Transcript Slide 1

Collaboration for Leadership in Applied Health Research and Care
for South Yorkshire (CLAHRC SY). www.clahrc-sy.nihr.ac.uk
Translation of Knowledge into
Better Quality Care
Learning from the NIHR CLAHRC for
South Yorkshire
Kate Gerrish & Andrew Booth
CLAHRC
for South Yorkshire
[email protected]
Outline
Overview of the CLAHRC initiative
• Kate Gerrish
Translating knowledge into action: an example
• Kate Gerrish
Knowledge into action: everybody’s business!
• Andrew Booth
CLAHRC
for South Yorkshire
NIHR Collaboration for Leadership in Applied
Health Research and Care for South Yorkshire (CLAHRC)
NIHR programme of applied research, and
implementation of research focusing on self
management of long-term conditions
COPD, diabetes, obesity, stroke, genetics,
chronic depression, health inequalities,
telehealth
Collaboration between universities, NHS
commissioners and healthcare providers
Building capacity to undertake research and
implementation
£20 million over 5 years (2008-2013)
£10m from NIHR with matched funding from
partners
CLAHRC
for South Yorkshire
Doncaster
Barnsley
Sheffield
Rotherham
Translating knowledge into action
Aim
• To achieve improvements in the
quality of patient care and service
delivery through developing step
change in the implementation of
research evidence into
healthcare practice
CLAHRC
for South Yorkshire
Principles
Focus on NHS clinical priorities for which there is an evidence-base
• Priorities identified by NHS partners.
• NICE guidelines, national guidance etc.
Partnership working to facilitate KT
• Projects embedded within the NHS
• Shared ownership
• Focus on multi-disciplinary teams to change practice
Use evidence-based strategies to achieve change
• Use KT frameworks to guide implementation
• Evidence-based strategies to implement change
• Embedded evaluation & feedback
Capacity building
• Knowledge translation facilitator secondments from NHS partners
• Knowledge translation research secondments from HEI partners
CLAHRC
for South Yorkshire
Knowledge translation
Closing the gap between what we
know and what we do
Making users (practitioners,
managers, patients) aware of
knowledge / innovations and
facilitating their use of it to improve
patient care and care delivery
CLAHRC
for South Yorkshire
KT is a dynamic, iterative process
that includes the synthesis,
dissemination, exchange, and
ethically sound application of
knowledge within a complex system
of interactions among researchers
and users with the intention to
improve the health of (Canadians),
provide more effective health
services and products, and
strengthen the health care system
Canadian Institutes for Health Research
CLAHRC
for South Yorkshire
Clinically focused KT projects
Management
of patients
with
dysphagia
CLAHRC
for South Yorkshire
Oral nutrition
support for
patients at
risk of
malnutrition
Reducing the
risk of
hospital
acquired
VTE
KT projects focused on service
delivery
Trialling and
evaluating an
organisational
approach to quality
improvement through
the implementation of
a Microsystems
Coaching Academy
CLAHRC
for South Yorkshire
Evaluating the
application of clinical
microsystems
methodology to
redesigning a
community falls
service
Promoting patient
safety through cross
boundary working to
promote medicines reablement
KT projects focused on theory
development
Tinkering and
tailoring:
understanding the
trajectory of
complex
innovations in
healthcare setting
CLAHRC
for South Yorkshire
Exploring scaleup, spread and
sustainability:
tracing a health
care innovation
about dysphagia
KT casebook:
capturing learning
from KT initiatives
Collaboration for Leadership in Applied Health Research and Care
for South Yorkshire (CLAHRC SY). www.clahrc-sy.nihr.ac.uk
Translating knowledge into action
Implementing evidence on the
prevention of hospital acquired
venous thrombo-embolism
CLAHRC
for South Yorkshire
Aims
To reduce the risk of hospital acquired VTE by ensuring
• Patients risk assessed on admission and 24
hours later
• Patients at risk prescribed appropriate
prophylaxis in accordance with NICE guidance
• Patients provided with anti-embolism stockings
have them fitted and monitored in accordance
with NICE guidance
• Patients/carers offered information (written &
verbal) on VTE prevention as part of admission
and discharge process
CLAHRC
for South Yorkshire
Approach
Setting
• Medical wards in one within an English NHS Foundation Trust
Approach
• Action research approach using Knowledge to Action cycle
(Graham et al 2006)
Implementation strategies
• Facilitation using best practice champion model
• Education intervention
• Audit and feedback, Root cause analysis
Data collection methods
• observation, interviews, questionnaires
• feedback interim data to evaluation wards
Monitor
Knowledge
Use
Select, Tailor,
Implement
Interventions
Assess Barriers/
Supports to
Knowledge Use
KNOWLEDGE CREATION
Knowledge
Inquiry
Synthesis
Adapt
Knowledge
to Local Context
Evaluate
Outcomes
Products/
Tools
Sustain
Knowledge
Use
Identify Problem
Knowledge to Action
Graham et al 2006
Identify, Review,
Select Knowledge
ACTION CYCLE
APPLICATION
Knowledge creation
Knowledge Inquiry
Knowledge
synthesis
Knowledge
tools /
products
CLAHRC
for South Yorkshire
Primary research
Systematic reviews risk
assessment & prevention
of VTE
Exemplar sites
NICE guidance
NICE Quality Standards
Risk assessment tools
Patient information
Multi-level problem
identification
Identify problem
Select
knowledge
Ongoing audit to
monitor sustainability
Roll out of interventions
and disseminate
learning
Sustain
Understand macro, meso, micro context
Ensure ownership of need for change at
different levels of the organisation
Adapt
knowledge to
local context
knowledge use
Appraise national
screening tool,
Reviewinformation
guidelines
patient
Develop local policy
Phased withdrawal
of facilitation
Measure patient &
staff outcomes
Evaluate
intervention /
implementation
strategies
Action research
approach
Collect baseline data
observation, audit
Survey knowledge,
Assess barriers
to knowledge risk assessment /
prevention VTE
use
Evaluate
outcomes
Repeat baseline data
collection
Feedback from best practice
champion, clinical staff and
patient representatives via
Project Steering Group
Feedback baseline
data to ward teams
Monitor
knowledge use
Select, tailor
implement
interventions
Develop interventions and
tailor to local context.
Facilitate implementation of
interventions in collaboration with
front-line staff
Modify interventions in response to changes in local context
Outcomes
Knowledge & attitudes
• Knowledge was limited but has improved
• Medication knowledge was good, then decreased when medication
changed, now improved again
• Prevention was not seen as a clinical priority but this is changing
Root cause analysis
• Patients received prophylaxis & still developed VTE
• Estimation that 50% of people develop VTE in the community
Compliance
• Initially risk assessment compliance was poor & prescribing of
chemical prophylaxis was good
• Risk assessment has improved significantly to attain CQUIN / patient
safety targets
• Other aspects that are improving are provision of patient information,
prescribing / management of anti embolic stockings
CLAHRC
for South Yorkshire
Challenges
Establishing effective engagement
• Board to bedside – importance of strategic and clinical leadership
Reconciling different agendas and time frames
• Immediacy of NHS agenda
Organisational capacity for change
• Lack of organisational slack in the NHS
Dealing with unpredictability
• Whole systems to clinical micro-systems change
Sustainability of change
CLAHRC
for South Yorkshire
Collaboration for Leadership in Applied Health Research and Care
for South Yorkshire (CLAHRC SY). www.clahrc-sy.nihr.ac.uk
Knowledge Into Action:
Everybody’s Business!
Andrew Booth
CLAHRC
for South Yorkshire
Take Home Points
Information
How
Evidence
Knowledge & Know
Not “knowledge brokers” but “knowledge broking roles”
Global
“Local”
Localised
“Patch”
Knowledge throughout Action
New skills/knowledge build on existing strengths
CLAHRC
for South Yorkshire
The Knowledge Supply Chain
Information
Evidence
Knowledge
The Knowledge Supply Chain
Information
Brokerage roles
Evidence
Brokerage roles
Brokerage
roles
Increasing Importance of Context
Knowledge
Q. Who are the Knowledge Brokers?
Strategic Brokering of Priorities and Actions
(NHS/CLAHRC/University)
Facilitators (CLAHRC/NHS/University)
Local leads (NHS/CLAHRC)
Local academics (University/CLAHRC)
National/International academics (Universities)
A…..We All Are!
(i.e. Knowledge Broker is a role not a job description! Main variables
are type of knowledge, context and intensity of involvement)
CLAHRC
for South Yorkshire
“Our experience with the Knowledge to Action
theme of the National Institute for Health
Research-funded South Yorkshire
Collaboration for Leadership in Applied Health
Research and Care (CLAHRC) suggests that
the knowledge broker position is not a single
role but rather comprises a complex network
of complementary roles”.
Booth A. Bridging the 'Know-do gap': a role for health
information professionals? Health Info Libr J. 2011;
28(4):331-4.
CLAHRC
for South Yorkshire
What is the Knowledge?
Role
Knowledge
Strategic
National/Local Priorities; Local
Context; KT methods
Facilitators
The Health Service; Facilitation
Local Leads
“Patch” knowledge; clinical expertise
Local Academics Local context; KT methods
National/
International
Academics*
Models, Techniques and Examples
* e.g. Professor Huw Davies; Professor Ian Graham
CLAHRC
for South Yorkshire
Some Examples
Role
Example
Strategic
What are the Must-Dos? Locally?
Nationally? Who do we need to influence?
Facilitators
What is After Action Review? How has it
been used in the NHS?
Local Leads
Which wards can we work with? Who are
their Opinion Leaders? Who do I need to
speak to?
Local Academics
What is Implementation Fidelity? Why is it
Important? How do you collect, organise
and share Good Practice?
National/ International
Academics
How useful is the Canadian Institutes of
Health Research model of knowledge
translation? What are the advantages of the
Knowledge to Action framework?
CLAHRC
for South Yorkshire
Achievements
Role
Example
Strategic
Facilitators
Organisational relevance/support
Local Leads
Local Academics
Local relevance/support/capacity
National/ International
Academics
Organisational Training & Development;
Capacity Building
CLAHRC
for South Yorkshire
Judicious Selection of Methods. Successful
Change projects. Organisational Learning.
Tools, Individual and Team Training &
Development; Structure for KT Workbook
CLAHRC
for South Yorkshire
150 Google Scholar
Citations
CLAHRC
for South Yorkshire
Knowledge Throughout Action
Evidence Search and Synthesis (Initiation)
• e.g. patient safety in community medicine management
Identification of Good Practice (Consolidation & Review)
• e.g. After Action Review
Identification of Models/Theories (Evaluation)
• e.g. Sustainability and Spread
Identification of Good Practice (Dissemination)
• e.g. KT Workbook
CLAHRC
for South Yorkshire
Building on Existing Skills
Searching (Literature and Good Practice)
Synthesis (Scoping/Mapping etc)
Facilitation (cp. Evidence Based Practice)
Development of Tools/Checklists etc.
Dissemination Products and Mechanisms
BUT ALSO
Local Knowledge
Knowledge of the NHS
CLAHRC
for South Yorkshire
A Brief Note on Sources
Good Practice
• e.g. King’s Fund Library
• e.g. SHSC Health Management Library and
Information Service
Knowledge Translation
• e.g. KT Clearing House http://ktclearinghouse.ca/
• e.g. Canadian Foundation for Healthcare
Improvement http://www.cfhi-fcass.ca/
• e.g. Implementation Science
http://www.implementationscience.com/
CLAHRC
for South Yorkshire
Take Home Points - Recap
Information
Evidence
Knowledge & Know How
Not “knowledge brokers” but “knowledge brokering roles”
Global
“Local”
Localised
“Patch”
New skills/knowledge built on existing strengths
CLAHRC
for South Yorkshire
“The value of a team approach comes not
simply from the cumulation of skills,
knowledge and expertise. Arguably an even
more important outcome comes from the
broadening of perspective offered by different
disciplinary backgrounds and interests”.
Booth A. Bridging the 'Know-do gap': a role for health
information professionals? Health Info Libr J. 2011;
28(4):331-4.
CLAHRC
for South Yorkshire
Conclusions
Challenges / barriers to knowledge translation
Enablers
• Techniques and tools
• Leadership and collaboration
• Knowledge brokering
CLAHRC
for South Yorkshire
Conclusions
• Implementation in the real
world is complex and messy
• We need to be able to deal
with unpredictability, be able
to adapt and cope with
complexity
• Knowledge brokering,
leadership and
collaboration, tools and
techniques help handle this
complexity
CLAHRC
for South Yorkshire
Collaboration for Leadership in Applied Health Research and Care
for South Yorkshire (CLAHRC SY). www.clahrc-sy.nihr.ac.uk
Contacts
Kate Gerrish: [email protected]
Andrew Booth: [email protected]
This presentation presents independent research by the Collaboration for
Leadership in Applied Health Research and Care for South Yorkshire (NIHR
CLAHRC SY). The views and opinions expressed are those of the authors, and not
necessarily those of the NHS, the NIHR or the Department of Health. CLAHRC SY
would also like to acknowledge the participation and resources of our partner
organisations. Further details can be found at www.clahrc-sy.nihr.ac.uk.
CLAHRC
for South Yorkshire