Tag Archives: knowledge management

Supporting health care systems to reduce variation and nurture a learning culture

As health care organisations transition to health care systems delivering services across a geographical footprint, there is a wealth of opportunities for library and knowledge services to support and enhance evidence-based care.

A 2017 study, despite being published a while back, demonstrates the enormity of the challenge facing the NHS of ensuring that all patients receive high quality, evidence based care. It’s a useful study for us as library and knowledge professionals to be aware of, highlighting as it does the level of variation and reasons why our expertise in mobilising knowledge is such an important contribution to the delivery of high quality health care.

Willis et al (2017) explored the variations in achievement of evidence-based, high-impact quality indicators in general practice. Seven high impact quality indicators were developed for primary care and the variation in achieving these indicators was measured across GP practices in West Yorkshire. Four indicators focused on processes of care (e.g. prescribing or testing) and three on clinical outcomes (blood pressure, cholesterol and glycaemic control).

Two key findings in the study are of particular interest.

1) The performance of GP practices in achieving quality indicators.

Achievement of the seven evidence based quality indicators across participating GP practices was as follows:

  1. Diabetes processes of care: 59.1%
  2. Risky prescribing: 8.7% (a low percentage indicates safer, more desirable practice)
  3. Anticoagulation in atrial fibrillation and risk of stroke: 63.0%
  4. Secondary prevention of myocardial infarction: 54.6%
  5. Diabetes control: 43.2%
  6. Blood pressure control in hypertension: 71.7%
  7. Blood pressure control in chronic kidney disease: 74.2%

These differences against quality indicators are perhaps expected, and demonstrate that some GP practices are struggling to achieve evidence-based practice in key areas of patient care.

2) A marked variation in performance between practices

The second key finding of interest to us is that the likelihood of receiving evidence-based treatment varied substantially as a consequence of the practice attended. Even accounting for contributing factors (such as the age profile of patients), the study found considerable variation in achievement of the seven quality indicators between GP practices.

What can we draw from this? It highlights that there are likely to be several contributing factors at play that prevent evidence-based recommendations from being implemented. According to the authors, this is likely to be due to differences in culture and behaviours:

“The odds of patients receiving recommended care or achieving recommended treatment targets varied between two- and over ten-fold by indicator according to the practice attended. These marked variations were partly explained by a range of routinely available practice and patient variables; it is likely that much variation is related to clinical and organisational behaviours.” (p11)

Library and Knowledge Services can play an active part in enhancing clinical and organisational information behaviours in health care systems. This may be through ensuring easy and timely access to the evidence base, equipping health care staff with skills in information searching and critical thinking, or embedding optimal knowledge management behaviours to encourage a learning culture. Accordingly, our contribution to organisational culture and behaviours can support health care systems to reduce unwarranted variation and improve the quality of care.

As knowledge specialists working in health, we are keenly aware that there is a gap between evidence and everyday practice, but perhaps most people attending an appointment at their local practice isn’t?

Reflecting on the findings of this study presents some interesting challenges to us as a profession. Firstly, as our perspective shifts towards supporting the knowledge requirements of health care systems, how can we work more effectively together to help the NHS tackle unwarranted variation in treatment? Secondly, knowledge management is more than simply disseminating evidence across our networks. How can we use our skills to influence behaviour, and how far should our role extend into embedding evidence into practice? Finally, library and Knowledge Services have a role in ensuring citizens are supported to self-manage their conditions effectively and are empowered them with knowledge. How can we do that most effectively?

Please share your thoughts on the issues discussed here, and if you have any interesting studies on this topic please share them too!

Victoria Treadway, Knowledge Management Facilitator, NHS RightCare Email: victoria.treadway@nhs.net Twitter: @librarianpocket

References

Willis, Thomas A, West, Robert, Rushforth, Bruno et al. (5 more authors) (2017) Variations in achievement of evidence-based, high-impact quality indicators in general practice : An observational study. PLoS ONE. e0177949. ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0177949

Knowvember: honing your skills

Now we’re at the end of Knowvember I thought it would be a good moment to remind you of all the great resources we have via the Learning Zone and Knowledge Management sections of this blog to help you hone your KM skills or revisit some of the basics. There are resources to help you with searching, synthesis and critical appraisal.

If you want to support your organisation and your colleagues in mobilising evidence and knowledge then remember the NHS Knowledge Mobilisation Framework Postcards and the Knowledge Mobilisation Framework programme are designed for a general audience plus we have the Evidence and Knowledge Self-assessment Tool.

If you haven’t already done so sign up for the CILIP Knowledge & Information Management Special Interest Group (K&IM) and for our new KM community of practice which is a lively discussion group.

David Stewart
Workforce Planning and Development Workstream lead.

The Seven Deadly Sins of Knowledge Sharing in Networks

On 16th July, I was fortunate enough to take part in this webinar organised by NHS England’s Sustainable Improvement Team and Source4Networks, which posed the  following questions:

  • What are the barriers to sharing knowledge across your networks?
  • How can we learn from others to apply this knowledge to the NHS?

Chris Collison, author and expert in networks and knowledge management, was on hand to guide us through some of these critical barriers, namely the seven deadly sins – or syndromes – that can affect networks and stifle the supply or demand for knowledge sharing.

1) Tall Poppy Syndrome – Based on the idea that the tallest poppy in a field is the first to get cut down to size, this syndrome illustrates a reluctance to put your head above the parapet and a tendency to keep a low profile and not get involved.

2) Shrinking Violet Syndrome – Another “sin” that stifles the supply of shared knowledge in a network, based on a feeling of false humility, and that you have nothing useful to share.

3) Not-Invented-Here Syndrome – This syndrome impacts the demand for knowledge
sharing; the view that your organisation or team has a unique set of problems that can’t be
fixed by adopting other people’s solutions. Besides (the thinking goes) why use someone
else’s solutions when you can gain kudos for inventing your own?

4) Tom Tom Syndrome – Also known as Real-Men-Don’t-Ask-For-Directions Syndrome. A
reluctance to ask for help when you’re lost, due to a fear of being seen to be incompetent.
This “muddling along” approach is another barrier that stifles knowledge sharing by reducing demand.

5) Lacknowledgement Syndrome – The perception that by sharing good practice there is
somehow a “lack of acknowledgement”, and a suspicion that someone else will take the
credit for your hard work.

6) Lock-it-Away Syndrome – Here, a potential solution, idea or example of good practice is
not shared, either because it is never quite finished, or because everything produced by the organisation or team is locked down by default due to security policies.

7) Hamster-on-the-Wheel Syndrome – This “sin” comes down to time – or lack of it. A feeling that you’re just too busy going round in circles to stop and share what you’re doing.

A quick webinar poll indicated that this last “sin” was particularly prevalent, and something that most of the attendees were familiar with, but we all recognised the various other syndromes as well. Chris went on to suggest some antidotes, such as:

  • Make it safe to share
  • Think about use of language – e.g. looking for “answers” can place an unintended
    burden on people
  • Establish what “good” looks like, so the network has a frame of reference – e.g. using
    a maturity model for an agreed scale of good practice
  • Make it easier for people to ask for help – e.g. awards for things like:
    o Transferring good practice
    o Re-using a solution
    o Embedding a good practice
  • Share failures as well as successes
  • Acknowledge everything – where it came from etc.
  • Check what security policies actually say about sharing information outside the
    organisation
  • Legitimise the time spent sharing knowledge, e.g.
    o Establish a network sponsor
    o Find and share stories of things that worked

From my experience, we already have many of these antidotes in place in our LKS network in the South, but we all interact with networks at an organisational or directorate level, and personally I recognised quite a few of these deadly syndromes. I found the webinar
extremely illuminating,engaging and motivating.

For anyone interested in viewing the recorded webinar, you can find it here. For those of you who would like to dig a bit deeper, both Chris Collison’s and Source4Networks’ websites and twitter details are below:

Chris Collison: www.chriscollison.com / @chris_collison
Source4Networks: https://www.source4networks.org.uk/ / @source4networks

Andrew Brown
Library Services Manager
Wexham Park Hospital (WXM)

This article was first published in Swimming Pool, Issue 109, August 2018, p.7-10