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Enabling Partnerships:

Sharing Knowledge for a Mutual NHS

DRAFT- for consultation

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Enabling Partnerships:

Sharing Knowledge for a Mutual NHS

DRAFT- for consultation

A Knowledge Management Strategy and Action Plan for Better Health and Better Care in Scotland, 2009-2012

February 2009
Contents

Executive summary 3

1. Introduction 6

2. Why is this important? 6

3. What will it involve? 9

4. What will the National Health Knowledge Network look like? 15

5. How will it be delivered? 16

5.1 Objective 1: Managing Knowledge for a mutual NHS 16

5.2 Objective 2: Managing knowledge to create an enabling health service -improving health and delivering health equality. 20

5.3 Objective 3: Delivering safe and effective patient care 21

6. Conclusion 23

References 25

Annex 1: Strategy development process and membership of working groups

Annex 2: Data, Information and Knowledge

Annex 3: Evaluation of strategic demonstrator projects

Annex 4: Glossary

Executive summary

The NHS belongs to the people of Scotland and exists to serve their needs. A mutual NHS is one where patients and the public become active partners in the NHS and not just passive recipients of care. It also involves the active engagement of staff and collaboration across NHS organisations. Knowledge and learning are powerful tools in helping to achieve that level of engagement and involvement.

This draft strategy and action plan sets out proposals to maximise use of knowledge and learning to help to create a mutual NHS based on participation by patients and staff and organisational collaboration. It recognises the rights and responsibilities for sharing information, learning and knowledge among patients, carers and staff, and across services that deliver care for patients. It aims to enable and empower practitioners, individuals and communities to ask questions, find information and apply it in their own working practice and day to day lives. It aims to create systems and processes and develop a competent, confident workforce to translate evidence and knowledge into safe and effective patient care.

The ultimate vision is of:

A truly mutual health service, transformed through empowering practitioners, patients and organisations to work in partnership by accessing, sharing and applying knowledge and learning as a vital component of improving health and delivering care.

This will be delivered in two main ways:

1.  Creating a national infrastructure of knowledge networks and resources;

2.  Developing three delivery channels for access to information and knowledge.

The national infrastructure will comprise:

·  A National Health Knowledge Network – this will involve NHS organisations and partners in voluntary sector, local authorities and education working and learning together to realise the shared vision, values and standards set out in Enabling Partnerships. Each organisation belonging to the network will define its own knowledge management objectives in line with the network’s overall goals. They will receive support and guidance in knowledge management developments, and will be able to re-use and customise the shared information resources of the network and to lead on deliverables aligned with their organisational objectives.

·  Technology tools will be developed to enable partner organisations in this network to share information and learning resources. They will also help to link knowledge support to clinical eHealth systems.

·  A portfolio of support for information literacy will be available to equip people with the skills and confidence to share and use knowledge in everyday practice.

The three delivery channels will comprise:

·  An online information network – a shared pool of information and learning resources, integrating content from the many providers in the NHS and partner sectors. NHS Education’s information-sharing technology will create this shared pool of resources and will create an “NHS Google” so that patients and practitioners can easily access, from any location, the full range of quality assured health information and learning resources of NHS Scotland and partner agencies.

Organisations belonging to the National Health Knowledge Network will re-use and customise this shared pool of content and information-sharing technology to create services tailored to support their different audiences and priorities.

·  Person to person sharing of information, underpinned by information literacy skills. This is central to effective team working to delivering health and care, and to ensuring that patients and carers feel they are listened and talked to as equals, with honesty, dignity and respect. It will include face to face, person-centred communication to share information effectively among patients, carers and healthcare staff. It also involves use of online tools for social networking and building online communities. It will be supported by creating online maps and directories that draw together information about helplines, counselling services, financial advisory services and other information sources that depend on person to person sharing of information.

·  A network of physical access and support points which will allow people both in the community and in hospital to access information in all formats and receive support in doing so. There will be clear processes for referral across services and sharing of resources and expertise.

The National Health Information and Support Service led by NHS 24 is rooted in the consultation and delivery model outlined in this strategy. It will provide the primary, first-level entry point to public-facing national health information services. In order to achieve this, it will draw upon the resources and expertise of the National Health Knowledge Network and will work through the three delivery channels described.

These developments will empower members of the public, NHS staff and organisations to deploy knowledge more effectively to deliver more efficient and effective patient care. They will contribute to health improvement and will reach out to disadvantaged communities to spread the benefits of quality assured health information. By building strong partnerships across all sectors and with patients and the public, the strategy and action plan will seek to realise the vision of a truly mutual NHS.

1. Introduction

1.1 This draft strategy and action plan sets out proposals to make best use of knowledge and learning to improve patient experience and patient outcomes. Through collaboration and sharing, it seeks to build on existing foundations and make the use of knowledge an integral part of everyday practice..

1.2 This document sets out why this is important, explains what is involved and describes how it can be delivered. The proposals are based on extensive consultation and a series of demonstrator projects to test out the principles and approach. It is important to get feedback on the proposals from as many people as possible. If you want to contribute to this process, please complete the questionnaire at [to be inserted] http://tinyurl.com/cvkjzu or contact with your comments.

2. Why is this important?

2.1 Knowledge management is central to equipping patients, public and healthcare staff in all sectors to deliver the vision of a mutual NHS outlined in the Scottish Government’s action plan Better Health, Better Care 1. This mutual NHS is based on a common sense of purpose, full patient participation and ownership in decisions, and using the patient experience as a key measure of the success of the work of the NHS. The mutual NHS also depends on strengthening the collaborative and integrated approach across NHS organisations and partner agencies to plan and deliver services. This knowledge management strategy is founded on the mutual ethos. Creating a mutual NHS depends on recognising rights and responsibilities for sharing information, learning and knowledge among patients, carers and staff, and among the partner organisations involved in supporting all stages of the patient journey.

2.2 Better Health, Better Care underlines the importance of sustaining and improving health and addressing inequalities. Effective use of information and knowledge is essential in analysing and reducing health risks. An enabling health service will empower individuals and communities to ask questions, find information and make changes that will improve personal health and wellbeing.

2.3 The Better Health, Better Care action plan reaffirms that the core mission of the NHS is delivering best quality patient care. Transforming knowledge into practice is at the heart of patient safety and clinical effectiveness, service improvement, and the delivery of efficient and timely care. Knowledge management will provide the essential infrastructure to support research, leadership and continuous learning while helping to build a confident and competent workforce at all levels to deliver safe and effective care.

2.4 The principles of mutuality and partnership have been followed in developing this strategy. NHS Education for Scotland (NES) and NHS 24 jointly led a process of consultation based on interviews, focus groups and a questionnaire survey involving practitioners, senior managers, patients and carers. Special attention was given to hard to reach groups. A steering group and three working groups were established, made up of representatives from NHS Boards, the voluntary sector and patient groups. A series of demonstrator projects ran during 2008 to explore the practicalities and costs of the proposed development model. A national conference was held in December 2008 which consolidated the findings of the consultation to that point and helped to refine the proposed collaborative working approach.

2.5 This work took place at the same time as the development of a social services knowledge management strategy 2 .There has been close involvement between these two development processes to ensure a shared approach is taken across these closely related sectors. Annex 1 describes the development process in full.

2.6 The consultation process has highlighted five key development themes:

1.  There is a need for a system that supports human skills, confidence, values and behaviours in finding, sharing and using knowledge as much as the technology to organise and deliver information. It should focus at the personal level of individual information and knowledge needs.

“….(it) should be a combined human and technical system that tailors support to the needs of the individual.” 3

2.  A wide range of disparate , overlapping information sources is currently available. This results in duplication of effort and expense, fragmentation and confusion. Technology and governance systems need to integrate the information from different sources into a single pool with tools to tailor and re-use information to meet the diverse needs of different healthcare audiences and contexts. This principle of sharing and re-use of resources will maximise benefit from investment in information resources.

“Knowledge management should be a fully joined-up story.” 4

“A collaborative information “hub” (is needed) involving knowledge services from NES, QIS, ISD, NHS 24, charities etc – it should simplify access and experience for the end-user.” 5

3.  Information literacy –, the skills and confidence to ask questions, find, evaluate and share information and put it into practice 6 - is central to building the partnership between patients and healthcare practitioners in all sectors. If patients and the public are to become true partners, there needs to be human contact, support and dialogue, alongside access to information resources. Sharing personal knowledge and experience through dialogue is as important as access to published information.

“Professionals should have the necessary level of information access and skills to act as knowledge brokers in dialogue with patients.” 7

“Public and patients should be enabled to access information directly, simply, with understanding, and with support available from people and at a place and time where they can discuss and debate the information.” 8

4.  Information requires to be provided in different ways and in different formats, focusing particularly on supporting disadvantaged communities and hard to reach groups. For those without immediate access to a computer, best use should be made of routes that support person to person information sharing – for example, helplines, counselling and financial advice services, and health information access and support points in the community. These routes provide the highly valued person-to-person contact which helps in the sharing of information.

“It is not just about technology; also about skills, culture, and support. For those without IT access at home, best use should be made of community information points – eg libraries, health information centres, pharmacies, “silver surfer” services…..” 9

“Phone seems ideal to provide human support and a route to information for those who are not Internet-literate or do not have access.” 10

5.  Patients and professionals should have access to the same information. It needs to be presented appropriately in a way that is tailored for different audiences, but there needs to be equitable access to the same global knowledge base. This basic right of equity of access to knowledge is crucial in embedding knowledge management more firmly as part of the culture of day to day work in the health service.

“Patients and professionals should be accessing the same knowledge base.” 11

2.6. In summary, the strategy recognises that the knowledge held jointly by staff, patients and carers is the most valuable asset available to the health service as a whole. Organisations and individuals need to accept a shared responsibility to work in partnership to harness, cultivate and share this knowledge if it is to realise its potential to modernise healthcare delivery and support the development of a mutual NHS.

3. What will it involve?

3.1 What is knowledge management?

Knowledge management covers the ways in which people and organisations capture, store, organise, access and share internal and external information - including personal and collective know-how and experience - and put it into practice to support their vision and goals.

Components of successful knowledge management are:

People: The emphasis is on building the competencies, values, behaviours and culture which make it possible to manage knowledge for organisational benefit.

Technology: This is a powerful tool in capturing, organising, accessing and sharing information and knowledge. It has been said that “computers are incredibly fast, accurate and stupid; humans are incredibly slow, inaccurate and brilliant; together they are powerful beyond imagination.” 12

Processes: Organisations need to design and implement social, technological and cultural policy and processes that will make best use of knowledge to support their organisational goals.

Knowledge management builds on effective data and information management (see

Annex 2). It is closely linked to organisational learning, bringing to it an emphasis on