Tuesday, 6 July 2010


Finally, my notes from KMUK 2010 conference - presentations available at

Lee Bryant: "Innovation can't work until we understand the problem to be solved" - there's a role for KM in helping the business understand the problem at hand but also a warning not to engage in KM for KM sake.

Lee was a little bit harsh on IT departments, citing dysfunctional relationships with IT as a barrier to KM (mixed reaction from the audience on this as so dependent on the personalities and culture). Other barriers include:

  • Extent of organisational responsibility - how much authority or influence do you really have to make change happen?
  • Too much focus on repositories and not enough attention to the information flows
  • Too much focus on structure vs emergence - e.g. Imposing a taxonomy vs nurturing a wiki
  • Assumptions about sharing for the "common good" - not always a clear argument - need to understand motivations and incentives
  • Too much focus on process rather than the people
  • Intranets haven't kept pace with the internet and are clunky - difficult to find what you need

KM has potential as a network-centric role to overcome silo working.

Lee talked about the emerging field of "social business":

  • Adhocracy - simplifying organisational forms - cf Clay Shirky
  • Collapsing distance - intimacy and scale at the same time
  • Social web - "ambient intimacy" (Stefana Broadebent)
  • Network productivity - about collaboration, typically not supported by HR policies

Lee suggested 4 areas of focus: connections, content, collaboration, culture

A key question is how can we help our customers make sense of the huge amount of content out there - a need for a filtering, sense making role. Our role should develop as knowledge networkers - find and open up data to improve performance, drive service improvement etc.

David Gurteen talked about the need to develop a "participatory culture" - this echoes a little of what Lee Bryant said that KM should focus on the people not the processes.

Gurteen was especially keen to encourage conversation within organisations as a way of connecting people and used a series of quotes to demonstrate this - a couple of my favourites here:

Bonnie Cheuk and Samantha Bouzan presented on a project to use KM techniques, to drive an initiative to capture and share staff ideas, with the aim of "co-creating" the overall business strategy. The project was essentially an 8 month strategy development process consisting of:

  • Knowledge management - Web 2.0 tools to complement face to face working
  • Internal comms
  • HR and staff engagement

3100 out of 3300 staff actively participated - 94% involvement rate

From a KM perspective:

  • Redefined what is understood as "knowledge" - includes insights, opinions, ideas as well as facts
  • Demonstrated value of KM with a purpose
  • Web 2.0 tools can help connect staff and different sites
  • Set expectations with regards to decision-making - involvement does not equal final decision
  • The interdisciplinary approach meant a broader perspective

Web 2.0 tools proved useful as can see emerging ideas quickly, and can encourage reflection - also open and transparent but can exclude some people. Whilst the project increased knowledge flow, the key was to put that knowledge to action - this involved visualising and summarising the input for leaders to inform decision-making as well as demonstrating to staff how their input was shaping strategy

Marc Gooch gave a very open and honest presentation on the ideas which have and haven't worked in his organisation (Royal Sun Alliance).

Interestingly, they found that online communities didn't work and this was a theme throughout the conference (communities of practice cannot be designed and typically will only work when they come from within the community). Royal Sun Alliance found that individuals didn't have enough incentive to participate.
deas that didn't work:

Ideas that seem to be working include a series of technical forums: these are face to face meetings, around case scenarios to stimulate discussion - these have proven successful as it's an opportunity for technical staff and head office to engage. A development programme has been designed to develop a cohort of champions who deeply understand the business and network together - networking events are held to link different skills and knowledge.

Hank Malik talked about linking KM to the talent management cycle - top down support was needed to get this up and running and the support from HR has been at times variable. A community charter is agreed with community leads before a community is set up and resourced - knowledge cafes/lunch'n'learns are held every month. Interestingly, Malik has done quite a bit of work on KM to support induction of new staff. The cycle (and there does seem to be quite a lot of activities so I wonder how well each is resourced) is shown in his slides (link at top of this post).

Dave Snowden gave a great presentation, challenging us all to be more strategic. He gave quite a stark warning that if we don't get more strategic, we risk our services and our jobs. Some of what he said echoed what Lee Bryant had opened with - we focus too much on systems and not enough on the way people work. Dave challenged us to think of new ways of doing things - we can't do more with less unless we change our ways of working.

His point was that we can't know in advance all the knowledge we will need so the most effective and pragmatic approach is to develop networks to enable access to knowledge when needed, as opposed to trying to capture it all in some kind of system. The price of networking is to share so you need to work at these relationships and be willing to share what you have and what you think. Dave advocated "messy coherence" over too much structure - structure goes out of date very quickly, for example, keeping taxonomies up to date can be a full time job.

Dave also covered the 7 principles of KM:
  • Knowledge can only be volunteered it can’t be conscripted
  • We only know what we know when we need to know it, we are pattern based intelligences not information processors
  • In the context of real need few people will refuse to share their knowledge
  • Tolerated failure imprints learning better than success
  • The way we know is not the way we say we know
  • We always know more than we can say, and we will always say more than we can write down
  • Everything is fragmented, humans seek messy coherence
  • There are limits to the semantic web
Dave introduced the concept of a "crew" (like the navy) as an alternative to communities of practice - the key is to bring people together but to train them in their individual roles and expectations of other roles - this enables working across silos, building on naturally occuring roles. He argued this is a more dynamic way of sharing knowledge - gather the people and give them the tools to share as opposed to defining the structure for them.

There was some discussion around terminology with some delegates mentioning that the phrase "KM" is in itself a barrier as it is fairly meaningless - Dave recommended "sense making" instead . He referred to Gary Kline (Sources of Power) who uses the model: See Attend Act. The common definition of "Right info to right people at right time" isn't enough - we have to ensure people pay attention to and act on information.

Dave talked about some of the work he's currently involved in, particularly in relation to risk maangement. He argued that best practice doesn't capture anomalies and it's important to discover anomalies to identify threats and opportunities effectively.

He closed with the argument that KM needs to be more scientific and focus on real practical outcomes, addressing real-world intractable problems.

Ben Gardner talked about using OneNote to encourage cross-silo working and knowledge sharing. OneNote is used to create collaborative notebooks. Key lessons included: don't overengineer tools or environments (echoing the structure vs messy coherence argument from Dave Snowden); need to consider issues around trust; clarity of user experience; and the need for a clear purpose for the notebooks. OneNote is now used to run and capture meetings. Research has shown the project has saved around 45 minutes per week per person but it is hard to show that that time has gone towards new work. A charter is agreed with participants to agree how sharing will work and to build trust. The collaborative notebooks don't replace the lab books - the purpose of the collaborative notebooks is to capture knowledge to support decision making in individual projects. There have been issues around synchronising to Sharepoint - versioning has been a problem so there may be a need to consider checkin/checkout.

All in all, a very good conference and found it really helpful to discuss ideas - particularly alternatives to communities of practice. The key lesson is to adapt to the needs of the organisation and put in just enough structure to enable collaboration and evidence-based decision making.

Thursday, 24 June 2010

Ideas from the National Quality Board on improving information

hsj.co.uk has an article today (Quality advisers say all NHS information should go online) which refers to the latest report from the National Quality Board (which I couldn't find on the DH web site as it's impossible to find anything on it while they reorganise it - who knows when they'll actually finish reorganising it).

Key recommendations include:
  • single organisation to manage the collection of information
  • more of a mandate for providers to provide full and accurate data
  • sharing of information with the public
David Haslam, who led the report, said:
"All the organisations that collect data should be brought together into a single organisation, and the state should make it clear the responsibility to collect data is the providers"

Hmmmm....interesting - there is an issue regarding data quality and it's right that information should be shared. But a single organisation to manage all data collection? Not sure this would work due to the need for local information to be collected...

Monday, 21 June 2010

CILIP Gazette - leadership and tweeting

Cilip gazette 17/6/10 highlights the need for leadership in these difficult times - the cover article focuses on the academic sector but the messages are relevant to all of us: "Leadership is also about understanding the environment in which we work, where issues of efficiency gains, shared services, the rationalistaion of services, effective staff management and creativity in the configuration of services have a new urgency” (John Lancaster, Uni Huddersfield).

Linda Carter of Leadership Foundation suggests the following qualities as essential to lead in the current climate– “confident, agile, enquiring, passionate, refective, and self-aware”.

In another article, Laura Woods talks about tweeting etiquette at meetings and events – it seems people are divided and some assume people are just mucking about on their phones and/or laptops. Laura suggests an area specifically for people who wish to use phones and laptops which would avoid distracting others – could be a good idea, particularly locating near power sockets which is usually a problem at events.

Monday, 14 June 2010

Guardian report on HES data

The Guardian had an interesting story yesterday on the poor quality of HES data:
Includes discussion of data in surgery, comparing that collected by surgeons with that collected via HES route by administrators. Also mentions how data has been used to move complex surgery to specialist centres, and the subsequent impact on patient safety, covered in more detail in an accompanying article:
The research comparing HES and surgeon-collected data (for abdominal aortic aneurysms) is also shared:

Thursday, 10 June 2010

Marketing yourself

Have read two recent articles on this subject:

What did you say your job was? by Venessa Harris, CILIP Gazette, 3-16 June 2010, 9
Reputation management by Rob Brown, Business Information Review, 2010, 27(1) 56-64

Some interesting thoughts:
  • Venessa Harris talks about taking (informed) risks and opportunities presented by new roles
  • Marketing yourself helps with sharing, networking and collaboration as well as career development
  • Use online tools to build and manage a consistent identity
  • - We all need to manage our own personal reputations as well as the reputations of our respective services/organisations
  • There are three aspects to reputation management: building the reputation, maintaining it, and salvaging it should all go wrong
Some ideas for managing reputation:
  • be visible through writing articles, presentations
  • keep up to date - read (not just specialist but generalist sources), maintain personal collection of valuable information, keep up with cpd
  • get involved in projects, committees, associations
  • keep examples of successes
  • focus on excellent customer service and on outcomes (not process)
  • take time to build and maintain relationships
  • keep skills fresh and learn new skills
  • build on your network
  • develop a good "elevator pitch"

Bits and bobs

Project Manager Today, June 2010

Interesting article on project to renovate Lincoln Centre for Performing Arts in New York – involving New York City Ballet and New York City Opera – had to fit around performances. Highlights the need for clear governance and decision-making (a number of committees focused on specific specialist areas which all had to escalate decisions for approval to an overarching committee so all decisions signed off in same place; need for constant, ongoing engagement with those affected to minimise disruption and to promote understanding of rationale behind decisions, and to enable shared decision making where possible)

Joseph Czarnecki includes an interesting comparison on PMBOK v PRINCE2

Henny Portman writes about avoiding PRINCE 2 In Name Only – must follow 7 principles of PRINCE2 to do properly – continued business justification; learn from experience; defined roles and responsibilities; manage by stages; manage by exception; focus on products; tailor to suit project environment.

Dante Peagler writes about the need for effective planned project handovers – so often, there is no formal handover and there is then a period where the new PM has to catch up and may not pick up on the tacit knowledge. Need to allow enough time, ensure project documentation is up to date, introduce new PM to key stakeholders, work in parallel if possible, make transition dates clear.

HSJ 27/5/10

Interesting article on risk modelling - which includes mention of PARR and West Mids BUPA solution – and growing use of virtual wards to avoid A&E admissions. Now looking into social care applications – identifying elderly people who are at risk of losing independence through ageing/ill health. 80% of PCTs estimated to be using predictive modelling. Different approaches to virtual wards – nurse-led with GPs becoming involved as required (Croydon), dedicated virtual ward doctors (Wandsworth); general practice led (Devon); virtual discharge ward running predictive model on inpatients and offering those at high risk of readmission 30 days of support (Toronto). NHS Devon now looking to commission a front end – including dashboards – to help manage their GP led service.

Also supplement on Health Intelligence focusing on PHOs. Outlines following challenges:

  • smarter management of multiple data sources
  • helping local users understand and use health intelligence in decision making
  • intelligible health information for informed consumers
  • more intelligent approach to real time data
  • filling persistent gaps – new health and quality measures and reliable population-based registers
  • better sharing of health and local authority data
  • better grip on measuring the whole pathway of intervention.

Talks about the tension between needing data quickly or needing assurance that data is clean – (reminds me of usefulness = validity x relevance/work). Also talks about role of PHOs e.g. production of annual health profiles, and topic-themed PHOs e.g. obesity, injury, child and maternal health. NWPHO has alcohol profiles which are being used across the NHS. London PHO has developed health inequality tools – smoking cessation, statin prescribing, antihypertensive prescribing, controlling high blood sugar in people with diabetes, interventions to reduce infant mortality. Also considers how PHOs support WCC showing example of Y&H’s SPOT tool, to help prioritise investment and disinvestment. Also mentions the SHAPE (Strategic Health Asset Planning and Evaluation) toolkit to inform strategic planning of services and physical assets. Nice to see mention of NLPH.

HC 2010 notes

Hmmmm....some time since the HC2010 conference but finally here are my notes:

- Gwyn Thomas – Informing Healthcare talked about the programme in Wales. He covered how they established “rules of the road” at the start to manage communication and expectations. The approach has been to take mostly small rapid steps with occasional large ones. There has also been an emphasis on learning together and developing a sense of common purpose. The architecture model considers different types of architecture: information; systems; and social (trust, relationships, collaboration).

- Aidan Halligan – gave a talk on values. He quoted Don Berwick “culture eats strategy for breakfast” giving the example of what hasn't worked with the NPfIT. He outlined how the explosion of knowledge has outstripped the ability of the NHS to keep up and some of the tools they are using in Imperial such as After Action Reviews (lessons learned debriefings) but set up to ensure that lessons learned are immediately implemented.

- Richard Hamblin from CQC – talked about the new Quality and Risk Profile and how it will show the synthesis of information on an organisation and will be used to identify problems. V1.1. available May, v2 in Autumn. A network of RIEOs has been set up (Regional Intel Officers). The plan is not to publish risk estimates but they do plan to publish judgements of inspectors. Data is fed and aggregated into a risk model – this is used to produce a dashboard which has dials (RAG) prepared by analysts – the dashboard is shared with the organisation; the inspector will then confirm any red lights (or not) at the inspection. Dashboard measures are around involvement, innovation; quality and management; suitability of staffing; safeguarding and safety; personalised care, treatment and support; suitability of managementt. Drilling down enables exploration of inherent risk, situational risk, population risk, uncertainty risk. Indicators are derived from HES, patient/staff surveys, national clinical audits, regulators and bodies such as PEAT and NPSA. Publicly accessible data will be based on the inspection not data alone – public will be able to view high level dials and be able to drill down into inspection report. Planning to provide access to principal commissioner.

- Samantha Riley – SEPHO – presented on how they have changed the culture of presentation and visualisation of data and information, through education/training and design of dashboards. They now provide regional benchmarking for 6 standard indicators (example of incorporating knowledge from library service on MRSA/C Diff). They're looking at how to evidence variation e.g. one example around hip replacement was due to innovative practice – needs to be shared to improve length of stay, mortality, readmissions across the health economy.

- Robert Lake – talked about Strategic Programme for Adult Social Care Information – includes development of the Adult Care Support Record ( aCSR), review and update of social care information guidance, zero-based review of data/information needs. 5 key themes – standards, aCSR, intelligence (NASCIS launched by IC in Oct 09) and JSNA, infrastructure, workforce (culture, leadership, training). NHS number to be applied to all adult social care records. aCSR will lead to a NMDS and data dictionary. Need to engage with self funders – currently no information on this, not even sure of extent of population. aCSR will assist personalisation agenda, by helping individuals to identify and manage their needs.

- James Walker – talked about localising MoM. Suggests that a typical pathway involves 800 hours of development. Highlighted importance of clinical ownership. Demonstrated ability to drill down to BNF and NHS Evidence. Outlined differencess between administrative and clinical localisation and implications of each.

- Rick Jones – talked about national pathology info strategy. Data in pathology has unpredictable downstream uses, can be merged from multiple sources and persists over time. Tests throughout 18 week pathways – data collected from different places (e.g patient in Cumbria could get referred to number of DGHs) and there are some variations which may not be taken account of if the data is used later for R&D. For example, different formulae can be used to test for chronic kidney disease – can lead to misclassification, unreliable results, underdetection, inappropriate referrals. Equivalent of BNF for lab tests is run by Royal College.

NHS Scotland launches Knowledge Network

"The NHS Scotland e-Library has evolved into The Knowledge Network. It offers a wide range of resources and services to help you to FIND knowledge and also to SHARE knowledge. It supports evidence-based practice, communication and collaboration by communities, and access to e-Learning."

JISC and RLUK launch Resource Discovery Taskforce

"The vision focuses on the aggregation of metadata about library, museum and archive collections to allow the creation or enhancement of innovative resource discovery and library collection management service."


Friday, 21 May 2010

HSJ 20 May

Interesting article on patient safety, which includes mention of the RWHT patient safety model - their aim is to address "human factors" through a range of workstreams.

May CILIP Update

May's Update features an article on creating a sharing culture, which should've been really interesting but instead is just a load of management-speak and not very readable or accessible.

I did like the article by Martin White, though, on collaboration. It's very readable with some practical insights:
"If an organisation has an effective information management strategy, all its employees are able to say:
- I can find the information I need
- I trust the information I find
- I can publish information for others to use
- I am able to share my expertise
- My manager supports my information responsibilities
- My networks extend beyond the firewall"

This could be our long-term vision - for me, the focus for this year is for the first two bullets - getting the information together and agreeing quality assurance processes to build trust. We'll be dabbling with sharing information but it's getting the balance of small steps and big leaps forward so that any change can be sustained...

Business intelligence system at Shrewsbury

E-Health Insider features a news article on a new system at Shrewsbury, to help manage business intel - the idea is that the system helps address the lack of capacity for number crunching and analysis.

"The software displays four bars, including how many people have breached the 18 week promise, those patients that are yet to be see, whether the data was right and can be validated, and a backlog of patients."

Recent HSJs

Having trouble keeping this up to date!

Here are some recent snippets from HSJ...

22 April issue included a supplement on informatics to coincide with HC2010. Most interesting is an article about North Bristol NHS Trust's approach to a data warehousing/business intelligence solution. They opted to build a solution inhouse as they felt there wasn't an off-the-peg solution which suited. There may be some lessons to learn here for our own data warehouse project. North Bristol have over 1000 users for the new system which equates to 1 in 9 of the Trust’s employees. The data warehouse pulls information in from 30 existing IT systems.

13 May has an article on NHS Evidence and how it can support the quality and productivity agenda. Part of the problem is that there is little evidence around the impact of commissioning. There is a recognition that there needs to be more clinical input to commissioning decisions and that more use could be made of tools out there, e.g. NHS Institute's Better Care Better Value indicators. The roundtable discussion concluded the NHS must look at innovation and quality but keeping cost in mind. They also predicted that in future, there will be more emphasis on information for patients (and the coalition government has suggested more patient-friendly performance information). The role of accreditation in highlighting guidance based on robust evidence is discussed– participants saw this as important so clinicians and managers understand the strength of evidence on which guidance is based. They also talked about a fear of spreading and implementing evidence due to increased cost pressures so predicted future decision making will have to balance cost to benefit as well as patient outcomes - NHS Evidence is developing as a tool to support decision-making but I suspect awareness is still quite low on the ground.

Sunday, 25 April 2010

News and opinion in HSJ 15 April

HSJ 15 April issue:

  • Report from NQB on lack of quality information – suggests that organisations review what info is needed for decision-making and improving patient care and stop collecting data that isn’t useful. Data from secondary care tends to be good but very little on community services or primary care. Final version of the report is due in May.
  • Article on reaction to growing talk of the need to close hospitals – quotes recent McKinsey report which included a review of bed occupancy – suggests up to £700m spent on hospital procedures having limited clinical benefit – if patients receive more info on options, likely outcomes and risks, fewer tend to opt for surgery e.g. mastectomies (can drop by half) and prostatectomies (can drop by a quarter) – report also claims that up to 40% of patients in typical hospital at any one time don’t need to be there – due to delays in receiving tests/therapies; lack of more suitable care facilities in community. A Picker Institute study – a trial of shared decision making with pts in gynaecology – led to 40% reduction in treatment costs
  • Tackling foundation trusts and enabling them to fulfil their role as leaders – suggest there is a role for commissioners to “develop into the local driving force of service improvement, challenging providers to be more efficient and effective and to meet the needs of patients in the most clinically effective – and cost effective – way. Commissioners need different ways of assessing the needs of the populations, and effective methods to ensure needs are met and demand is managed. Above all, commissioners need to embrace the concept of being the patient’s friend."

Tuesday, 13 April 2010

Open access - costs and benefits

The April edition of CILIP Update reports on a new JISC report by Key Perspectives on scholarly communications – and finds that open access is likely to cost research-intensive HEIs more. However, the report also lists the benefits of open access to the HE sector: better accessibility of research information, savings from less duplication of research, reduction in plagiarism, facilitation of inter-disciplinary research. The last three of these are dependent on usage of open access publications and reaching a critical mass. The report also talks through scenarios of how open access might develop.

Monday, 12 April 2010

Fair share formula; care closer to home and prevention

Interesting articles in HSJ – 8/4/10:

  • Article on fair share formula for practice budgets – reports new allocation formula for determining target commissioning budget of each GP practice and some speculation that may be applied in 2011-12.
  • Article on moving care closer to home and focusing on prevention by Jennifer Taylor. Virtual wards concept to prevent emergency hospital admissions – uses predictive risk modelling to predict patients at risk of emergency hospital admission within next 12 months. Then given intensive preventive care to reduce risk. NHS East of England delivering care at home using a personal health planning tool, for patients with long term conditions. This allows patients to state what they need and allows pooling of services so care is more systematised – therefore less duplication.

Wednesday, 7 April 2010

RIF projects - West Midlands

West Midlands SHA has announced the recipients of the latest round of the Regional Innovation Fund at : http://www.westmidlands.nhs.uk/Default.aspx?id=337&tabid=139

Would be useful to have links to the project descriptions tho....

Next round opens later this month...

Tuesday, 30 March 2010

Bit of a while since I posted last...

Time to get organised again and get back to regular posting...

Just been reading "Better" by Atul Gawande, recommended by a speaker at the recent IFM Healthcare study day. Gawande is a surgeon and is known for writing about quality and improvement. In this book, he focuses on what he calls "three core requirements for success in medicine":
  • diligence - essentially about identifying and embedding best practice and avoiding errors. He talks through the attempts in various organisations to reduce hospital-acquired infections, including campaigns to promote handwashing. It seems the most successful attempts stemmed from wide-ranging campaigns which involved all staff submitting their ideas, implementation of some of these ideas and a comprehensive comms programme keeping everyone informed of progress. Another example is how more American troops are saved than ever before because the whole system of treating them was reviewed - this resulted in Forward Surgical Teams who are there to provide immediate care - their focus is damage control rather than repair. The next level of care is a Combat Support Hospital designed to care for patients for up to 3 days - any longer and they are transferred home - "the average time from battlefield to arrival in the US is now less than four days".
  • doing right - refers to ethics, dignity and respect. Gawande explores ethical dilemmas around examinations and considers the lack of evidence on issues such as the use of chaperones. "How each interaction is negotiated can determine whether a doctor is trusted, whether a patient is heard, whether the right diagnosis is made, the right treatment given". He also considers the malpractice system and litigation in the US which he points out, doesn't really address the fundamental issues of errors and negligence in a fair way and doesn't encourage dialogue.
  • ingenuity - reflection and innovation. Gawande considers how we measure performance and how we recognise and learn from excellence, using treatment centres for children with cystic fibrosis as an example, showing that some centres achieve an average life expectancy of 46 whereas others only 30.
An interesting read...enough to make me request "Complications" and "The Checklist Manifesto" at the library!