22/10/2013. Overview. Knowledge into Action Strategy. Bridging the Knowledge-Practice Gap. Knowledge Brokers

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Quality Education for a Healthier Scotland

DEVELOPING KNOWLEDGE BROKERS TO

GET KNOWLEDGE INTO PRACTICE FOR

HEALTHCARE QUALITY

Dr Ann Wales, Programme Director for Knowledge Management. Annette Thain, Knowledge-Based Practice Manager

NHS Education for Scotland [email protected]

Overview

Why?

• Context and Purpose What?

• Knowledge Broker Network Capability Framework • Alignment with Healthcare Improvement How?

• Learning as a Network

• Contributing to healthcare priorities. • Evaluating impact

Bridging the

Knowledge-Practice Gap

“Knowing is not enough;

we must apply.

“ Willing is not enough;

we must do.”

Johann von Goethe 1749-1832

Knowledge into Action Strategy

• help practitioners to

applyknowledge to frontline practice.

• embeduse of knowledge in healthcare improvement..

Knowledge Management for

Healthcare Improvement

Deming’s Profound Knowledge. (1993)

Batalden and Berwick (1998)– 8 types of knowledge for improvement.

Batalden and Davidoff (2007) – 5-stage knowledge system for improvement.

Glasziou (2011)– Combining research knowledge with practice and systems knowledge.

NHSScotland evidence reviewof conceptual frameworks and interventions to translate knowledge into frontline practice highlight importance of the intermediary role.

Knowledge Brokers

Intermediaries who facilitate the transfer, exchange

and application of knowledge – from research,

practice and experience - into practice.

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Aim

Define, develop, apply and evaluate

knowledge broker capabilities to support

healthcare improvement priorities.

Methods

1. Evidence reviewto identify knowledge broker practices and capabilities.

• Research literature • Interviews • Tests of change.

2. Mappingof capabilities to healthcare improvement models and education frameworks.

3. Assessment tool to analyse gaps and enable mutual learningacross national network.

4. Applyknowledge broker support to national healthcare priorities; evaluateimpact.

Who are knowledge brokers in healthcare?

Backgrounds

Non-clinical: Library , Informatics, Research, Education, Policy, Management

Community: Public health, Health promotion, Social care

Clinicians: Medical, nursing, physiotherapy, pharmacy, rehabilitation and long term care staff, in acute, primary care and community settings.

Knowledge Broker Practice

Three change agency approaches: • Problem-solving

• Building networks and relationships

• Embedding use of knowledge in organisational systems.

Underpinned by:

• Integrationwith healthcare teams

• Collaborationto combine complementary skills.

Problem-Solving

Planned Action Theory of Change.

1. Inquiry.

2. Source knowledge – research, practice setting, experience.

3. Organise knowledge. 4. Evaluate knowledge.

5. Combine and create knowledge. 6. Translate into format and process for use. (Lomas 2007, Rankin 2008, Davidoff 2011)

Building networks and relationships

Social theories of change.

“Knowledge transfer, linkage and exchange” (Lomas 2012)

1. Facilitate collaboration across traditional boundaries – e.g. communities of practice.

2. Virtual knowledge brokers.

3. Community knowledge navigators - throughout journey of care.

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Embedding use of knowledge in

organisational systems

Organisational theories of change.

1. Assess enablers and barriers for knowledge use. 2. Role modelling

3. Managing organisational knowledge 4. “Change toolbox”.

5. Embedding knowledge in clinical and performance systems and education.

(Gerrish 2011, Booth 2011, Psarras 2006)

From Practice to Capabilities

Knowledge, Skills, Behaviours, Attitudes

Knowledge Broker Network

Capability Framework

“An outline of what Scotland’s

network

of

knowledge brokers

collectively

should

be able to do in practice.”

• 5 capability statements each with 10-12

core and non-core learning outcomes.

• Mandatory networking capability.

Capability Statements

The knowledge broker network:

1. Buildsorganisational capacity and workforce capabilityfor using knowledge, across health and social care.

2. Operates as a coordinated and connected system. 3. Identifies knowledge needs; sources, combines and presents knowledge from research, practice and experience.

4. Delivers knowledge in actionable formats, embedded in practitioner workflow.

5. Supports people and organisations to interact and share knowledge.

Knowledge, Skills, Attitudes

10 Knowledge Areas

11 Skills and Behaviours 7 Key Attitudes – including: • Collaborative leadership • Entrepreneurial approach • Solution-focused mind-set • Customer / User-centred approach

Knowledge Broker Capabilities

and

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Contributing to Healthcare Quality

Knowledge

Brokerage

Person-Centred Care

Inter-professional Team Working

Continuous Improvement

Evidence-Based Practice

Health Informatics

Capturing knowledge from experience

Sharing knowledge within networks.

Innovating – new ideas

from old knowledge.

Evaluating Research Knowledge.

Embedding knowledge in clinical systems

IOM 2010: 5 Generic Competences for Healthcare

Quality Quality Education for a Healthier Scotland

Knowledge Broker Capabilities Supporting Improvement Processes

Capturing knowledge from practice and experience

Facilitating sharing of knowledge – communities of practice and social networks.

Sourcing knowledge

-research, practice, experience. Presenting knowledge _{in actionable formats.}

Dissemination

Knowledge Broker Network Supporting the Sepsis Improvement Collaborative

Search and synthesis

Community of Practice Actionable knowledge

Developing

the Knowledge Broker Network

Capability Self-Assessment

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Applying

Knowledge Broker Network

Capabilities

Contributing to Healthcare Priorities

Diabetes and Multiple Conditions

Community of Practice

Supporting Community of Practice Creating Decision Support Rules for Complex Diabetes Care Needs.

Agreeme nt of approach Literature search Draft guideline eLearning Implementation Package

Developing a standardised search protocol developed in conjunction with clinical staff

Quality assurance procedures

Quality assurance procedures using reciprocal peer review

ensured a quality, standard search

Support in accessing books and journal articles where not

readily available Knowledge brokers were supported

by shared learning and support through teleconferences and online

communities

Formatting of references for publication

Implementing Palliative Care Guidelines

Web and mobile solutions Social networking

Implementing Learning from

Adverse Events

1.Process mapping – flow of learning from adverse events in key themes within and across programmes. 2. Identifying and addressing gaps in knowledge flow.

Evaluating Impact – Knowledge into Action

Outcomes Chain

Inputs Activities/ Outputs Reactions Reach Knowledge, skills, behaviours, attitudes More effective practice Quality Outcomes INDIRECT INFLUENCE DIRECT INFLUENCE DIRECT CONTROL

Knowledge Broker self-assessment Learning and development

Knowledge Broker Activities Reaching stakeholders Change in clinician knowledge, skills, behaviours in sepsis, palliative care, multiple conditions, adverse events.

Change in clinical decisions and practice.

Patient outcomes.

Summing Up

New lens for knowledge management contribution to healthcare quality.

Knowledge broker network as: • Change agency

• Underpinning infrastructure • National support service

- To translate knowledge into practice for healthcare quality.

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Acknowledgements

Annette Thain, Manager, Knowledge-Based Practice, NHS Education for Scotland.

Dr Karen Ritchie, Head of Information and Knowledge, Healthcare Improvement Scotland.

NHSScotland Knowledge into Action Change Team

DEVELOPING KNOWLEDGE BROKERS TO

GET KNOWLEDGE INTO PRACTICE FOR

HEALTHCARE QUALITY

Dr Ann Wales, Programme Director for Knowledge Management. [email protected]