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

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

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

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

What does Head of KM do? 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 ‘SOFT’ KM ‘HARD’ KM

So much to know, so little time!

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

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!

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

Connecting for Health - KM Directorate of clinical knowledge process and safety led by Sir Muir Gray ry/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.

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)

The application of what we know can prevent and minimise the 7 ubiquitous healthcare problems 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 Muir Gray (January 2005)

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)

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

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

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

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

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

The mission of the National Knowledge Service is to ensure 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- 1/1/2005

Better Consultations, Better Decisions, Better Communication Generation Organisation Localisation Mobilisation Utilisation National Knowledge Service 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 Muir Gray (January 2005)

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

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

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

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

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

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

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

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

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

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

Hospital “X” PAS Data IP Episodes331,207 OP Episodes1,010,713 AED Episodes217,756 Imaging Procedures1,172,398 Endoscopy Procedures79,048

Elective Surgery

Frequency of Procedures

Breast Surgery Elective

Joint Replacements Hips & Knees

SHA Analysis Joint Replacements

Imaging Data RIS Systems

Lessons from the 18 week exercise To develop analysis methodologies Inform PAS system development Establish a baseline position  National  SHA  Trust  Specialty To identify “Pinch Points”

Summary and conclusions You may now open the Knowledge Management question paper You have until 2010 to complete all questions You may begin

Did it all sink in? Any questions?