Better Intelligence Boosts Quality

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Better Intelligence Boosts Quality

• Sir Muir Gray CBE
• 23 February 2009

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The future is not a destination like the hill at
Harrow, waiting for our arrival it is something
like the Metropolitan Line that we have to
imagine, plan and build.
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The future is here it is just not evenly
distributed

• William Gibson

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Great innovations of the first and second
healthcare revolutions
First Second

Broad Street - John Snow

• MRI and CT scanning
• Statins
• Antibiotics
• Coronary artery bypass graft surgery
• Hip and knee replacement
• Chemotherapy
• Radiotherapy
• Randomised controlled trials
• Systematic reviews

Gower Street - Doll Hill
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21st C health and healthcare problems

• Safety
• Errors
• Quality
• Substandard clinical practice
• Poor patient experience
• Failure to maximise value
• Waste
• Overenthusiastic adoption of low value
  interventions
• Failure to get new evidence into practice
• Inequalities
• Failure to prevent disease

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The drivers of the third industrial revolution
Knowledge
Citizens
I T
Manuel Castells
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Knowledge
Generalisable knowledge
Explicit
Tacit

• From research
• evidence

• From data
• research
• statistics

• From experience
• experiential

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VALUES
THIS PARTICULAR
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Knowledge the enemy of disease
The application of what we know will have a
bigger impact than any drug or technology likely
to be introduced in the next decade
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Evidence from recent trials, no matter how
impressive, should be interpreted with
cautionClaims made in 45 highly cited reports
were subsequently contradicted (n7) or weakened
(n7) for 14 of the interventions

• Ionnidis JPA (2005) Contradicted and initially
  stronger effects in highly cited clinical
  research JAMA 294 218-228

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Research reports

• NICE
• guidance

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Who is responsible for

• What a new GP in Muswell Hill knows about
  indications for referral when there is
  hoarseness?
• What a citizen in Ealing knows about PSA
  screening?
• What a Year 1 SpR knows about fractured neck of
  femur?
• What a teacher of children with learning
  disability knows about epilepsy?

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Someone on the Board of every healthcare
organisation, directly responsible to the Chief
Executive, will be given the responsibility of
acting as Chief Knowledge Officer
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Knowledge flows
20th Century
Knowledge
Clinician
Patient
informs
is given to
21st Century
discusses with
is given to
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most patients were not given clear information
about the survival gain of palliative
chemotherapy in most (26/37) consultations
discussion of survival benefit was vague or
non-existent

• Audrey S et al (2008) What oncologists tell
  patients about survival benefit of palliative
  chemotherapy and implications for informed
  consent
• BMJ 2008 337a752

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Muir Gray has hypercholesterolaemia

• Every six months he receives an email reminder
  from the lab to have a blood test
• He receives 2 SMS reminders if no blood sample is
  received within 2 weeks
• If no blood arrives his GP receives a copy email
• If there is a result appropriate advice and
  support is automatically generated and emailed to
  Muir who lives in Oxford OX2 8JQ

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London Laboratory Service Muir Gray 21/06/1944
NHS no 400 186 6897 Cholesterol 5.3
The cholesterol level is unchanged, there is no
need to increase statins Step 1 increase your
walking Try to increase your walking by 3,000
steps a day (30 minutes walking, the brisker
the better)
Have you considered buying a dog? To find a big
dog for sale near you, click here
To test your knowledge in one minute, click here
NB This test was last done 12 months ago. There
is no need to restest more often than once every
3 years. The lab will not process a sample until
3 years has elapsed
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Public Health is a knowledge businessThe
application of what we know from research, from
data analysis and experience will have a bigger
impact on health than any drug or technology
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• Librarians
• Information scientists
• Chief Knowledge Officers
• Clinical epidemiologists
• Public health professionals

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Informing Healthier Choices
Box 1 Workforce capacity and capability Better
workers
Box 3 Stronger organisations Stronger teams
Box 2 Improved data and information Cleaner
clearer knowledge
Box 4 Health information and intelligence portal
and systems Better pipes
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• Box 1
• Available now!

• Suite of Job Descriptions and Person
  Specifications for information and
  intelligence staff
• 10 e-learning modules (5 at specialist and 5 at
  practitioner levels)
• 13 modules with .ppt slides, tutor notes and
  workbooks
• www.healthknowledge.org.uk hosts training
  resources for all public health competences

Workshop this afternoon to find out more
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Any thoughts ?

• drschiller_at_email.com
• muir.gray_at_medknox.net
• sueatkinsonph_at_aol.com
• Thank you!