Connecting People

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Connecting People Knowledge

• rather than collecting information
• Rachel Cooke
• Acting Lead for Libraries Knowledge
• East of England (NHS)

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Outline

• Background
• Umbrella 2007
• Knowledge Management Fellowship
• NHS Knowledge Management Drivers
• Knowledge Knowledge Management
• Case Studies from the NHS

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Umbrella 2007

• Librarians make it look too easy so dont get the
  support actually need
• KM is often misunderstood
• No culture of information knowledge sharing
• Lack of leadership
• Turnaround reorganisation make it hard to get
  input needed to get started
• Reliance on technology

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Knowledge Management Fellowship

• NHS Institute for Innovation
• Improvement
• (National Library for Health)

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Knowledge Management Fellow

• NHS Institute for Innovation Improvement
• Practical not research Fellowship
• Fellows as NHS leader in innovation
• Knowledge Management Fellow
• KM Organisation Development
• Improvement Methodology

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Knowledge Management Fellow

• KM in the context of organisational development
• Outcomes
• Identified ways to influence support change in
  practice in NHS organisations
• e.g. Practical Knowledge Management Workshop
• Adaptation of a KM self-assessment tool for NHS
• Ran eight workshops on KM
• With Prof. Peter Hill ran a national workshop for
  Chief Knowledge Officers (CKOs)

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Knowledge Management Fellow

• Improvement Methodology
• Improvement Advisor Programme
• Institute for Healthcare Improvement USA
• Nine month long graduate programme
• Improving Quality of Care at the Bedside
• Paediatric Intensive Care Unit, Royal
  Brompton Hospital
• Model for Improvement
• What are we trying to achieve?
• How will we know a change is an improvement?
• What changes can we make that will result in
  improvement?
• Quality Improvement for Librarians West Midlands

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Drivers for Knowledge Management in the NHS
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KM Drivers in NHS

• World Class Commissioning Competencies
• December 2007
• 5. Managing Knowledge Assess Needs
• Manage knowledge and undertake robust and regular
  
• needs assessments that establish a full
  understanding of
• current and future local health needs and
  requirements
• 8. Promote Innovation Improvement
• Promote and specify continuous improvements in
  quality
• and outcomes through clinical and provider
  innovation and
• configuration
• http//www.dh.gov.uk/en/Managingyourorganisation/C
  ommissioning/Worldclasscommissioning/index.htm
  (accessed July 2009)

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KM Drivers in NHS

• Report of a National Review of NHS Health
  Library
• Services in England. (Hill Report)
• 2008 February
• Recommendation 11
• In every organisation someone at board level
  should be entrusted with the role of Chief
  Knowledge Officer for that organisation
• Recommendation 14
• Every clinical or management team in the NHS
  should identify someone in the team as Team
  Knowledge Officer (or equivalent). The Team
  Knowledge Officer will have responsibility for
  ensuring the effective input of evidence to
  enable the team to function properly.

http//www.library.nhs.uk/forlibrarians/review
(accessed May 2009)
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Chief Knowledge Officer Role

• To ensure relevant experience, evidence,
  research, information and data are available to
  all staff. This will enable knowledge-based
  strategic, operational and clinical planning and
  activity.
• To lead horizon scanning to ensure their
  organisation is prepared for future service
  needs.
• To participate in national / regional networks of
  CKOs to steer knowledge management in the NHS
• To develop specific strategies to protect
  organisational knowledge, for example during
  times of major change.
• To work with people responsible for HR, CPD,
  Information, Innovation, Library and related
  strategies to develop a knowledge based culture.

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KM Drivers in NHS

• High Quality Care for All the NHS Next Stage
  Review (Darzi) 2008 June
• Quality Observatory
• Build on existing analytical arrangements, to
  enable local
• benchmarking, development of metrics
  identification of
• opportunities to help frontline staff innovate
  improve .. Make
• its information available through portals such as
  NHS Evidence
• NHS Evidence
• NICE will manage the synthesis and spread of
  knowledge
• through NHS Evidence a new, single portal,
  through which
• anyone will be able to access clinical and
  non-clinical evidence
• best practice, both what high quality care
  looks like how to
• deliver it.
• http//www.ournhs.nhs.uk/ (accessed July 2009)

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Knowledge Management

• What are we talking about

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Knowledge Management

• "...It's not about creating an encyclopaedia that
  captures everything that anybody ever knew.
  Rather, it's about keeping track of those who
  know the recipe, and nuturing the culture and the
  technology that will get them talking..."
• Arian Ward of Work Frontiers International

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Knowledge Management - People First

• Knowledge always involves a person who knows
  
• McDermott 1999
• McDermott R. (1999). Why information technology
  inspired but cannot deliver KM. California
  Management Review (41)4 103-117

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Knowledge Management focuses on

• Connections
• Collaborating
• Enabling
• But, more than anything
• sharing learning

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4 types of knowledge
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Knowledge ManagementCase Studies in the NHS
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Chief Knowledge Officers
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Knowledge, sharing, learning in NHS North East

• Our vision, our future
• NETS North East Transformation System
• CKOs
• Individual trusts
• WCC C5 development set

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Developing a Knowledge Sharing Culture
Our Vision, Our Future
Chief Knowledge Officers
NETS KSL compact
WCC Competency 5
NETS KSL sub-programme
PCT B
PCT A
Trust B
Trust A
Trust A
North East Transformational System Knowledge
Sharing Learning sub-programme
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Heart of England Foundation Trust

• Chief Knowledge Officer
• Medical Director
• Head of Learning Resources
• 3 Clinical Librarians
• 50 Team Knowledge Officers

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Heart of England NHS Trust

• Develop a shared understanding of KM TKO role
• Identify KM strengths weaknesses in the Trust
• Formulate strategy action plan for KM over the
  next 3 years as part of the Trusts Learning
  Development Strategy

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Maidstone Tunbridge Wells

• 90 C Diff deaths - cited in Hill Review
• Poor knowledge can result in patient harm
• Chief Knowledge Officer
• Director of Human Resources
• Head of Library Services
• New role, new approaches

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Maidstone Tunbridge Wells

• Using Knowledge to Reduce Risk
• Number of workshop run using KM self assessment
  tool
• Start of new MTW Community of Practice
• File management, good practice, template
  approach, help guides
• Joint work with Quality Observatory
• Information (best practice) Data
• Commissioning to reduce community acquired MRSA

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Maidstone Tunbridge Wells

• Strong leadership from CKO
• Partnership work producing increased job
  satisfaction, new contacts
• Enthusiasm but also scepticism
• Repositioning of staff networks within Trust
• Work in progress, momentum needs to continue
• Culture change a challenge

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QUALITY MKA whole system approach to quality
improvement

• IMPACTE Improving Medical Practice by Assessing
  CurrenT Evidence
• http//www.miltonkeynes.nhs.uk/default.asp?Content
  ID1359

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14/10/08
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QUALITYMK

• Placing
• Evidence
• Service users
• Primary care
• Central to
• Decision making
• Quality improvement
• Keeping them there

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IMPACTE Improving Medical Practice by Assessing
CurrenT Evidence

• IMPACTE Groups
• Typically GP practice
• Meet face to face or online
• Multidisciplinary
• GPs, nurses, pharmacists, practice manager etc
• Meet regularly, (e.g. lunchtime)

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IMPACTE Improving Medical Practice by Assessing
CurrenT Evidence

• The Process
• Identify a topic
• Look at the evidence (articles, NICE, Map of
  Medicine, expert opinion)
• Apply the evidence
• Establish an action plan
• Implement Audit (before during after)
• Review action plan
• Roll out to other GP practices - GP Champions
• Share via website

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IMPACTE Improving Medical Practice by Assessing
CurrenT Evidence

• Successes so far
• Clarification of procedures / protocols within
  practice
• Highlighting differences in prescribing practice
  within surgery
• Move towards consistency
• Increase in knowledge
• Changes in practice
• Audits of drug use

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14/10/08
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QUALITYMK

• A dynamic organic shift
• The success of this programme can be seen in the
  high level of patient and clinician involvement
• ... with greater use of evidence
• There is an explosion of patient involvement

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Practical KM Tools
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Knowledge Management ModuleSouth East Coast

• Practical KM workshop
• Developed by Librarians
• Open to all NHS staff in South East
• Promoted by SHA
• Run twice two more this year
• Raised profile of library services

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Knowledge Management Workshop South East Coast

• Build capacity to improve patient care by
  providing better access to understanding of
  knowledge
• Enable staff to create use share knowledge
  effectively to improve quality, safety and the
  patient experience
• Provide KM tools to facility the delivery of
  business objectives influence organisational
  values

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Knowledge Management WorkshopSouth East Coast

• Organisation Development
• Knowledge Audit and Assessments
• AAR (After Action Reviews)
• Lessons Learned (before during after)
• Knowledge Retention Transfer

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Knowledge Management Workshop South East Coast

• Connecting People to People
• White pages
• Peer Review/Assist
• Communities of practice
• Knowledge Sharing Event/Knowledge Cafes
• Case Studies and story telling

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Knowledge Management Workshop South East Coast

• Tools Resources
• Social Network Analysis
• Knowledge Mapping
• Data mining
• Team/ Project space
• Podcasts, RSS Feeds, Blogs.
• Document/Content Management
• Evidence Based Resources Libraries (proactive,
  targeted tailored)

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AAR After Action Reviews
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After Action Reviews - Ground Rules

• Leave hierarchy at the door
• Everyone contributes
• Discussing mistakes does not lead to blame
• Do not accuse
• Make no assumptions
• Seek agreement on the ground rules from each
  person individually

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After Action Reviews - The Questions

• What did we set out to do?
• What actually happened?
• Why was there a difference?
• What can we learn for next time?

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After Action Reviews Brighton Sussex
University Hospital

• Expected
• Sutures used in surgery should be within use-by
  date
• Actual
• Out of date sutures were used during surgery

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After Action Reviews - University College
London Hospital

• Structured but Organic
• Education Board
• Divisional Learning Leads
• AAR (After Action Reviews)
• Ward rounds, Meetings,
• Adverse events, Patient complaints
• Centre for Lessons Learned
• Breaking down barriers,
• Generating learning and sharing

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Commissioning Wiki

• Sponsored by National Library for Health
• (NHS Evidence)
• Project managed by QualityMK
• Created by information professionals
• Pool their knowledge of resources good practice
  
• Support staff commissioning health services
•  http//commissioning.pbworks.com/ (accessed July
  2009)

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• Contact Details
• Rachel.cooke1_at_nhs.net
• Useful Websites
• http//www.library.nhs.uk/KnowledgeManagement/
• http//www.gurteen.com
• http//www.chriscollison.com/l2f/