity, Culture.• Organisational / Systems theory of change

Implementational Example

Knowledge to Action FrameworkGraham and Logan, 2006

Interactional Example

Knowledge Transfer Process Model Ward et al 2010

Context and Agency Example

Normalisation Process Theory: May and Finch 2009

Evidence-BasedKnowledge into Action Methods

1. Knowledge in actionable formats:• Clinical pathways; checklists; bundles; computerised

decision support; audit and feedback.

2. Social knowledge approaches: • Communities and networks of practice, social

networking, interactive learning approaches.

3. Addressing factors in the wider organisational culture• Leadership, capabilities, change agents.

Congruence of Theory and Practice

• Conceptual Frameworks

• Implementational

• Interactional

• Context and agency

• Methods

• Actionable knowledge

• Social knowledge

• Organisation environment

Knowledge into Action Model

Know-what• Journals

• MEDLINE

• Cochrane

Know-where• Systems

• Processes

• Variation

Know-who• Service user

• Practitioner

• Teams

Practice

Experience

Research

Know-what

Can this intervention work?

How can we make it work best

in this context, for this person?

Knowledge broker network• Search & synthesis

• Actionable knowledge• Social knowledge

• Organisational knowledge

Methods and Agents

Actionable knowledge• Decision support

• Pathways

• Mobile apps

Relational use of knowledge• Communities of

Practice

• Social networking

• Social learning

Organisational enablers• Backing at

national and board level

• Tests of change to embed approaches

• Skills development

Change Agents:Knowledge Broker

Network

Search & synthesis• Evidence from

research, practice and experience

• Rapid reviews

Expertise in:

* Evidence search, synthesis.

* Presenting knowledge as decision aids * Facilitating sharing of knowledge

* Planned dissemination and uptake

* Building workforce KM capabilities

From librarians to knowledge brokers

How is Knowledge into Action Making a Difference?

Examples

Decision support in SCI-Diabetes

Community of Practice –Tailoring Decision Support

1. Reviews audit data to determine impact of decision support on practice.

2. Shares experience of using decision support – e.g. overriding in complex cases with multiple conditions.

3. Refines and adapts implementation approach.

Knowledge into action in nursery care

• Nursery identified need for reminders to implement training on language development recently cascaded to all staff

• They created a card with a checklist to hang from their security badges.

• Administrator identified as a knowledge broker; planning knowledge management training with her.

Summing up• New paradigm for managing knowledge in health and

social services.

• Grounded in theory and evidence.

• Know-how as important as Know-what

• Evidence-based implementation methods

• Operationalised as practical methods and support to improve quality of care.