Scotland’s knowledge network: a progress report on Knowledge into Action

Abstract

Launched in 2012, Knowledge into Action is the national knowledge management strategy for the health and social care workforce in Scotland. It is transforming the role of the national digital knowledge service – NHS Education for Scotlands’ Knowledge Network – and the NHSS librarian role to offer more active, tailored support for translating knowledge into frontline clinical practice. This includes the development of a national evidence search and summary service, help with converting knowledge into practical and usable formats for easy use at point of care and with using digital tools to share clinicians’ learning, experience and expertise. Through this practical support, Knowledge into Action is contributing to quality and safety outcomes across NHS Scotland, building clinicians’ capacity and capability in applying knowledge in frontline practice and service improvement.

Keywords

Knowledge translation knowledge management knowledge broker evidence-based practice online learning social networking

In 2012, Wales et al. introduced Knowledge into Action (K2A),^1–3 the national knowledge management response to the knowledge-practice gap, i.e. 30–45% of care not based on available evidence.^4–6 K2A aims to support the workforce to find, share and apply knowledge in everyday practice. This strategy set out to transform The Knowledge Network (http://www.knowledge.scot.nhs.uk), Scotland’s digital knowledge service for health and social care, and the NHS Scotland library workforce, to go beyond provision of information to translate knowledge into practice.

Figure 1 shows the K2A cycle, initiated by identifying a knowledge gap. Knowledge from research, practice and experience are sourced and summarised, then converted into actionable formats that practitioners can use at point of care, e.g. decision aids, pathways, mobile apps. Knowledge-sharing methods such as communities of practice, social networking and champions help spread and embed new practice.

Figure 1.

Knowledge into Action cycle.

Knowledge Network services now support each stage of this cycle. A national knowledge broker network including NHSS librarians, information support officers, learning and development managers offers specialist expertise and builds the capabilities of the wider workforce in finding, sharing and applying knowledge for themselves.

Key K2A services

Evidence search and summary services

NHS librarians are collaborating to provide coordinated national evidence search and summary services to all health and social care staff. The CLEAR service (http://www.clear.scot.nhs.uk) highlighted in 2012 has continued to grow in strength. From January 2013 to March 2015, it has received 303 clinical enquiries relating to patient care. NHS librarians collectively now provide evidence summaries for the national practice-based small group learning programme (http://www.gpcpd.nes.scot.nhs.uk/pbsgl.aspx), and have supported updating of the national palliative care guidelines. They have also developed a rapid review methodology to deliver 14 national evidence summaries on health and social care integration. An evidence enquiry gateway within The Knowledge Network will in future enable all health and social care staff to access this support.

Actionable knowledge

The Clinical Knowledge Publisher (http://www.ckp.scot.nhs.uk) is a user-friendly Knowledge Network tool, which helps practitioners to publish pathways on the web in a consistent manner, linked to evidence, guidelines and other resources. It is currently used in Greater Glasgow & Clyde, Lothian, Tayside, Lanarkshire, Forth Valley and Shetland. Examples of national use include pathway creation for the SIGN chronic pain guideline⁷ and Caring for people in the last days and hours of life.⁸

The Mobile Knowledge Library (http://www.knowledge.scot.nhs.uk/mobileknowledge) within the Knowledge Network provides access to point of care tools, including the e-BNF, Sepsis app, and SIGN guidelines. NHS Lothian and NHS Lanarkshire have tested provision of pre-loaded mobile apps at point of care in settings including out of hours and emergency care.^9,10 Clinicians reported greater flexibility, ease and speed of access to clinical information to support decision making.

Social knowledge

There are now 196 active community sites within the Knowledge Network, receiving 8300 unique visitors per month. They support quality and safety collaboratives, education, clinical topics, professional groups and managed clinical networks. Examples include communities in patient safety (http://www.knowledge.scot.nhs.uk/aapsp.aspx), Dementia (http://www.knowledge.scot.nhs.uk/dementia.aspx) and Children and Young People (http://www.knowledge.scot.nhs.uk//child-services.aspx).

In 2014, NHS Education for Scotland, in collaboration with The Scottish Government Quality and Efficiency Support Team and the Quality Improvement Hub launched People Connect (http://www.peopleconnect.scot.nhs.uk), a social directory enabling health and social care staff to find, email and discuss issues with colleagues with similar interests. Currently People Connect has over 1000 members.

Workforce capacity and capability

During 2014–2015, NES Knowledge Services delivered face-to-face and virtual training in using The Knowledge Network to over 1000 health and social care staff. In July 2014, NES Knowledge Services and IRISS¹¹ jointly created an online learning resource within the Knowledge Network to support development of personal and professional learning networks (http://www.iriss.org.uk/pln). This promotes social networking tools to enable people to learn with and from each other by finding and sharing information, knowledge and experience. A programme of training in health literacy sensitive practice is being developed, drawing upon resources from the Health Literacy Place toolkit within The Knowledge Network (http://www.healthliteracyplace.scot.nhs.uk).

Box 1 illustrates how the Sepsis Collaborative has used this K2A support.

Box 1.

K2A supporting the sepsis collaborative.

The knowledge-practice gap In the UK, 102,000 cases of sepsis arise annually, resulting in 36,800 deaths. The Scottish Patient Safety Programme’s Sepsis Collaborative identified a need for new ways to support clinicians to diagnose and treat sepsis at the point of care. Knowledge brokers across NHS Scotland collaborated to deliver a package of K2A support: Sourcing and summarising evidence – identifying clinical research, exemplars of sepsis improvement and key contacts. This was presented as an online evidence bundle on The Knowledge Network. Actionable knowledge – converting this knowledge into an intelligent clinical decision support mobile app registered with the Medicines & Healthcare products Regulatory Agency (MHRA). This forms one of The Knowledge Network’s suite of mobile point of care tools. Social knowledge – forming a community of practice, using The Knowledge Network’s community builder toolkit to create a digital space for sharing resources and experiences of improvement. Building capacity and capability – engaging junior doctors in using these tools to build knowledge and skills in sepsis management. Impact – The sepsis app has been downloaded over 6000 times since its launch in August 2013. A 2014 survey indicated that11 Boards were using the app. The community of practice has been accessed over 15,000 times with 8000 unique visits in 12 months; 57% of those surveyed said that K2A support had increased their awareness of sepsis diagnosis and treatment. Over 75% of survey respondents indicated that the app had contributed to safer decisions; 64% of survey respondents indicated that they believe this package of K2A support will enhance their clinical decisions in future. A GP respondent described patient benefits from the app: ‘[It] alerted me to the gentleman’s risk of deterioration and I requested an ambulance [sooner] than I would otherwise have done … the gentleman was assessed as “sepsis” at A&E triage, and received “sepsis 6”. The gentleman recovered and is now home again.’

Conclusion

K2A has transformed the Knowledge Network from a website for finding scholarly information into a vehicle for the K2A process, bringing together digital services and the support and specialist expertise of a national knowledge broker network.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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