Implementing Knowledge into Action in Scotland’s Health and Social Services

1. 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

2. Overview Why Knowledge into Action? What is the model? Types of knowledge Implementation methods 3. Howis it making a difference?

3. Why Knowledge into Action? • Values: Care that is: • Safe • Effective • Person-Centred

4. Knowledge Service Provide Knowledge Share and Apply Knowledge • Connecting to: • People’s experience of care. • Day to day working lives of healthcare staff.

5. NationalKnowledge into Action Review (2011-12) Knowing Knowledge Network - 12 million + resources Knowledge products – SIGN, HIS, HPS, NES IRISS, etc as “knowledge broker” organisations. Doing? How much of this gets used in a meaningful way to improve safe, effective, person-centred care? www.knowledge.scot.nhs.uk

6. Need for a new knowledge paradigm Limitations of research evidence – 15%-20% of clinical issues. Williamson 1979, Sackett, 1995. 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.

7. Translating Knowledge into Quality Care Embed knowledge in workflow Doing the right thing Care Decisions Improvement Knowledge: Practice, People, Context, System Doing it right Change systems and behaviours Know-How “Profound Knowledge” Quality Care & Support Research Knowledge MEDLINE, ASSIA, Cochrane etc Know-What Adapted from: Glasziou, P et al. Can evidence-based medicine and clinical quality improvement learn from each other? 2011. BMJ Qual Saf 20 (suppl 1): i13-i17

8. 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?

9. Conceptual Frameworks 1. 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

10. Implementational Example Knowledge to Action Framework Graham and Logan, 2006

11. Interactional Example Knowledge Transfer Process Model Ward et al 2010

12. Context and Agency Example Normalisation Process Theory: May and Finch 2009

13. 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.

14. Congruence of Theory and Practice • Conceptual Frameworks • Implementational • Interactional • Context and agency • Methods • Actionable knowledge • Social knowledge • Organisation environment

15. Knowledge into Action Model Practice Research Experience • Know-where • Systems • Processes • Variation How can we make it work best in this context, for this person? Know-what Can this intervention work? • Knowledge broker network • Search & synthesis • Actionable knowledge • Social knowledge • Organisational knowledge • Know-what • Journals • MEDLINE • Cochrane • Know-who • Service user • Practitioner • Teams

16. Methods and Agents • Relational use of knowledge • Communities of Practice • Social networking • Social learning • Search & synthesis • Evidence from research, practice and experience • Rapid reviews Change Agents: Knowledge Broker Network • Organisational enablers • Backing at national and board level • Tests of change to embed approaches • Skills development • Actionable knowledge • Decision support • Pathways • Mobile apps

17. 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

18. How is Knowledge into Action Making a Difference? Examples

19. Decision support in SCI-Diabetes

20. Community of Practice –Tailoring Decision Support Reviews audit data to determine impact of decision support on practice. Shares experience of using decision support – e.g. overriding in complex cases with multiple conditions. Refines and adapts implementation approach.

21. 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.

22. 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.