The Welsh Knowledge Transfer Study

South East Wales Academic Health Science Partnership

The Welsh Knowledge Transfer Study*Alison Bullock

6th May 2014, CardiffUsing Research Evidence to Improve Health and Social Care: NISCHR AHSC Workshop to Explore Strategies in Knowledge Transfer

*Funded by Aneurin Bevan and Cwm Taf UHBs

Features of the Wales policy context

National Institute for Social Care and Health Research (NISCHR) Academic Health Science Collaboration (AHSC)

The mission of NISCHR AHSC is to facilitate the collaboration between Health Boards, Trusts, Universities and Industry in Wales in order to combine clinical research, both basic and translational research, clinical care and education to create world-leading improvements in healthcare [NISCHR AHSC Strategy 2010]

Three regional hubs –North, South West and South East.

E.g. Collaboration between HEIs and NHS organisations in SE Wales to reduce fragmentation in R&D and accelerate health improvement in line with Government policies. • Building strategies incorporating healthcare, research

and education.

Using the Model for Improvement, each change is tested through a Plan-Do-Study-Act (PDSA) cycle

The DataInterviews conducted Nov-May25 (+7 scheduled)Lasting 30 mins on average.18 from HBs (5 Aneurin Bevan, 4 Cwm Taf, 3 C&V, 3 Betsi, 3 Powys), 4 HEIs (2 CU, 2 USW), 1 NISCHR 1 PH Wales 1 Velindre

Includes executive directors,senior managers and clinicians

Questionnaire data: 28

Informing the analysis frameworkContext: factors in the external and internal environmentContent: what knowledge, changeProcess: actions taken by the change agentsIndividual dispositions: attitudes, behaviours, reactionsWalker, HJ, AA Armenakis and JB Bernerth. 2007. 'Factors influencing organizational change efforts.' J Organ Change Manage 20:761-773.

Can be mapped to other frameworks – eg PARIHS

Analysis gridMain theme Indicative sub-themes

Definition Agreement; amendments

Systematic?

Barriers and Enablers

External Context Govt policy; funding; complex cases; expectations; REF

Internal Context Leadership; infrastructure; culture; professional silos

Content Knowledge types; patient benefit; information overload

Processes Time; management support; partnerships; communication; knowledge brokers

Individual dispositions ‘Right’ attitudes; communication skills; knowledge of evidence.

Note: over-lapping themes

What is KT? Working definition: the process whereby staff in the NHS (clinicians and managers) find out about new research evidence and put it into practice.

Knowledge transfer interlocked with knowledge implementation

KT “it is a little nebulous… differentiation between R&D, KT, innovation… confusing people” [#20]

How does KT relate to…. audit, research, innovation, EBP, R&D, NICE, 1000 Lives, quality improvement etc?

“There’s a lot of muddled thinking at the moment… groups are popping up across the organisation… how can we bring it all together?” [#45]

Is KT systematic?

“I think it’s just serendipity at the moment” [#6]

But “a new cancer drug, I think it’s pretty well developed” [#35]

“reasonably systematic in some professions and in other areas it’s ad hoc” [#60]

External context

Government policy leading KT* a ground swell of interest (eg today)

Methodology is good for some measureable, bundles of care

“It needs support at the highest level… I think it has to be a culture and an ethos driven model – and it is going to be difficult to change… - it can be done but its got to be pushed from the highest level” [#20]

“Where policy can helpful…is around setting agenda which is around collaboration and co-operation rather than competition” [#70]

External contextOther external factors

* pressures to deliver with finite budget and extensive service demands* patient comorbidity* patient expectations* REF as impact driver

“Across the university a vast majority of people just don’t quite get it. I think it is changing with REF and the whole impact agenda… but you’ve still got some people doing research for research sake and they don’t realise it should be part of this bigger picture.” [#40]

Internal context* Need a supportive ethos, culture which

embraces change

“We need to think much more carefully about what the title ‘university’ means” [#6]

* UHB status - potential

“…culture in an organisation that encourages conversation and imparting of knowledge… a prerequisite for high quality care” [#65]

Internal context

* Leadership and infrastructure helps

“We need to empower people… The people on the frontline will deliver far more than people like me in an ivory tower, but there is still a job for me as a leader to actually set that vision” [#10]

“You can be as wildly enthusiastic and committed and evangelical as you like but if the head of the monster isn’t supportive, nothing will happen.” [#11]

“The leadership of the organisation needs to say what is important… Not just say it, but do it” [#50]

Internal context* Linkage is important. Need to challenge ‘silo’ mentality

“…professional tribalism which stops it – and that can be within professions and between professions, you’ve got hierarchies, it’s a very difficult quagmire to find your way through.” [#15]

You’ve got to be able to break down those silos – so many of our problems are due to the fact that we are all divided in what we do and old-fashioned in the way we think” [#5]

“There does need to be more joined-up thinking between social care and health-care… A lot of knowledge goes across the blurred boundaries… we need to make sure that everybody who is a stakeholder …. can all play their part – so HEIs, the NHS and social care, and public health as well – are the four biggies.” [#20]

Content* Need to be driven by benefit to patient care and service needs

“Unless you speak to patients then you don’t know what their concerns are, what their worries are, and it is really important that you engage with people who do see patients” [#25]

Real knowledge is the knowledge of what patients need” [#50]

ContentKnowledge types* Importance of soft intelligence, conversations, experiential knowledge* Status of organisational services research

“A new drug will extend that person’s life, so it is clearly a no-brainer and we are all very excited, and we are all signed up to that. A new way of following up patients, which has slightly softer end points … is not quite so much in our training shall we say, so we are not so excited about it” [#35]

“Soft intelligence is very often not written down… I would want to include that in part of the knowledge transfer process” [#50]

“We need to reclaim experiential knowledge” [#65]

Content

• Manage the info overload

“We are living in the middle of a knowledge explosion… The wrong thing to do is to be beating practitioners up because they haven’t read enough papers, because they will never read enough papers”. [#15] 2

“We get bombarded by stuff all the time” [#35]

Processes The value of time for reflection and to

question current practice

“The pace of work is frenetic – so massive emphasis on getting through the work … I would like to see a more cerebral approach to healthcare, where there’s a bit more time to think about stuff.” [#5]

“So what we haven’t got in the NHS at the moment is headroom… which is the quiet space to sit down and think” [#15]

“Let’s just spend 2 hours thinking about it and get the librarian to do some literature search” [#45]

Processes Practitioners need focused, coordinated approach rather initiatives from all directions

“You need to have small numbers of very clear pieces of knowledge… good quality, non-complex” [#50]

“We had at one stage 38 improvement programmes coming through” [#70]

* Outcome measures can be valuable

“As soon as you measure something it becomes finite and almost tangible and so you know what you are doing, and everybody is doing the same.” [#20]

Processes

The benefit of collaborations and research/practice links SEWAHSP role in making connections.

"Chiefly through making a connection with our HEIs and industry. Helping to develop projects that could benefit patient care outcomes and experiences.” [#20]

Processes* Need for good communication

“It is important that we teach people the skills of appraising synthesised knowledge, and it is important that we commission synthesised knowledge” [#15]

“If it’s a big, fat, guideline, it is really difficult for busy practitioners to think actually what does this mean for me?” [#55]

“It’s 560 pages long, 200 recommendations… it sits on a shelf” [#45]

“It’s all communication, communication, communication…” [#70]

Individual dispositions

“I think it’s very person dependent then really. …So if you’re not intrinsically outward looking you can encourage that outward lookingness and softer networking.” [#16]

“I think if you surround yourself with can-doers, the chances of succeeding in knowledge exploitation and transfer are far greater” [#10]

“There are some people…that only ever look inwards… I see personalities as playing a huge part... Both enabling and inhibiting. ” [#45]

The value of qualities such as can-doers, ‘right’ attitude, motivation, open to change

Practitioners have a duty for EBP People practice KT but without having that badge

Who’s responsible? Everyone

“Directors and clinicians …have got to keep an eye on the horizon and see what’s coming on to develop and to change their algorithms, protocols, guidelines, etc to take into account new advice or new research which comes along.” [#11]

“Each individual in their own scope of practice should keep up to date… But you can be up to date with your CPD and still, I don’t think, be necessarily be fully cognizant of ..new research.” [#55]

Specific role holders/teams: Innovation and engagement officers, OD guys, patient care & safety team, audit team, R&D dept, improvement individuals, innovation leads, PH Directors, information services and librarians, (cancer) site specific teams…..

Who’s responsible? KB role

“Fundamentally you need to have people at high levels in organisations who have a specific responsibility for it… innovation leads…will have a major role in taking this forward” [#75]

“You do need to give somebody the responsibility for the transfer of knowledge” [#20]

“Explicit knowledge brokers to have a responsibility to enable the rest of the teams to work effectively rather than just simply feather their own knowledge nest” [#65]

“Knowledge …comes from the ground up,…from policy… from R&D internal and external. You need to have somewhere in the organisation that picks up on these… [#50]

28 returns @ 1 May: 13 NHS Managers, 7 nurses/midwives, 8 others

How seriously is KT taken in your organisation? 10-pt scale: mode/mean=6

How organised is your approach to finding out about new research findings or guidance? 10-pt scale: mode/mean =5Most common means: email alerts, colleagues, networks, seminars/lectures, journal searching, professional organisations.

How they communicate new info: email, presentations, meetings. Varies by target group

Deciding what’s relevant: patient benefit; healthcare improvement outcomes; linked to organisation's/national/dept priorities.

Half evaluate their KT activity (monitoring outcomes; feedback from target groups)

Questionnaire data: interim results

Some indication of what’s needed: sharing examples, user-friendly communication, support from leaders and infrastructure support, trust and respect, face-to-face contact.

It helps if the knowledge is aligned to practitioners’ interests and if there is sustained interaction between researchers and practitioners.

Local context seems to be less important and what’s important in one organisation was felt to be similar to that in other organisations in Wales.

Knowledge brokers should have knowledge and experience of the NHS and it helps if they understand different research methodologies.

Questionnaire data

In conclusion* Early days for KT* Recognition of importance. Not just about transfer but about

implementation of knowledge and innovation* Barriers identified but also positive examples and patient focused.

Requirements and way forward

Need for systematic approach, infrastructure and leadership* Clear Government policy and coordination linking KT, innovation, R&D, QI* Collaborations - sharing across Wales, creating time by avoiding

duplication

* Policy direction will help HBs to prioritise* Govt guidance on what UHB means – following consultation

Requirements and way forward

Need also local policy that encourages and expects KT * Tailored, focused, patient-centred, manageable

Optimise what’s already there* Potential for integration (of groups) and consolidation of roles (individuals

in knowledge brokering roles)* Role of R&D

Training in KT* Learn from clinical field? E.g. Multidisciplinary cancer SSIs who meet

regularly to “run through stuff that’s new or audits..or.. Patient incidents… Recommendations of the SST …feeds up to the Board to the annual delivery plan” [#35]

Key issues and way forward

“If you keep doing what you’ve always done you’re gonna keep getting what you’ve always got.” [#45]

“So it’s a bit about individual motivation, expectations, curiosity; it’s a bit about time, and it’s a bit about systems and processes, probably a bit about all those in different degrees in different contexts and different places” [#6]

Does this resonate?