Ann Wales

The Potential of Communities of Practice to Promote Evidence-Informed Practice Within Nursing Homes

Debbie Tolson, PhD, MSc, BSc (Hons), RGN, Andrew Lowndes, MSc, BA, RNT, RCNT, RN,Joanne Booth, PhD, BSc (Hons), BA, RN, RNT, Irene Schofield, PhD, MSc (Gerontology), RNT, RGN,and Ann Wales, PhD, BSc (Hons), DipLib, MBEHealth care providers are increasingly seeking new tech-nologiestoimprovequalityandcosteffectiveness.

Knowledge into action - supporting the implementation of evidence into practice in Scotland.

BACKGROUND The knowledge into action model for NHS Scotland provides a framework for librarians and health care staff to support getting evidence into practice. Central to this model is the development of a network of knowledge brokers to facilitate identification, use, creation and sharing of knowledge. OBJECTIVE To translate the concepts described in the model into tangible activities with the intention of supporting better use of evidence in health care and subsequently improving patient outcomes. METHODS Four areas of activity were addressed by small working groups comprising knowledge services staff in local and national boards. The areas of activity were as follows: defining existing and required capabilities and developing learning opportunities for the knowledge broker network; establishing national search and summarising services; developing actionable knowledge tools; and supporting person-to-person knowledge sharing. CONCLUSION This work presents the development of practical tools and support to translate a conceptual model for getting knowledge into action into a series of activities and outputs to support better use of evidence in health care and subsequently improved patient outcomes.

Scotland's Knowledge Network: translating knowledge into action to improve quality of care

The Knowledge Network (www.knowledge.scot.nhs.uk) is Scotlands online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions (‘know-what’) and knowledge about how to implement this knowledge to support individual patients in working health-care environments (‘know-how’). An ‘evidence and guidance’ search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle – acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.

International trends in health science librarianship Part 9: the UK – Scotland and Wales

This is the 9th in a series of articles exploring international trends in health science librarianship. The previous article in this series looked at Northern Ireland and the Republic of Ireland. In this issue the focus is Scotland and Wales. There will be three or four more articles this year tracking trends in the Far East, Africa, South Asia and the Middle East. JM.

Scottish toolkit for knowledge management.

BACKGROUND Using specific examples, this paper describes the tools, methods and resources used to develop Managed Knowledge Networks (MKNs) within the NHS Scotland e-Library (http://www.elib.scot.nhs.uk). MKNs help to complete the knowledge management cycle by providing a place to share the learning and discuss the evidence for practice through combining the use of the published material (explicit knowledge) with the experience and knowledge held by individuals, communities and organizations (tacit knowledge). OBJECTIVES First of all, this paper outlines the e-Library infrastructure, which provides an inter-operable framework to manage the published knowledge using a metadata management system; and a knowledge-sharing tool to support the development of MKNs. It then covers the various stages involved in developing an MKN: gathering and analysing information needs in a variety of ways; presenting and organizing the resources and services for the users as identified in the needs analysis; managing the tacit, personal and local knowledge. CONCLUSION The toolkit described enables the Knowledge Services Group to take the needs of users, transcribe these into Specialist e-Libraries to provide access to the published information and to support this with accessing and sharing the knowledge of colleagues via MKNs.

Scotland’s knowledge network: a progress report on Knowledge into Action

Launched in 2012, Knowledge into Action is the national knowledge management strategy for the health and social care workforce in Scotland. It is transforming the role of the national digital knowledge service – NHS Education for Scotlands’ Knowledge Network – and the NHSS librarian role to offer more active, tailored support for translating knowledge into frontline clinical practice. This includes the development of a national evidence search and summary service, help with converting knowledge into practical and usable formats for easy use at point of care and with using digital tools to share clinicians’ learning, experience and expertise. Through this practical support, Knowledge into Action is contributing to quality and safety outcomes across NHS Scotland, building clinicians’ capacity and capability in applying knowledge in frontline practice and service improvement.

Decision Support for Diabetes in Scotland: Implementation and Evaluation of a Clinical Decision Support System:

Background: Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users’ reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014. Methods: Feedback was sought via patient questionnaires, health care professional (HCP) focus groups, and questionnaires. Multivariable regression was used to analyze HCP SCI-Diabetes usage (with respect to CDSS message presence/absence) and case-control comparison of clinical processes/outcomes. Cases were patients whose HCP received a CDSS messages during the study period. Closely matched controls were selected from regions outside the study, following similar clinical practice (without CDSS). Clinical process measures were screening rates for diabetes-related complications. Clinical outcomes included HbA1c at 1 year. Results: The CDSS had no adverse impact on consultations. HCPs were generally positive toward CDSS and used it within normal clinical workflow. CDSS messages were generated for 5692 cases, matched to 10 667 controls. Following clinic, the probability of patients being appropriately screened for complications more than doubled for most measures. Mean HbA1c improved in cases and controls but more so in cases (–2.3 mmol/mol [–0.2%] versus –1.1 [–0.1%], P = .003). Discussion and Conclusions: The CDSS was well received; associated with improved efficiencies in working practices; and large improvements in guideline adherence. These evidence-based, early interventions can significantly reduce costly and devastating complications.

Developing a framework to evaluate knowledge into action interventions

BackgroundThere are many challenges in delivering and evaluating knowledge for healthcare, but the lack of clear routes from knowledge to practice is a root cause of failures in safety within healthcare. Various types and sources of knowledge are relevant at different levels within the healthcare system. These need to be delivered in a timely way that is useful and actionable for those providing services or developing policies. How knowledge is taken up and used through networks and relationships, and the difficulties in attributing change to knowledge-based interventions, present challenges to understanding how knowledge into action (K2A) work influences healthcare outcomes. This makes it difficult to demonstrate the importance of K2A work, and harness support for its development and resourcing. This paper presents the results from a project commissioned by NHS Education for Scotland (NES) and Healthcare Improvement Scotland (HIS) to create an evaluation framework to help understand the NHS Scotland Knowledge into Action model.MethodsThe team took a developmental approach to creating an evaluation framework that would be useful and practical. This included a literature review to ensure the evaluation was evidence-based; adaptation of contribution analysis for K2A project; action research with K2A project leads to refine the work and develop suitable measures.ResultsPrinciples for evaluation and an evaluation framework based on contribution analysis were developed and implemented on a trial project. An outcomes chain was developed for the K2A programme and specific projects. This was used to design, collect and collate evidence of the K2A intervention. Data collected routinely by the intervention was supplemented with specific feedback measures from K2A project users.ConclusionsThe evaluation approach allowed for scrutiny of both processes and outcomes and was adaptable to projects on different scales. This framework has proved useful as a planning, reflecting and evaluation tool for K2A, and could be more widely used to evidence the ways in which knowledge to action work helps improve healthcare outcomes.

21st century medical education: critical decision-making guidance through smartphone/tablet applications—the Lothian pilot

Introduction In starting a new clinical placement, doctors in training must become aware of and apply standard operating procedures, as well as learn guidelines, simultaneously adjusting to new patient presentations, environments and personnel. This transition is thought to correlate with increased risk to patient safety, notably during the annual UK changeover. Mobile technologies are increasingly commonplace throughout the National Health Service. Clinicians at all levels are employing medical technology and applications (apps) with minimal local guidance. We set out to test the feasibility and utility of offering medical apps to out-of-hours (OOH) practitioners as an aid to clinical decision-making at point of patient contact. The theorised benefits were threefold: clinical education—real time support for clinical decision-making as one component of deliberate practice to build expert performance; decreased administrative burden–updating and accessing current guidelines; and service development—readily accessible feedback from users. Method We provided 32 devices in our emergency departments and OOH environments. The devices were preloaded with apps approved by our medical education department and clinical service leads to be used in support of care delivery. Results We surveyed 123 clinical staff prior to the pilot discovering that 65% had used mobile apps to aid their decision-making. During our project, we saw the number of clinical users expand with our data series, suggesting the apps most useful to care delivery for this group of service providers. Future developments There was huge enthusiasm for the project and we hope to maintain a clinician-led environment.

Knowledge Management and the National Health Service in Scotland

This chapter aims to consider the National Health Service (NHS) in Scotland (NHSiS) from a knowledge management (KM) perspective and describe some of the issues, advances, and successes. It begins with some background information on the NHSiS. There follows a discussion on the advances made in terms of developing the NHSiS as a knowledge-based organization, based on some models from the KM literature. Finally, there is a case study: the National Pathways Project, giving an example of KM in practice.