The Best Kept Secret?

Knowledge Support for Senior Managers – Improving Service Delivery & Quality

HLG Conference 20

th

July 2010

Debra Thornton

Library & Knowledge Services Manager

Trevor Morris

Management Librarian

Background

• Successful clinical librarian service

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Clinical Librarian Searches March 08 - May 09

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Clinical Librarian Searches

Searches by staff group

Manager 17% Midwife 6% Nurse 28% Doctor 35% Doctor Nurse Midwife Manager AHP GP Student Other

What’s in a name?

“Like detergent, the word ‘librarian’ is an accurate description of function, but not a value proposition”

(Janice Lachance. Information Outlook 2009)

Aligned with Trust Objectives

Continuous improvement Develop leaders Empowerment

A LEARNING ORGANISATION

Stimulate innovation University Hospital

Management Librarian

A ‘leap of faith’

What the Service has offered the Trust?

 Management Librarian to work with management teams throughout the Trust  Ensure that decision making at the highest level is evidence based and supported by relevant knowledge and information  The service enables access to this knowledge store at the exact time it is required.

 The service is a personal service provided at the point of need by telephone request, by e-mail or in person at meetings.

–  Librarian attendance at Board and other meetings engenders a culture of evidence based decision making in a non-clinical setting.

 Provide high quality evidence of new developments and practices that have proven to show benefits in terms of improved quality services and financial gains.

Impact of The Service:

Senior Management Meetings:

 Trust Board of Directors  Executive Directors/Divisional Directors Meeting  Change Management Group Meeting  Associate Directors of Operations Meeting  Directorate Managers Meeting

Impact of The Service:

 Attendance at senior management meetings has resulted in information searches taking place on some of the following topics:  Recruitment of Nurses – Examples of best practice  Closing Wards to Improve Healthcare  Trusts publishing their own data to the public

Trusts publishing their own data to the public

Impact of The Service:

 Attendance at senior management meetings has resulted in information searches taking place on some of the following topics:  Recruitment of Nurses – Examples of best practice  Closing Wards to Improve Healthcare  Trusts publishing their own data to the public  Examples experience of best practice around the patient

Question: How can we share patient experiences with our staff?

Stories share ‘are a way to teach, inspire, persuade, and information’.

‘Patient stories can be effective as a tool for informing the service planning process’

Impact of The Service:

 Attendance at senior management meetings has resulted in information searches taking place on some of the following topics:  Recruitment of Nurses – Examples of best practice  Closing Wards to Improve Healthcare  Trusts publishing their own data to the public  Examples experience of best practice around the patient  Restructuring Hospital Departments to reflect Care Pathways

Restructuring Hospital Departments to reflect Care Pathways

Search Requests by Division

Impact of The Service:

 Utilisation of the Service by managers : 7% 8% 8% 46% Corporate Cardiac Medical Surgical Clinical Support Services Non-Trust Womens & Childrens 10% 10% 11%

Includes:

        Chief Executive Associate Directors of Operations Associate Director of Corporate Affairs Assistant Director of Strategic Development Deputy Director of HR and OD Assistant Director of Pharmacy Director of Finance Director of Nursing & Quality

Chief Executive’s Blog

Working closely with service improvement leads to advise on information and evidence to support specific projects and work streams.

 QuIPP Programme managed by the Service Improvement Team use service to advise on current legislation, guidance, best evidence and practice to support all future cross divisional projects and work streams taking place in the Trust.

Impact of The Service:

 Supporting QuIPP Carry out review of the evidence base in relation to the proposed business case:     Looking at current legislation and national guidance Review of all published research in the area Review of peer-reviewed content Identifying similar implementations Potential for the evidence base to impact on business case by :     Highlighting if the work has been done elsewhere Identify successful implementation Identify lessons learned Provide contacts that have gone through the process

QuIPP Example:

Methicillin-Sensitive Screening Programme Staphylococcus Aureus (MSSA)

 Evidence search for CSS Division in December 2009:

‘Cost of MRSA and MSSA infections or bacteraemia’

QuIPP Examples:

‘By screening for MSSA at the same time as we screen for MRSA it is expected that we will be able to reduce infection rates and improve patient safety. Were we to achieve similar rates for the reduction of all MSSA infections as we achieved against MRSA bacteraemias (40%), within the first year a net cost saving of £0.3m million could be achieved by savings in from reductions in length of stay’

(Business case for MSSA screening programme, March 2010)

 Clinical Pathway for MSSA Screening Programme now been produced.

 Looking to submit it for national recognition.

Management Search Procedure:

How Were These Searches Requested?

18% 5% 39% 38% Email Informal Meeting Formal Meeting Printed Request Form

Management Search Procedure:

Main Sources consulted:

 Emerald Collection of Management Resources  NHS Evidence - Specialist Health Management Collection  NHS Institute for Innovation and Improvement  NHS Economic Evaluation Database (NHS EED)  Intute: Business and management Studies  Health Business Elite Database  Health Management Information Consortium (HMIC)  Google Scholar  Google

Supporting Clinical Pathways

 Service has been involved in the utilisation and promotion of the Map of Medicine across the Trust.  Currently supports the process of developing localised clinical pathways in the Hospital in the following stages:

1. Select and prioritise a topic that is important for your service

.

 The Service performs a search on current pathways and guidelines.

Sources Consulted for National Guidance

Supporting Clinical Pathways

 Service has been involved in the utilisation and promotion of the Map of Medicine across the Trust.  Currently supports the process of developing localised clinical pathways in the Hospital in the following stages:

1. Select and prioritise a topic that is important for your service

.

 The Service performs a search on current pathways and guidelines.

6. Gather information to underpin the pathway development

 Provide an expert literature search of the evidence base  Provide examples of other hospital experiences

Latest Evidence on Cardiac Rehabilitation The effectiveness of a newly developed cardiac rehabilitation phase III program -- a quantitative and qualitative approach to enhance service delivery.

Crowley L. Physiotherapy Ireland, 01 June 2010, vol./is. 31/1(4-10),

Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume.

Hansen D, Dendale P, Raskin A, Schoonis A, Berger J, Vlassak I, Meeusen R. Clinical Rehabilitation, April 2010, vol./is. 24/4(319-27), 0269-2155;1477-0873

Home-based versus centre-based cardiac rehabilitation.

Taylor RS, Dalal H, Jolly K, Moxham T, Zawada A. Cochrane Database of Systematic Reviews, 01 March 2010, vol./is. /1(0-), 1469493X

New process for developing clinical pathways:

 Streamlined process cycle  Virtual review of proposed pathways without waiting for monthly meeting with audit trail  Support and co-ordinate pathway development  Harnessing tools such as SharePoint and Map of Medicine  Supports whole system pathways across the health community  Pathways will now link to the Trusts new £30m EPR system called ALERT

Evolution of the Service:

 Development of the Management Librarian role to Clinical Pathways Manager  Continuation of the Management Librarian Service by the Library team  Personalised horizon scanning for senior managers in each division based on their KPI’s  Develop an Intranet hosted database of completed searches, beneficial for identifying what kinds of management questions are asked most often and which questions lack satisfactory answers.

‘It is clear that the service is helping us to make better, more evidence based decisions, and supporting better quality care for patients.

’ (Aidan Kehoe, CE, 27 th May 2010)

Debra Thornton

Library & Knowledge Services Manager

01253 655596 [email protected]

Trevor Morris

Clinical Pathways Manager

01253 655497 [email protected]