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

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1 Overview 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 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. Knowledge into Action Strategy help practitioners to apply knowledge to frontline practice. embed use of knowledge in healthcare improvement.. Johann von Goethe 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. Knowledge Brokers Intermediaries who facilitate the transfer, exchange and application of knowledge from research, practice and experience - into practice. NHSScotland evidence review of conceptual frameworks and interventions to translate knowledge into frontline practice highlight importance of the intermediary role. 1

2 Aim Define, develop, apply and evaluate knowledge broker capabilities to support healthcare improvement priorities. Methods 1. Evidence review to identify knowledge broker practices and capabilities. Research literature Interviews Tests of change. 2. Mapping of capabilities to healthcare improvement models and education frameworks. 3. Assessment tool to analyse gaps and enable mutual learning across national network. 4. Apply knowledge broker support to national healthcare priorities; evaluate impact. 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: Integration with healthcare teams Collaboration to 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. (Ward 2012, Dobbins 2009, Henderson 2012). 2

3 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. From Practice to Capabilities Knowledge, Skills, Behaviours, Attitudes (Gerrish 2011, Booth 2011, Psarras 2006) 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 core and non-core learning outcomes. Mandatory networking capability. Capability Statements The knowledge broker network: 1. Builds organisational capacity and workforce capability for 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 Healthcare Quality 3

4 Health Informatics Evidence- Based Practice Contributing to Healthcare Quality Embedding knowledge in clinical systems Evaluating Research Knowledge. IOM 2010: 5 Generic Competences for Healthcare Quality Person-Centred Care Capturing knowledge from experience Knowledge Brokerage Sharing knowledge within networks. Innovating new ideas from old knowledge. Continuous Improvement Interprofessional Team Working Knowledge Broker Capabilities Supporting Improvement Processes Sourcing knowledge - research, practice, experience. Capturing knowledge from practice and experience Facilitating sharing of knowledge communities of practice and social networks. Improvement Collaborative Model IHI Presenting knowledge in actionable formats. Dissemination Knowledge Broker Network Supporting the Sepsis Improvement Collaborative Developing the Knowledge Broker Network Community of Practice Actionable knowledge Search and synthesis Capability Self-Assessment Mutual Learning across Network 4

5 Diabetes and Multiple Conditions Applying Knowledge Broker Network Capabilities Supporting Community of Practice Creating Decision Support Rules for Complex Diabetes Care Needs. Contributing to Healthcare Priorities Community of Practice Implementing Palliative Care Guidelines Agreeme Knowledge brokers were supported nt of by shared learning and support approach through teleconferences and online communities Quality assurance procedures Quality assurance procedures using reciprocal peer review ensured a quality, standard search Literature search Draft guideline Developing a standardised search protocol developed in conjunction with clinical staff Support in accessing books and journal articles where not readily available 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. Web and mobile solutions Social networking elearning Implementation Package Formatting of references for publication Evaluating Impact Knowledge into Action Outcomes Chain INDIRECT INFLUENCE Quality Outcomes More effective practice Patient outcomes. Change in clinical decisions and practice. Summing Up New lens for knowledge management contribution to healthcare quality. DIRECT INFLUENCE Knowledge, skills, behaviours, attitudes Reactions Reach Change in clinician knowledge, skills, behaviours in sepsis, palliative care, multiple conditions, adverse events. Reaching stakeholders Knowledge broker network as: Change agency Underpinning infrastructure National support service DIRECT CONTROL Activities/ Outputs Inputs Knowledge Broker Activities Knowledge Broker self-assessment Learning and development - To translate knowledge into practice for healthcare quality. 5

6 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. 6