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 [email protected]
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.
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