Reform, choice and wellbeing: implications of health service change on the roles of 21st century kno

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Reform, choice and well-being implications of
health service change on the roles of 21st
century knowledge workers

• Anne Brice
• Head of Knowledge Information Sciences,
• Public Health Resource Unit, Oxford

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Positioning librarians in the modern NHS

• Context - what is the agenda?
• Can knowledge can make a difference
• What is being done - the English NSF
• What librarians need to know and do
• Understanding content and quality
• Service delivery reform - driven by users
• Understanding networks and communities
• Health and well being

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Facing the challenges

• Increasing need as a result of
• Population ageing
• New technologies
• Increasing demand because of rising expectations
• Failure of resources to grow as quickly as need
  and demand

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c20th Clinical Communities

• Based on one to one paper communication with
  occasional face to face meetings
• Have multiple paper records for one patient
• Do not have a common core of knowledge, relying
  on memory and the cascade of paper documents

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2 million consultations 10 million clinical
decisions daily
Decisions
Decisions Made by
made by Clinicians
Patients
Shared Decisions
Consultation time
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What problems do clinicians face ?

• Time
• External pressures
• Lost notes
• Missing data
• Welter of paper and websites
• Poor access to knowledge at work
• Managers/policy makers who have not experienced
  clinical decision making
• Complexity of care
• Fragmentation of support

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An Afternoon Clinics Records
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(No Transcript)
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Choosing Health Making Healthier Choices Easier

• The White Paper is about making a difference to
  the choices people make
• It aims to inform and encourage people as
  individuals, and to help shape the commercial and
  cultural environment we live in so that it is
  easier to choose a healthy lifestyle
• changes need to be based on choices

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Priorities

• Reducing the number of people who smoke
• Reducing obesity and improving diet and nutrition
• Increasing physical activity
• Encouraging and supporting sensible drinking
• Improving sexual health
• Improving mental health

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Chapters

• Health in the consumer society (marketing health)
• Children and young people starting on the right
  path
• Local communities leading for health
• Health as a way of life (health trainers etc)
• A health-promoting NHS
• Work and health
• Making it happen national and local delivery

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Delivery mechanisms

• Better information for the public (including
  marketing health)
• More effective working with children and young
  people
• More effective working with local communities
• Increased support to individuals to help them
  make healthy choices
• A re-balancing of the NHS investment
• More working with employers to promote healthy
  lifestyles at work, including the NHS
• Spearhead Primary Care Trusts

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Better information, better choices, better
health Putting information at the centre of
health

• Modern public services are built on effective
  partnerships
• Easy, equitable access to high quality
  information lays the foundation for such
  partnerships to flourish

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Key concepts

• Generalised and personalised information
• Information embedded as an integral part of
  delivering healthcare
• New channels of delivery
• A single approach to information
• Make information more effective

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Specific areas

• Translation and interpreting services
• Community based navigators
• NHS Digital TV
• Access to health records
• Health search engine
• Information prescriptions
• Reaching the public

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Our health, our care, our say a new direction
for community services

• Better prevention services with earlier
  interventions
• Life Check
• Health Direct
• More choice and louder voice for patients
• Tackling inequalities and access
• Supporting long term needs

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Why do we need a National Knowledge Service

• The application of what we know can prevent and
  minimise the seven ubiquitous healthcare problems
• Errors and mistakes
• Poor quality healthcare
• Waste
• Unknowing variations in policy and practice
• Poor patient experience
• Overenthusiastic adoption of interventions of low
  value
• Failure to get new evidence into practice

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The mission of the National Knowledge Service is
to support the decisions and actions of NHS
professionals and patients by organising,
mobilising, and delivering best current knowledge
when and where it is needed
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National Knowledge Service
The National Knowledge Service will achieve its
aim by supporting and facilitating the
collaboration of all those involved in
generating, organising, mobilising or supporting
the use of knowledge for professionals and
patients
Generation Organisation Mobilisation Localisati
on
Better Consultations, Better Decisions, Better
Systems of Care
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National Knowledge Service
Generation Organisation Localisation Mobilisati
on Utilisation
Co-ordinated procurement National Library for
Health NHS Direct Online eLibrary for Social
Care Map of medicine NHS Care Record
Service Patient professional education
Question Answering Service

Better Consultations, Better Decisions,
Better Communication
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A National Library for Health

• A modern hybrid, network based, library service
  for the NHS, providing seamless access to high
  quality knowledge
• To ensure that clinicians and patients have easy
  access to best current knowledge wherever and
  whenever it is needed

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Reform in libraries
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• The aim of the national framework
• The national service framework will be developed
  to provide direction for library service
  development, focusing on the delivery of local
  services to support the needs and expectations of
  the customer, within the context of partnership
  with local and national service providers, with
  quality of content and service a priority.
• National Library For Health Strategic Plan
  2005-2008

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Framework Core Service Areas
The service areas define what is required from
library and information services

• Customer focused service
• Resource management
• Role of library and information staff
• Knowledge Management
• Patient and Public
• Quality
• Information-handling skills
• Partnership
• Information Technology

The list of core service areas may expand or
reduce after consultation
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Framework Core Service Areas

• Service area Definition
• Core Specification (123)
• The core specification describes the level of
  service which is acceptable and which must be
  universal. Many of the core specifications are
  based on existing service and reflect
  requirements defined in accreditation standards.
  Meeting the core specification is not optional.
• Developmental Specification (34)
• The developmental specification describes areas
  for development and once developed will become
  part of the core specification.

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Key results from Phase 1

• Core components were accepted without change by
  the majority (acceptance ranged from 29 - 64)
• Core component d (knowledge management) gained
  the least acceptance at 29
• All other core components gained acceptance
  between 55 and 64.
• Support for development components was less, with
  a range between 42 and 49 acceptance

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What is Knowledge Management?

• The capabilities by which communities within
  an organisation capture the knowledge that is
  critical to them, constantly improve it, and make
  it available in the most effective manner to
  those people who need it, so that they can
  exploit it creatively to add value as a normal
  part of their work
• (Royal Dutch/Shell as reported in BSIs A Guide
  to Good Practice in KM, 2001

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What do health librarians need to know and do?

• Organisational know-how
• The state of the market place
• Understand what an evidence-based culture in
  health care means
• Understand networks and communities
• Negotiation, teaching and facilitation skills
• Refer to HEAG (Future Proofing the Profession)

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What else?

• Content and quality
• Networks and communities
• Health care interfaces
• Community services
• Common languages/taxonomy
• Common technical standards and interface
• Structured management evaluative frameworks,
  governance issues, programme management

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Evidence based librarianship is

• an approach to information practice that
  promotes the collection, interpretation, and
  integration of valid, important and applicable
  user-reported, librarian-observed and
  research-derived evidence. The best available
  evidence moderated by user needs and preferences,
  is applied to improve the quality of professional
  judgements.

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c21st clinical communities will have

• A community knowledge service, part of the
  National Knowledge Service but tailored,using
  tool, such as the Map of Medicine, for each
  community
• A single digital patient record
• A common core of knowledge, regularly updated and
  universally available
• eMail and shared webspace for virtual, as well
  as, face to face meetings

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c21st healthcare organisations will need to have
.

• A culture that manages knowledge with as much
  energy as it manages finance, and one which
  values librarians!!
• systems for importing and distributing knowledge
  so that all staff, including agency staff, and
  patients have the knowledge they need for safe
  and effective practice the NCRS
• structures to create the culture, develop the
  systems ,and promote the skills to manage
  evidence eg a Chief Knowledge Officer at board
  level and knowledge managers in every unit

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• Information for choice
• Working to support well-being

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• What will transform knowledge management in
  health care, is the patient of the 21st Century