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Better Intelligence Boosts Quality

Better Intelligence Boosts Quality. Sir Muir Gray CBE 23 March 2009. The future is not a destination like Cheviot Hills , waiting for our arrival; it is something like Durham Cathedral that we have to imagine, plan and build. The future is here; it is just not evenly distributed.

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Better Intelligence Boosts Quality

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  1. Better Intelligence BoostsQuality Sir Muir Gray CBE 23 March 2009

  2. The future is not a destination like Cheviot Hills, waiting for our arrival; it is something like Durham Cathedral that we have to imagine, plan and build.

  3. The future is here; it is just not evenly distributed William Gibson

  4. Great innovations of the first and second healthcare revolutions MRI and CT scanning Statins Antibiotics Coronary artery bypass graft surgery Hip and knee replacement Chemotherapy Radiotherapy Randomised controlled trials Systematic reviews First Second Broad Street - John Snow Gower Street - Doll & Hill

  5. 21st C health and healthcare problems Safety Errors Quality Substandard clinical practice Poor patient experience Failure to maximise value Waste Overenthusiastic adoption of low value interventions Failure to get new evidence into practice Inequalities Failure to prevent disease

  6. The drivers of the third industrial revolution Knowledge I T Citizens Manuel Castells

  7. Knowledge Generalisable knowledge Explicit Tacit • From research: • evidence • From data: • statistics or information • From experience: • casebook

  8. CHOICE DECISION KNOWLEDGE VALUES THIS PARTICULAR

  9. Knowledge: the enemy of disease The application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade

  10. “Evidence from recent trials, no matter how impressive, should be interpreted with caution”Claims made in 45 highly cited reports were subsequently contradicted (n=7) or weakened (n=7) for 14 of the interventions Ionnidis JPA (2005) Contradicted and initially stronger effects in highly cited clinical research JAMA 294; 218-228

  11. Research reports NICE guidance

  12. Who is responsible for… What a new GP in Hartlepool knows about indications for referral for hoarseness? What a citizen in Gateshead knows about PSA screening? What a Year 1 SpR in geriatrics in Darlington knows about fractured neck of femur? What a teacher of children with learning disability in Newcastle knows about epilepsy?

  13. Someone on the Board of every healthcare organisation, directly responsible to the Chief Executive, will be given the responsibility of acting as Chief Knowledge Officer

  14. Public Health is a knowledge businessThe application of what we know from research, from data analysis and experience, will have a bigger impact on health than any drug or technology

  15. Librarians • Information scientists • Chief Knowledge Officers • Clinical epidemiologists • Public health professionals

  16. “most patients were not given clear information about the survival gain of palliative chemotherapy… in most (26/37) consultations discussion of survival benefit was vague or non-existent” Audrey S et al (2008) What oncologists tell patients about survival benefit of palliative chemotherapy and implications for informed consent BMJ 2008; 337;a752

  17. www.bettervaluehealthcare.org

  18. Box 1 Workforce capacity and capability Better workers Box 3 Stronger organisations Stronger teams Informing Healthier Choices Box 2 Improved data and information Cleaner clearer knowledge Box 4 Health information and intelligence portal and systems Better pipes

  19. Improving public health information and intelligence skills and capacity across England for all levels of the public health workforce PH Specialists PH Practitioners Wider PH workforce 2 objectives Developing a career pathway and supporting infrastructure tools Developing training resources to build competencies for all those using information and intelligence Box 1 Workforce capacity and capability Better workers

  20. Box 1 Available now! Box 1 • Suite of Job Descriptions and Person Specifications for information and intelligence staff • 10 e-learning modules (5 at specialist and 5 at practitioner levels) • 13 modules with .ppt slides, tutor notes and workbooks • www.healthknowledge.org.uk hosts training resources for all public health competences

  21. Centrally from provider • data eg general practice • smoking • raised BP • Special surveys eg • well being • dental health • exercise levels • Surveillance systems eg • child health systems • disease registers Box 2 Improved data and information provision Cleaner, clearer knowledge Reliable data on key health challenges

  22. Box 2 data workstreams Health Profiles 3 Primary care data development Prevalence modelling Child height and weight Dental survey data Drug misuse data Nutrition & dietary data JSNA dataset Local health surveys Sexual health data Other initiatives e.g. basket of health inequalities indicators Box 2

  23. CHD: expected prevalence in people over 16 Box 2

  24. CHD: observed over expected prevalence in over 16s Box 2

  25. Competencies for WCC, inc JSNA Skills to use intelligence for Public Health and commissioning Health Impact Assessment Government Impact Assessment (national) Specific proposal impact (regional, local) Training Strategic Environmental Assessment Box 3 Stronger organisations Stronger teams

  26. Policies for action on WDH

  27. Better presentation and accessibility of data to professional public health people Better use of information systems and tools by networks of people web-based improved ease of use interactive Examples and inspiration to promote more productive use of information Box 4Health information and intelligence portal and systems Better pipes

  28. Projects NLPH – online, free to access APHO, IC, DH, PHAST development work Data analytic tools Knowledge management systems Single portal for accessing PH intelligence Plus social networking? Other Web 2.0 resources? Box 4

  29. Expedites shared learning All public health practitioners must submit 1 (or more) report pa Reports contain Outline of problem Why prioritised Objective of PH investment Project impact Lessons learned Signpost to full documentation Contact details Box 4 Public health casebook proposal

  30. Any thoughts ? drschiller@email.com muir.gray@medknox.net sueatkinsonph@aol.com Thank you!

  31. PHINE meeting NLPH – busy online library with monthly newsletter (>7500 hits per month) National guidelines Systematic reviews www.library.nhs.uk/publichealth National knowledge weeks (synthesised for quality) eg HIV/AIDS Dec 2008, drug misuse Jun 2009

  32. PHINE meeting Capacity development: posts and courses Better understand networks of practitioners, networks of information, networks of quality observatories, relations to wider networks beyond NHS (esp PHOs) eg GOs Distinct role of PHOs Commissioning competencies within PCTs esp competency 5 (NEPHO workshops with SHA on knowledge management) All PCTs aiming for level 3 in coming year, using DOAS CKO group self assessing knowledge management

  33. PHINE meeting Comp 5: CEOs across Region have started group led by CEO N Tyne NE Regional Information Partnership with John Carling leading – good online resource Centre for Population Research – UKCRC set up 5 centres of excellence. In NE 5 universities collaborate (quoted by CMO) Has attracted funds for research on 10 important themes (social group – economy environment and mh; lifestyle - tobacco, alcohol, obesity, phys activity; prevention fair and early treatment – provision of healthcare not prioritised in other work stream; life course – early years, good life, good later life, good death

  34. PHINE meeting Individual universities tackle specific areas Feedback from pairs – what can IHC do for you? ONS birth – gestational age please ONS website design, hard to find what you want Rationalise web access Provide digests (but NLPH does this) Train CEOs in PH knowledge management – show them the benefits

  35. Feedback from pairs Data from OGDs and IC easier to find Access for PHOs to PPA data and NHS central registry for GP registrations at a national level – use a single issue to highlight, maybe statins Promote imp of PH to commissioning – demonstrate risks of not having PH info central to commissioning decisions Help PH people use media their partners use

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