CLAHRC for South Yorkshire Collaboration for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC SY). Translation.
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CLAHRCfor South Yorkshire
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
kate.gerrish@sheffield.ac.uk
CLAHRC for South Yorkshire
Outline
• Kate Gerrish
Overview of the CLAHRC initiative
• Kate Gerrish
Translating knowledge into action: an example
• Andrew Booth
Knowledge into action: everybody’s business!
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
BarnsleyDoncaster
Rotherham Sheffield
CLAHRC for South Yorkshire
Translating knowledge into action
• 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
Aim
CLAHRC for South Yorkshire
Principles
• Priorities identified by NHS partners.• NICE guidelines, national guidance etc.
Focus on NHS clinical priorities for which there is an evidence-base
• Projects embedded within the NHS• Shared ownership• Focus on multi-disciplinary teams to change practice
Partnership working to facilitate KT
• Use KT frameworks to guide implementation• Evidence-based strategies to implement change• Embedded evaluation & feedback
Use evidence-based strategies to achieve change
• Knowledge translation facilitator secondments from NHS partners• Knowledge translation research secondments from HEI partners
Capacity building
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
Oral nutrition support for patients at
risk of malnutrition
Reducing the risk of
hospital acquired VTE
CLAHRC for South Yorkshire
KT projects focused on service delivery
Trialling and evaluating an organisational
approach to quality improvement through the
implementation of a Microsystems
Coaching Academy
Evaluating the application of clinical
microsystems methodology to redesigning a
community falls service
Promoting patient safety through cross boundary working to promote medicines
re-ablement
CLAHRC for South Yorkshire
KT projects focused on theory development
Tinkering and tailoring:
understanding the trajectory of
complex innovations in
healthcare setting
Exploring scale-up, spread and sustainability:
tracing a health care innovation
about dysphagia
KT casebook: capturing learning from KT initiatives
CLAHRCfor South Yorkshire
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
• 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
To reduce the risk of hospital acquired VTE by ensuring
Approach
• Medical wards in one within an English NHS Foundation Trust
Setting
• Action research approach using Knowledge to Action cycle (Graham et al 2006)
Approach
• Facilitation using best practice champion model• Education intervention• Audit and feedback, Root cause analysis
Implementation strategies
• observation, interviews, questionnaires• feedback interim data to evaluation wards
Data collection methods
MonitorKnowledge
Use
SustainKnowledge
Use
EvaluateOutcomes
AdaptKnowledge
to Local Context
Assess Barriers/Supports to
Knowledge Use
Select, Tailor,Implement
Interventions
Identify Problem
Identify, Review,Select Knowledge
Products/Tools
Synthesis
Knowledge Inquiry
Tailo
ring
Kno
wle
dge
KNOWLEDGE CREATION
ACTION CYCLEAPPLICATION
Knowledge to Action Graham et al 2006
CLAHRC for South Yorkshire
Knowledge Inquiry
Knowledge synthesis
Knowledge tools /
products
Tailoring knowledge
Systematic reviews risk assessment & prevention of VTEExemplar sites
NICE guidanceNICE Quality StandardsRisk assessment toolsPatient information
Knowledge creation
Primary research
Identify problem
Select knowledge
Adapt knowledge to local context
Assess barriers to knowledge
use
Select, tailor implement
interventions
Monitor knowledge use
Evaluate outcomes
Sustain knowledge use Review guidelines
Develop local policy
Appraise national screening tool, patient information
Action research approach
Multi-level problem identification Understand macro, meso, micro context
Ensure ownership of need for change at different levels of the organisation
Collect baseline data observation, audit
Survey knowledge, risk assessment / prevention VTE
Feedback baseline data to ward teams
Develop interventions andtailor to local context.Facilitate implementation of interventions in collaboration with front-line staff
Modify interventions in response to changes in local context
Repeat baseline data collectionFeedback from best practice champion, clinical staff and patient representatives via Project Steering Group
Measure patient & staff outcomesEvaluate intervention / implementationstrategies
Phased withdrawal of facilitation
Ongoing audit to monitor sustainabilityRoll out of interventions and disseminate learning
CLAHRC for South Yorkshire
• 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
Knowledge & attitudes
• Patients received prophylaxis & still developed VTE• Estimation that 50% of people develop VTE in the community
Root cause analysis
• 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
Compliance
Outcomes
CLAHRC for South Yorkshire
Challenges
• Board to bedside – importance of strategic and clinical leadership
Establishing effective engagement
• Immediacy of NHS agenda
Reconciling different agendas and time frames
• Lack of organisational slack in the NHS
Organisational capacity for change
• Whole systems to clinical micro-systems change
Dealing with unpredictability
Sustainability of change
CLAHRCfor 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 Evidence Knowledge & Know How
Not “knowledge brokers” but “knowledge broking roles”
Global “Local” Localised “Patch”
Knowledge throughout Action
New skills/knowledge build on existing strengths
The Knowledge Supply Chain
Information
Evidence
Knowledge
Brokerage roles
Brokerage roles
Brokerage roles
Increasing Importance of Context
CLAHRC for South Yorkshire
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 KnowledgeStrategic 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 ExamplesRole ExampleStrategic 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 ExampleStrategic Organisational relevance/support
Facilitators Judicious Selection of Methods. Successful Change projects. Organisational Learning.
Local Leads Local relevance/support/capacity
Local Academics Tools, Individual and Team Training & Development; Structure for KT Workbook
National/ International Academics
Organisational Training & Development; Capacity Building
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
CLAHRCfor South Yorkshire
Collaboration for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC SY). www.clahrc-sy.nihr.ac.uk
ContactsKate Gerrish: kate.gerrish@sheffield.ac.uk
Andrew Booth: A.booth@sheffield.ac.uk
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.
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