Knowledge into Action

Knowledge into Action Supporting Person Centred Health Care This is the final paper reporting on the national demonstrator testing Knowledge into Action supporting Person Centred Health Care in NHS Greater Glasgow and Clyde Michelle Kirkwood, Knowledge Services Manager. Ann McLinton , Person Centred Health & Care Programme Manager April 2015

Contents Introduction...................................................................................................................... 3 Background ...................................................................................................................... 3 NHS Greater Glasgow and Clyde ..................................................................................... 3 Knowledge into Action ................................................................................................... 3 The 5 priorities of K2A ................................................................................................ 4 The Four Pillars .......................................................................................................... 4 Summary of knowledge management tools and techniques .......................................... 4 Implementing K2A in GGC .......................................................................................... 4 Person Centred Health and Care Collaborative.............................................................. 5 Methods ........................................................................................................................... 5 An Analysis of K2A Support ............................................................................................ 6 Case Studies ................................................................................................................. 7 North West Community Respiratory Team (NWCRT) ..................................................... 7 Auchinlea ................................................................................................................... 7 Ward 36, Royal Alexandra Hospital .............................................................................. 8 Mental Health Services Physical Health Policy Implementation....................................... 9 Themes from the After Action Reviews .......................................................................... 11 Expectations ............................................................................................................ 11 What actually happened ........................................................................................... 11 What worked well..................................................................................................... 11 Key Lessons ............................................................................................................. 12 Impact ........................................................................................................................... 12 Collaboration between K2A and PCHC ........................................................................ 12 The Role of the Knowledge Broker ............................................................................ 12 Organisational Change .............................................................................................. 13 Creating Capacity ..................................................................................................... 13 Developing Services and Resources ........................................................................... 13 Summary of Lessons Learned .......................................................................................... 13 Appendix 1: The Team .................................................................................................... 14 Appendix 2: Step Up and Step Away ................................................................................ 15 Appendix 3: Summary Evaluation Grid .............................................................................. 16

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Introduction

As part of the NHS Scotland Knowledge into Action strategy NHS Greater Glasgow and Clyde was commissioned by NHS Education Scotland Knowledge Services to undertake a demonstrator project to define and provide knowledge support for person centred health and care within the board area. The demonstrator project ran for 12 months from April 2014 to April 2015, and this is the final report.

Background NHS Greater Glasgow and Clyde

NHS Greater Glasgow and Clyde (NHSGGC) is the largest territorial board in Scotland serving approximately a fifth of the population and with a staff of approximately 40, 000 it provides the whole range of health services. NHSGGC has 35 hospitals of different types, more than 300 GP practices, and over 50 health centres and clinics 1.

Knowledge into Action

Knowledge into Action (K2A) 2 began in 2011 as a review of knowledge management across NHS Scotland, led by NHS Education for Scotland and Health Improvement Scotland, and sponsored by the Scottish Government Quality Division. The initial work was around a review of the evidence, specifically of the models best suited to pushing out knowledge to frontline practice where it would have the greatest impact on patient and client care 3. The initial review identified six dimensions 4 which could be used to get evidence into practice (known as the change package). To evaluate the use and impact of these dimensions a range of ‘Tests of Change’ 5 took place across a number of boards. After further evaluation 6 the K2A strategy was published in 2012 7. Boards across NHS Scotland are now working to implement this strategy at a local level and according to local priorities.

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For more information about NHSGGC see www.nhsggc.org.uk All Knowledge into Action papers and presentations can be found online at http://www.knowledge.scot.nhs.uk/together/knowledge-into-action.aspx accessed 14/07/2014) 3 Davies, H., Ward, V., Smith, S. Supporting NHS Scotland in developing a new Knowledge to Action Model. University of St Andrews and University of Leeds, 2011. 4 The 6 dimensions which make up the K2A review change package are: Evidence Search & Synthesis; Actionable Knowledge; Transform Use of Library Space; Relational Use of Knowledge; Knowledge Broker Network; National Support, Leadership and Culture. These dimensions can now be identified within the tools and techniques used for getting knowledge into action. 5 Test of Change project list 2011-12, http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4015207/14_Evaluated_Proj ects.xls (accessed 14/07/2014) NHSGGC registered 2 projects: (1) Rapid Search and Synthesis for decision support in the clinical setting – this tested well and became the Clinical Search and Synthesis service available through QUEST and (2) Develop and test utility of a database of tests and measures in mental health – this was very quickly evolved into the Tools and Measures copyright service for NHSGGC which has subsequently been up scaled to a national level and will soon be available as the National Copyright Permissions Repository. 6 Ritchie, K. Knowledge into Action: evaluation of test of change projects. Health Improvement Scotland, July 2012 http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4016118/20120326%20eval uation%20report%20v1.pdf (accessed 14/07/2014) 7 Getting knowledge into action to improve healthcare quality: report of strategic review and recommendations, NHS Education for Scotland, and Healthcare Improvement Scotland, June 2012. 2

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The 5 priorities of K2A The recommendations made for implementation of K2A have been further refined and are summarised in the 5 priorities listed here: 1. Understand and respond to knowledge needs of people in Scotland’s health and social services 2. Delivery products and tools which bring knowledge to people when and where they need it, whatever device they are using – “digital first” 3. Connect people to share experience 4. Bridge the current gap in translating knowledge into action 5. Build a national Knowledge Broker network The Four Pillars These priorities can be delivered through 4 types of knowledge management intervention: Search and Synthesis, Actionable Knowledge, Social Use of Knowledge and Organisational Capacity, supported by a network of Knowledge Brokers. Examples of knowledge management tools and techniques

Workforce skill development to find, share and use knowledge including health literacy skills

Knowledge Broker/librarian support to use knowledge and to make connections with others

Social media tools Communities of practice for specific topics Methods and tools to share knowledge and learning e.g. After Action Review

Social Use of Knowledge

Peer assist- learning before doing – e.g. collation of helpers and learning session via WebEx

Databases and websites e.g. The Knowledge Network

Organisational Capacity

Knowledge Management Tools and Techniques Summary

Organisational support or processes that promote the use of knowledge to inform practice Case studies and stories

Actionable Knowledge

Mobile app with an evidence bundle Task or resource lists as an aide memoire to improve consistency

Search and Synthesis Librarians and knowledge managers carry out expert searches combining knowledge from experience as well as research.

Implementing K2A in GGC NHS Greater Glasgow and Clyde has been a part of Knowledge into Action from the start, and early on during the ‘tests of change’ phase recognised that frontline leadership was key to the implementation and use of knowledge management tools and techniques. Following

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on from this the NHSGGC K2A Task Force 8 has been created, local Clinical Champions identified and aligned with the local Knowledge Broker Network to work together to develop the use of KM approaches within NHSGGC, develop the local Knowledge Broker skills and experience, and test out frontline use and acceptance of such approaches. Person Centred Health and Care Collaborative The Person-Centred Health and Care Collaborative (PCHC) was launched in November 2012 by the Scottish Government with a clear and strong commitment to support NHS Boards with quality improvement work in pursuit of the person-centred quality ambition set out in the NHS Scotland Healthcare Quality Strategy (NHS Scotland 2010). A central focus and key aim of the PCHC Collaborative is to develop real-time feedback systems and methods to capture care experience from people who are using health and care services and to use this feedback to drive improvements in care. The development and testing of a range of evidence-based interventions and approaches designed to improve person-centred care is pivotal to clinical teams achieving the quality ambition. As part of the NHSGGC commitment to person centred care a group of thirty-two clinical improvement teams were recruited from the acute services division and the community health and care partnerships to develop, test and implement change and improvement interventions known to enable health and care services to be more person-centred. The teams are supported and mentored by the Person-Centred Health and Care Collaborative Programme Team (PCHCT) from the Clinical Governance Support Unit. Each of the pilot improvement teams is multi-disciplinary in nature and where possible are representative of all staff who come into contact with the patient while in hospital or the community setting. The PCHC Team has developed and implemented a bespoke system to listen to and gather care experience feedback from people using services in NHSGGC. The methodology used is a “themed conversation” approach designed to enable people who use services to have their voice heard and to support, coach and mentor health and care services to use the feedback to learn and drive improvement in care experience at a local level in the individual clinical teams and services. The ‘themed conversation’ is sub-divided into eight person-centred focused domains: admission experience; consistency and coordination; respect and dignity; communication and involvement; safety; meal time experience; environment and facilities and overall care experience. All the feedback is used to identify what adds value to the care experience and is used to endorse and enhance elements of the health and care experience which is viewed to be positive. This feedback also helps to identify what does not add value, and identify the opportunities for learning, change and improvement.

Methods The Knowledge Services Team joined the monthly improvement meetings held with three clinical teams involved in the PCHC Collaborative, and became integral members of these teams through their involvement in the demonstrator project for Knowledge into Action. Working in close partnership with the clinical improvement teams, they select and tailor knowledge management methods to: • support clinical teams in working with service users and carers to identify the problems or challenges most important to them. • identify or create information that staff can use for shared decision-making with service users and carers. • support staff to help service users and carers in understanding and using this information to take charge of their health and wellbeing. 8

The K2A Task Force during 2014 was made up of Michelle Kirkwood, Knowledge Services Manager representing knowledge management and Knowledge Brokers, Jonathan Todd from HI&T representing eHealth, Professor Kevin Rooney who is, amongst many other things, national clinical champion for K2A and Dr Anne Scoular, Consultant in Public Health Medicine representing the K2A Executive Lead Dr Linda de Caestecker, Director of Public Health. 5

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capture and share staff, patient and carer experiences as a basis for improvement. help strengthen relationships between each team and the wider community support network, to improve the care experience of service users and carers.

An Analysis of K2A Support Search & Synthesis The NHS Greater Glasgow and Clyde Library Network offers staff a range of search and synthesis services as well as referring to other services such as CLEAR, Health Management Library Search Service, and Medicines Information. These services are owned by the Subject Specialist Team and delivered by all professional staff within the Library Network, and the services are governed by robust guideline and protocols. The services are evaluated highly in terms of impact for patient care, and end users are invited to provide feedback. During 2014 the Library Network provided 742 searches across all search & synthesis services, with the most used search service being the Literature Search Service. 9 This type of support is the most used by the PCHC teams. What is especially interesting is seeing the knowledge gleaned from the search being put into practice and then hearing the feedback from patients and staff, such as with the search into the use of patient diaries within a multidisciplinary/physio setting. Along with the searches for the teams, as the relationships developed further searches to inform individuals practice were also requested. Actionable Knowledge – as well as putting searches into action the knowledge services team were also asked to investigate and advise on many other forms of knowledge which could be put into action by staff /patients and carers such as: creating a Community of Practice for use by the clinical team when out and about in patients’ homes, or scoping the development of an app to monitor the physical health of mental health patients. Organisational Capacity – this type of support took many forms such as: providing links and signposting to other services within the organisation, for example linking with the Community Engagement Team to develop Patient Stories online; or linking in with the IT Service Delivery Manager for specialist support; or providing tablets for the clinical team to use in the community to save time and also help engage with their patients. The knowledge services were also able to refer to specialist support within knowledge services such as the Core Skills Tutor or Copyright lead when required. Social Use of Knowledge – having regular meetings with the PCHC team, Knowledge Services team, and the frontline team offered a great way to share knowledge, plan future work, and develop relationships (the Knowledge Brokers themselves met regularly to discuss interventions and methods). Specific support provided to the teams included the setting up of a Community of Practice, and working with the frontline team to train them to continue the development of the CoP for both theirs and their patients benefit.

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There are five NSHGGC Library Network search and synthesis services, Literature Search Service (LSS) which provides a list of references, Clinical Search and Synthesis (CSS), which provides a short response to a patient specific question with a short turn around (CLEAR which is a national service which delivers a similar output is also listed here as all queries originating within NHSGGC are returned to NHSGGC to do); Literature Analysis (LA) is a large review of evidence in respond to complex questions usually as part of a service improvement, Tailored Knowledge Support (TKS) is an amalgam of search, keeping up to date, and knowledge skills training services delivered to provide tailored support in response to a user’s project needs; and Tools & Measures (T&M) is a copyright search to support the diagnostic tools and outcome measure requirements of the organisation.

LSS 631

CSS + CLEAR 11 (+ 8 CLEAR)

LA 10

TKS 28

T&M 54

Total 2014 742

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Case Studies North West Community Respiratory Team (NWCRT) This is a physiotherapy led multidisciplinary team providing care to patients with COPD in their own home setting. Patients are supported by the team through exacerbations of their condition and on discharge from hospital. The team also aims to prevent future hospital admissions through anticipatory work. Example: Information Technology Category: Actionable Knowledge At the initial improvement meeting attended by Knowledge Brokers the frontline team described their way of working, which involved travelling back and forth between the patients’ home and their base. If there was any patient information, patient notes, or equipment required the team would return to base do their computer based work and return with the results the next time they visited the patient’s home. After a short discussion their Knowledge Broker Figure 1: Using Tablets for Patient Education enquired as to whether the use of mobile devices would be a benefit to the team. The team clearly saw that this would benefit both them (to create capacity and enable hospital avoidance by having access to records for emergency call outs) and to the patients (ordering equipment and viewing educational material online with the NHS staff there to discuss). Although there was no mobile device on the standard procurement list for NHSGGC, this was seen as an opportunity to gather evidence on their use, especially for the purpose of knowledge support. Although it took some time six Dell Tablets were purchased along with 3G cards for use in the community – these were delivered to the team late within the demonstrator project so their full evaluation is still pending. Although there was some difficulty in getting this new technology up and running and embedded within the consultation already there are positive reports on their use. Auchinlea Auchinlea House Mental Health Resource Centre forms part of the Easterhouse Community Health Centre which is situated to the east of Glasgow city centre. It provides mental health services to the Easterhouse, Baillieston, Garthamlock, Craigend and the Barlanark areas of Glasgow's east end. The Community Mental Health Team (CMHT) is multidisciplinary and works with patients with a range of mental health conditions including schizophrenia and personality disorders. The current improvement team includes: Sharon Devlin - Community Psychiatric Nurse Dr Paul Fleming - Consultant Clinical Psychologist Stevie Gearie - Community Psychiatric Nurse Iain Jones - Community Psychiatric Nurse Dr Lovely Rajan - Consultant Psychiatrist Dr Sarah Thomson - Consultant Psychiatrist Amanda Ramsey - Occupational Therapist Christine Roberts Clinical Improvement Coordinator (Person-Centred Care)

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Example: Asset Mapping Category: Actionable Knowledge / Social Use of Knowledge The Improvement Advisor and the Knowledge Broker working with Auchinlea attended an Asset Mapping event on 24th February which was run by the ALLIANCE; the PCHC Collaborative organised the event based on the improvement feedback coming from the teams. The Improvement Advisor had feedback from Auchinlea patients that they would like to know more about the groups and other support available in their local community, the Auchinlea team agreed they would also like to know more so they can make onwards referrals. Figure 2: Asset Mapping

Asset mapping is a strength based approach to communities; it is about making connections and building relationships. It recogmises that patients/clients/service users have a lot to contribute as they all have individual knowledge of what is available in their local community. Asking the question ‘What keeps you well?’ can draw out all sorts of ideas (walking the dog in the park, going to the library, local carers support group) which can then be mapped on paper. At the workshop, held in February 2015, participants did some practical exercises to map areas of Glasgow using Lego® and coloured pens. There was also a chance to do some mapping ‘in the wild’ around the workshop venue in the West End. 10 Additionally Auchinlea are planning a Keep Well Café for June and the ALLIANCE will facilitate some asset mapping with patients, carers and staff on that day. Ward 36, Royal Alexandra Hospital Ward 36 at the RAH is a care of the elderly ward. It is a continuing care ward where many of the patients require long term medical care or are awaiting guardianship. There is a palliative aspect to the ward and many of the patients have dementia. It was recognised that changes were needed to improve the experience for patients and their relatives. This resulted in the ward being identified as a suitable PCHC test of change project. The project team comprises: Rosie Moffat Senior - Acting Ward Manager (Clinical Lead) Christine Roberts - Clinical Improvement Coordinator (Person Centred Care) Gordon Jones- Healthcare Chaplain Ruth Robinson - Library Manager, Clyde (Knowledge Broker) Example: Protected Meal Times Category: Search & Synthesis It is common practice to protect meal times. The purpose of protected meal times is to minimise un-necessary interruptions; allow patients to enjoy their meal at the time it is served and allow staff members to concentrate their resource on service food and fluids without delay and ensure that there are staff available to assist patients with eating and drinking who need it. However in a ward with dementia patients this can be problematic: patients may require 1-2-1 assistance; and they may be put off as meal times in a hospital can be quite different from their memory of meal times with their families. Although family feedback had indicated that many would be willing to be there during meal times, it was contrary to local policy. There was however an indication that if appropriate evidence 10

Once you map your assets they can be add to the ALISS database http://www.aliss.org/ this information can then be accessed, shared and updated by anyone. 8

could be found, then an exception could be made. The Knowledge Broker undertook a search of the literature – although no evidence was found to suggest that protected meal times were contrary to best practice, evidence showed that having families and carers present during meal times with dementia patients was a positive experience for both – providing an opportunity for maintaining a family norm, as well as helping to meet the nutritional needs of patients. Subsequently the Acting Ward Manager made her case (based upon the evidence) and an exception was granted. Consequently feedback was received from families about this new practice.

“His partner comes and feeds him during lunch times to make sure that he gets enough to eat. She really likes that interaction and time spent with him. He’s eating fine!” “I really like that this ward lets us come and be with them during mealtimes. This puts my mind at ease because I can make sure he’s getting enough to eat.” “He loses weight because of the Parkinson’s, but he eats and eats. He needs assistance, and we help him to eat when we can. The dining room is nice, out of the ward a wee bit.”

Example: Basic IT Training Category: Creating Capacity

Figure 3: Staff trained in Basic IT

The Acting Ward Manager identified a need for some staff to improve their confidence in using IT. This was to allow them to use PCs for both patient care purposes and staff development tools. A referral was made to the Core Skills Tutor who arranged and provided a tailored Basic IT session with staff on the RAH site, this session also contained onward referral to further training including ELITE for more advanced IT skills. The Knowledge Broker also encouraged participants to utilise the Library and dedicate time to practicing and developing new skills on library PCs.

Mental Health Services Physical Health Policy Implementation The support for this work was done outside the usual format of liaison with the PCHC improvement team. However this work was referred to the team by the Executive Lead for K2A as it was specifically about improving person centred health and care in mental health. The first aspect of this work involved a Knowledge Broker working with key clinical staff to identify questions regarding physical healthcare monitoring within ESTEEM; one of the specialist mental health teams.

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Example: Esteem Category: Search & Synthesis/ Actionable Knowledge The NHS Greater Glasgow & Clyde Early Intervention Team for First Episode Psychosis (ESTEEM) works with individuals aged 16-35 who are experiencing their first episode of psychosis. ESTEEM aims to make access easier, avoid hospital admission whenever possible, support the young person and their family in the community and provide education in the recognition of psychosis to all professionals who have contact with young people. ESTEEM is a multidisciplinary team and works across the entire health board. The contacts for the improvement work were: Dr Susie Brown - Consultant Psychiatrist Dr Alexis McLaughlin - ST6 This team required use of the search and synthesis service to identify key evidence and expertise with regards to best practice in physical healthcare monitoring in first episode psychosis patients. Two drug specific questions were referred to Medicines Information colleagues for additional input as it met their requirements 11. With support from colleagues the Knowledge Broker compiled seven search & synthesis reports using a narrative synthesis methodology. A continuing theme that arose both within the 3 PCHC teams, and within this work for ESTEEM was the need to have a short turn around search and synthesis service. The Library Network provides a short turn around 12 Clinical Search Service for specific patient care which provides a very short focussed response from point of care resource, and it also provides a Literature Analysis service for complex queries sometimes taking several months to complete. What was coming through clearly was the need to have a service that sits between the two. Our frontline team members wanted search results presented in a way that could be quickly understood and put into use for improvement. Example: Coproduction of the Physical Health Bulletin Category: Search & Synthesis

Figure 4: Current Awareness Bulletin

Following on from this work the Knowledge Broker became aligned to the Physical Health Care Policy Implementation Group (the driver behind Knowledge Broker involvement in ESTEEM). One of the key actions for this group was to produce an evidence bulletin to ensure that staff was continually kept aware of the policies and evidence related to the topic. What they also wanted was a way to keep track of the distribution of the bulletin and which sections of the bulletin were popular. Normally the Library Network provides current awareness bulletins by librarians creating them on their own and then delivering them via the local QUEST 13 service which results in an email with an attachment being sent to all subscribers with no way of tracking use. A multidisciplinary editorial group was formed to produce four bulletins over a 12 month pilot period using Mail Chimp; the software allows in depth tracking of bulletin statistics. An evaluation will be carried out at the end of the pilot period. 11

NHSGGC Library Network and NHSGGC Medicines Information have a referral agreement defining the search & synthesis each performs and the referral process between them. 12 The Clinical Service and Synthesis service has turnaround times of 4 hrs, 8hrs, 24 hrs, and 5 days. 13 www.quest.scot.nhs.uk > Keeping Up to Date 10

Themes from the After Action Reviews 14

Each team participated in an After Action Review near the end of the demonstrator project. Expectations As this was a new way of working no-one had much in the way of expectations prior to the Knowledge Brokers joining the teams. In some cases this was the first time that they had used the knowledge services so they had no idea what a knowledge consultation was, or the range of services and resources available to them via the Library Network. Although the Library Network had worked with the lead for Person Centred Health and Care and had worked collaboratively with other parts of Clinical Governance it was also the first time the PCHC Improvement Advisors and Knowledge Brokers had worked together. For the Knowledge Brokers themselves, although they had extensive experience of supporting frontline staff and practice, this was the first time outreach support had been provided in collaboration with an improvement team, and in such a structure. It was also the start of providing a ‘consultancy’ approach – the Knowledge Broker would listen to the needs of the team and make recommendations, sometimes requiring them to think beyond what was usually done and to try something new. What actually happened Very quickly the benefits of having a Knowledge Broker as part of the team became apparent, with immediate actions were taken away, and at every subsequent meeting further actions were requested. Very quickly the Knowledge Brokers became involved with ‘their’ team, sharing their goals and vision. Over and above this, individuals were also making use of their Knowledge Brokers for 1-2-1 support. Instead of a two way relationship between the knowledge broker and the frontline team as originally envisioned, a three way relationship developed of equal partnership between the improvement team, the frontline team and the Knowledge Brokers. As the relationships developed the clear demarcation of roles did blur with Improvement Advisor, Knowledge Broker, and Frontline team becoming the ‘improvement team’ with tasks and actions meted out on an equitable basis. Although search and synthesis was identified as the cornerstone of support for Person Centred Health and Care, the need for a narrative approach to the synthesis was identified with a workable turnaround to ensure that the results could be put to use in good time. Other interventions were also identified both within the current portfolio of the Library Network and those that required the Knowledge Brokers to go beyond the usual. What worked well Creating capacity for improvement – this was specifically raised by the PCHC Improvement team as a key benefit of having a Knowledge Broker on the team, allowing more actions to be undertaken. The Knowledge Brokers enjoyed being part of the improvement team and seeing goals met and improvements made. Often when providing knowledge services there is a distance between the provision of services and resources, and the application frontline teams put them to. Although search and synthesis were mentioned by all, there was also specific mention made to 1) Referral and use of IT. Although no special treatment is provided by the IT Department to the Library Network by being part of the Health Information and Technology Directorate it is possible that they are more aware of what is possible, and the processes by which things get done – so our role in actioning some IT requirements were singled out. 2) Signposting – we were very clear that sometimes the knowledge support required would not be provided by ourselves but we would be happy to identify these and refer where possible. Across all teams this signposting ability was put into action. Due to the Library Network being a corporate service, having a structure aligned to specialties, and having regular Knowledge Broker

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For more information about After Action Reviews visit www.qihub.scot.nhs.uk 11

meetings connections were made to other services and connections made for the benefit of the frontline teams. Key Lessons All agreed that having a dedicated support for improvement increased productivity, although any improvement that required funding was subject to some delay. There was a clear message that by extending the team greater capacity was created. Having a Knowledge Broker attend the meetings brought a wider array of expertise and experience to the table, providing a different view of what could be done and how it could be done. The improvement team very clearly were in favour of extending the support to other Person Centred Health and Care Teams, and they too became quite conversant in both Knowledge into Action and the kind of support a Knowledge Broker can provide.

Impact

So far short term evaluation and impact has been discussed. This next section will discuss the long term impact of the demonstrator project on the provision of knowledge services, both in terms of supporting Person Centred Health and Care with the Improvement Team and beyond. Collaboration between K2A and PCHC Having a collaborative and close relationship between knowledge services and the Person Centred Health and Care team was recognised as being mutually beneficial in terms of pushing forward improvement with frontline teams. The PCHC team could increase capacity and Knowledge Services could meet their obligation to provide outreach in a structured high value way. To this end both parties agreed a Step Up and Step Away (see Appendix 2) approach to enable the PCHC team to identify frontline teams requiring support and for the Knowledge Brokers to manage their workload by stepping away when intensive dedicated support was no longer required – but remaining in touch to step up again when required. This approach will continue to be monitored and developed – so far a further 3 teams have been referred to knowledge services for support, and one has been stepped away from. It is also important to note that in other areas of the NHS where there may not be a PCHC team it is still possible to support person centred health and care as is evidenced by the work done with ESTEEM et al. The Role of the Knowledge Broker Providing knowledge consultancy requires development of the traditional librarian role, becoming more aware of improvement approaches, being open to doing things differently, and stepping outside the usual comfort zone. This also presents a challenge regarding where to draw the line. This is where peer support and continual communication within the Knowledge Broker team is utilised to discuss possible interventions and whether it is appropriate for the Knowledge Broker to do them, or refer to another service, or as a “one off”. What was essential was that a Knowledge Broker be aligned to a frontline team and for that relationship to be maintained – rather than a different Knowledge Broker attending each improvement meeting. This allowed the relationship to develop and allowed the Knowledge Broker to see an intervention through from start to finish which was reported as one of the most enjoyable aspects of the work. In each case a back-up Knowledge Broker was allocated, however they were never required to attend meetings, as the primary Knowledge Brokers attended all their improvement meetings – testament to the Knowledge Brokers taking ‘ownership’ of their teams.

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Key skills identified by Knowledge Brokers during this time (driven by other needs apart from PCHC support) that would allow their roles to develop especially in terms of providing consultancy were: facilitation and negotiation, project management, and workload management. The Library Network is committed to continual development of the role of the professional, paraprofessional, and support staff – ensuring the board is appropriately resourced in terms of knowledge services, and that those staff have the required skills and experience to provide high end knowledge consultancy, services and resources. Organisational Change Given the success of providing knowledge support for Person Centred Health and Care and the commitment we now have to continue and expand there is a need to ensure that there is a Knowledge Broker available when required. Over and above this is the recognition that the Library Network needs to maintain the correct balance between onsite support within Libraries, and outreach support to frontline teams using the model developed as part of this demonstrator project and the step up and step away approach as its basis. Additionally the need to provide balance across acute, community and social services naturally requires an expansion of the Knowledge Broker role, services and resources and the need to create capacity to do so. With the opening of the new Southern General Hospital in June 2015 the Library Network decided in 2014 to plan an organisational change that would see a movement of staff across NHSGGC, re-organising the Library Network into a sector model (North, South, West and Clyde). The Library Managers turned their libraries into hubs for their sectors, and refocused their role to provide outreach in partnership with the Subject Librarians. The Subject Librarians are aligned to directorates and subjects to allow them to work across sectors, but each is based within a different sector. Creating Capacity To provide dedicated knowledge into action support to Person Centred Health and Care Improvement Teams it is important to keep capacity management at the forefront – what are the priorities for the service 15, what we can stop doing, and what can be done more efficiently. Technology plays a big part in this. with plans to use a more integrated approach to managing enquiries, making better use of technology for paper less/lite working and knowledge sharing 16, and mobile use of technology to support outreach work. Developing Services and Resources Given the staff resource and time required to deliver high end services it is important to continually review the portfolio of service and set aside time and effort for the improvement of knowledge services. That way they should remain relevant to the organisation they support and of high value to the end user.

Summary of Lessons Learned • •

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Building the relationship between PCHC and Knowledge Services is key The position of the Knowledge Services within the centre of the organisation is pivotal – and allows for signposting and referral to increase the capacity for improvement It is important for Knowledge Brokers to be open to doing things differently – this is not about setting out the selection of knowledge services and resources available but about listening to user needs and taking on a ‘consultancy’ role and advising on

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Four priorities were identified by the K2A task force for 2015: Person Centred Health and Care, Unscheduled Care, Integration, and On The Move & Teams 16 The Library Network already makes extensive use of WebEx and SharePoint. Additionally they will be testing the use of Evernote for Business to share their personal knowledge bases among their teams. 13

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the varying approaches, services, tools, resources or other individuals /teams which may be of use. Opportunities arise to get really involved with the team work – which is engaging for knowledge services staff but which must be balanced with setting out the limits of the support a knowledge service will provide To ensure continued capacity to provide support “a step up and step away” approach has been implemented. It may be worth assessing the role of the Knowledge Broker in the organisation and making changes to assist this way of working long term and on a much larger scale.

Appendix 1: The Team

Team Leads Michelle Kirkwood, Knowledge Services Manager, NHS GGC [email protected] Ann McLinton, Programme Manager Person-centred Health and Care (PCHC) Collaborative Programme Manager [email protected] Team Members Catriona Denoon, Library Services Manager [email protected] Tracey McKee, Specialist Librarian [email protected] Ruth Robinson, Library Manager (Clyde), [email protected] Chloe Stewart, Specialist Librarian, [email protected] Laura Keel, Clinical Improvement Coordinator (Person-centred Care) [email protected] Kathleen O’Reilly, Clinical Improvement Coordinator (Person-centred Care) [email protected] Christine Roberts, Clinical Improvement Coordinator (Person-centred Care) [email protected]

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Appendix 2: Step Up and Step Away

1. PCHC Team identifies frontline team that could benefit from Knowledge Management Support

2. PCHC Team approaches frontline team (with KM flier for illustrative purposes) for consent

3. Request made to KM for support, KM senior team align request to an appropriate Knowledge Broker (by specialty or location)

4. Dates for start meeting set in diary, KB will be provided (if required) with a mentor for initial meetings .

5.KB attends team improvement meetings.

6. In agreement with the PCHC team and the frontline team the KB will step down.

7.The frontline team can continue with ad hoc support from their KB as required, with the option of requesting a step-up when needed.

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Appendix 3: Summary Evaluation Grid Outcomes Chain Resource or Inputs

What resources or inputs will support the activities? Knowledge Services Manager 3 Knowledge Broker Leads Person Centred Care Improvement team

Assumptions

Teams engage with the librarians Librarians willing to mentor colleagues Training activities in place

Risks

Indicators

Meetings cancelled and Numbers of meetings staff do not have capacity Number staff engaging to engage with teams

Reports of Numbers of meetings and Number staff engaging

Clinical lead does not champion work with teams

A log was kept of all meetings attended and actions taken at each. Although the teams met regularly there were months (e.g. during summer) where no meeting took place.

Librarians do not want to evolve into new roles

Frontline teams x3 Knowledge Services team of librarians Band 5 and above = 28 staff

Activities

What activities will take place? Meetings with PCC lead Consultancy service Monthly meetings with Improvement Teams

Teams engage with the librarians Librarians willing to mentor colleagues Training activities in place

Evidence

Mentors unable to contribute to meetings

Evidence from librarians and mentors

Librarians do not engage in training and mentoring activities

Influence of clinical lead

Each team had a dedicated Knowledge Broker who remained aligned to the teams throughout the demonstrator.

Meeting notes Logs of activities

Log of activities maintained Mentors identified for each KB – especially later in the demonstrator- though more support was provided

they are assigned Mentoring other librarians Network meetings with librarians

through the regular Knowledge Broker meetings. Training needs were identified – 2 sessions provided so far:

Training, mentoring , network meetings

Outputs

What will the products/methods/ services be? Strategic plans Guidance documents Tailored knowledge support and solutions in response to needs under the 4 pillars of types of knowledge support including signposting other services Meeting with mentors regularly Logs of meetings and interventions

1 Facilitation and negotiation 2. Project Management

That the approaches taken by the KBs are accepted, are correct, and offer improvement. That signposted services deliver as advertised

Low expectations of team members can limit solutions proposed

Strategic plans Guidance documents Tailored knowledge support and solutions Meetings attended

Further training to be provided during 2015

Guidance available S&S reaction forms general for all searches not specific to project Logs of activity Feedback from Mentors PCHC identified as a LN Priority for K2A in 2015 by the K2A Task Force Knowledge Consultancy Guide developed Step Up and Step Away approach developed Feedback and further stats

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documented Sharing experiences and good practice with other librarians Reach

How far have the targeted groups been engaged at micro, meso and macro levels? PCC Lead encourages engagement of teams

for search and synthesis is available

Teams do not engage and Low expectations of do not try to implement team members can limit suggestions or use solutions proposed evidence supplied

Reports of meetings and solutions Training outcomes

Logs of activities Evaluation from training sessions Log of interventions kept Basic IT evaluation available from Core Skills Tutor

Frontline teams and Improvement advisers ask for librarians to input options and develop solutions Librarians share experiences Librarians attend training Reactions

How do the target groups react to the service? Satisfaction/timely/ relevance/ efficiency… Guidance notes used by teams and librarians Teams try solutions

Librarians embrace opportunity to work in a new way Teams are engaged with process so willing to try new solutions

Teams not engaged

Solutions used by teams

Librarians not engaged

Mentors and librarians report positive influence of interactions

Logs of solutions and report of test of change implementations Reports from mentors Log of interventions The interventions that have gone though to test of

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developed or based on the evidence provided by the librarians

change phase have been identified

Role of mentors embedded in practice Librarians report open to new ways of working Knowledge, Attitudes, Skills, and Aspirations

What knowledge, skills, attitudes change as a result of using the activity/outputs?

Knowledge services Network and management structures in place

Capability of librarians increased to contribute to teams

Themes can be identified therefore possible to reuse guidance or solutions

Librarians build networks with other GGC services to enable increased signposting and reduction of duplication

No themes identified Consultancy model not accepted

Evidence of signposting to other services Increase in numbers of librarians involved

Identify themes from logs reports from mentors and mentees Reported in demonstrator report

Evidence of increased consultancy role of more librarians Practice or Behaviour

What

All teams understand

Librarians do not take

Increased number of

After action review in

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Change

practices/behaviours do you expect to change as a result of the activity/outputs? Consulting with librarians embedded in the work of the improvement team and the 3 frontline teams

benefits of working in partnership

responsibility for suggesting solutions

librarians taking the lead with project teams

March 2015 reports AAR summarised in Demonstrator report

Librarians feel empowered to take responsibility and make decisions about how to work with teams and provide increasingly innovative solutions More Effective Practice and Wider Outcomes

How will practice be more effective as a result of the activity/outputs? The experiences of the patients and service user is improved More improvement teams understand the input of knowledge services and know how to engage with the

Improvement team sees benefit of involving Knowledge Services therefore spreads the word

Capacity and capability not available to work with more teams

Knowledge services input acknowledged

PCC team report of improvements Exec lead approves work with increased number of teams - operational planning for 2015-16 K2A Task Force approved priorities for 2015

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service Increased number of librarians working with additional teams

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