A perspective of Knowledge Management in the NHS

1. A perspective of Knowledge Management in the NHS Dr Jim Hughes Head of Knowledge Management Cheshire and Merseyside SHA

2. Broad questions • What does the Head of KM in Cheshire and Merseyside SHA do? • A(nother) definition of KM! • NHS KM and Connecting for Health • New role for librarians? • 18 week target – using data effectively

3. What does Head of KM do? • Internal role • IT services and Informatics • Library service • Freedom of Information • Knowledge Management – e-filing, effective use of tools, technology and people to work smarter

4. Job description – cut down this tree Tools available Tools / people required

5. What does Head of KM do? ‘SOFT’ KM • External • Line manage Health Care Libraries Unit (HCLU) • CfH - knowledge management • North West VLE (e-learning) • Data warehouse • PCT Shared services – Information knowledge management / contract management • Public Health ; Dr Foster; TIS • KM in – Practice based Commissioning; Management of Long term Conditions ‘HARD’ KM

6. So much to know, so little time!

7. A(nother) definition of knowledge management • A healthy mix of:- • Tools • Technology • Processes • People • Organisations • Behaviours • Culture

8. A(nother) definition of knowledge management • What do we do with it? • Capture • Code • Store (organise) • Access • Disseminate – MOBILISE – collaborate - share Put it back in!

9. A(nother) definition of knowledge management • And of course - the management bit • Strategy • Implement • Monitor • Evaluate

10. Connecting for Health - KM • Directorate of clinical knowledge process and safety led by Sir Muir Gray http://www.connectingforhealth.nhs.uk/delivery/serviceimplementation/kps/ • The following eleven slides are taken from Muir Gray’s presentation on the National Knowledge Service taken from the above public web site.

11. The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade Muir Gray (January 2005)

12. Errors and mistakes Poor quality healthcare Waste Unknowing variations in policy and practice Poor patient experience Overenthusiastic adoption of interventions of low value Failure to get new evidence into practice The application of what we know can prevent and minimise the 7 ubiquitous healthcare problems Muir Gray (January 2005)

13. 3 types of generalisable knowledge Knowledge from research - Evidence Knowledge from measurement of healthcare performance - Statistics Knowledge from experience - Of patients and clinicians 2 types of particular knowledge Knowledge about this patient Knowledge about this service Muir Gray (January 2005)

14. For good health people need pure clear knowledge, just as they need pure clear water Muir Gray (January 2005)

15. The knowledge spectrum before the internet Knows Knows A little A lot Secondary (hospital) Care Professor Patient PrimaryCare Muir Gray (January 2005)

16. The knowledge spectrum after the internet -1 Knows Knows A little A lot Secondary (hospital) Care Professor PrimaryCare Patient Muir Gray (January 2005)

17. The knowledge spectrum after the internet - 2 Knows Knows A little A lot Professor PrimaryCare Secondary (hospital) Care Patient Muir Gray (January 2005)

18. The knowledge spectrum after the internet - 3 Knows Knows A little A lot PrimaryCare Secondary (hospital) Care Professor Patient Muir Gray (January 2005)

19. The mission of the National Knowledge Service is toensure that all decisions can be based not only on best current knowledge but also on the needs and preferences of the individual patient Contact Muir Gray- muir.gray@his.ox.ac.uk 1/1/2005

20. National Knowledge Service Generation Organisation Localisation Mobilisation Utilisation Co-ordinated procurement & Production (£100M) National Library for Health (£50M) NHS Direct Online Map of Medicine NHS Care Records Service N3 National decision support service Patient & professional Education & services Question Answering Service Better Consultations, Better Decisions, Better Communication Muir Gray (January 2005)

21. Ignorance is like cholera; it cannot be controlled by the individual alone it requires the organised efforts of society Muir Gray (January 2005)

22. Delivering the benefits from CfH • Key knowledge management principles • Making knowledge the enemy of disease • Supporting decisions that patients make • Supporting decisions in clinical practice • Creating and mobilising the knowledge base • Using knowledge in the consultation process • Integrating knowledge into learning and decision making

23. A vision of using knowledge in the consultation process Picture Archiving and Communication System Order Communications Tests Results Assessment Diagnosis and Decision Intervention 1. Existing knowledge sources 2. New sources 3. Present Knowledge ‘in patient’ context 4. Suggest appropriate decision – patient specific Care Records Service Choose and Book Electronic Transmission of Prescriptions

24. A vision of integrating knowledge into learning and decision making Knowledge used in the consultation Knowledge from local innovations Knowledge Delivery National Specialist Groups Knowledge Acquisition Warranted codified knowledge Capture knowledge from growing information base – eg care pathways Disseminate knowledge e.g. Map of Medicine National learning and dissemination Disseminate knowledge through existing local professional activity Capture local experience Local learning and dissemination Local healthcare professional communities of practice

25. Clinical Knowledge Management Do Once and Share – developing clinical pathways (Sharing) Map of Medicine and national clinical guidelines (Evidence) National Library for Health (Resources) Single Search Environment (Search and Retrieval) Communities of clinical practice (People / Experts) Virtual Learning Environment (Learning) National care record / Data spine / common IT / common coding (Technology)

26. And finally from Muir Gray…. • “Love your librarian and free her from the library” Muir Gray (January 2005)

27. A new role for librarians? • HCLU review outcomes • Focus on core business • Professional development • New roles for new times • Improved communication

28. A new role for librarians? • Do Once and Share • 50 clinical areas • Developing common care pathways • Communities of interest • Giving context to the technology • Librarian role • active clinical engagement • Access to clinical knowledge resources • Works alongside clinical team

29. 18 week target – using data effectively • Background • NATCANSAT commissioned to develop data warehouse for SHA • HES • Clearnet data (CDS) • Ambulance • A+E • Diagnostics • Outputs to assist in development of strategic configuration of services and Monitor diagnostic

30. 18 week target – using data effectively • Most recently to develop models to understand pinch points in the 18-week referral to treatment pathway • NATCANSAT working with DH and pioneer Trusts. • Following slides courtesy of Dr Brian Cottier – Head of National Cancer Services Analysis Team (NATCANSAT) – March 2006

31. Hospital “X” PAS Data • IP Episodes 331,207 • OP Episodes 1,010,713 • AED Episodes 217,756 • Imaging Procedures 1,172,398 • Endoscopy Procedures 79,048

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36. Frequency of Procedures

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48. Joint Replacements Hips & Knees