Q Exchange
#EvidenceBasedQI – Putting our Heads Together!
- Winning idea
- 2019
What is the challenge your project is going to address and how does it connect to your chosen theme?
Clinicians wouldn’t consider making a clinical decision without consulting the evidence. Yet we, as healthcare improvers don’t routinely use evidence in our projects.
The challenge we are tackling is:
– We do not/cannot routinely find and use evidence for our improvement projects.
– When we look for it, we get overwhelmed with too much information of various types and quality, and struggle to find what we need in a format that we can use.
– As a result, we repeat mistakes, work less efficiently, make uninformed decisions and reinvent the wheel.
This is a live challenge for QI projects. This is evidenced in the recent AHSN Report on NHS Research & Innovation Priorities (Section 4, May 2019).
References
https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/081808243/#/
https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/081808242/#/
http://bit.ly/NHSResearchNeeds
What does your project aim to achieve?
We want you to be able to access to the knowledge and experience that will help you in your QI projects. Our project aim is “Support the QI community to better use evidence in improvement projects by December 2020”.
We will do this by:
– Identifying system wide improvement themes/priorities for QI evidence
– Understanding/putting plans in place to tackle barriers to knowledge sharing
– Creating directory of subject specific experts/champions (using existing infrastructure eg Q directory where possible)
– Partnering with NHS libraries to educate QI teams in benefits of using/sharing evidence
– Collecting, evaluating and signposting to the ‘top’ sources of evidence for QI
– Providing materials, tools and training to support knowledge sharing
We hope that anyone working in or with QI will directly benefit from this project.
How will the project be delivered?
Our ‘evidence based improvement’ approach has been piloted in Somerset, where the use of evidence is fully embedded (see video). It has won national awards and recognition. The September improvement evidence update we produce is here: http://www.libraryservicemusgrove.nhs.uk/media/702637/September-2019-Improvement-Evidence-Update-Q-v05-.pdf
To deliver the project we will work with Health Education England, AHSNs, NHS Libraries, Universities and Q members. We will do this through face to face and virtual meetings. We will also ask you for input/feedback using a new SIG and surveys. We will use existing infrastructure/tools where possible.
What and how is your project going to share learning throughout?
Sharing the learning is a success criteria for this project. We will therefore role model how learning can be used and shared. We will show how we use, appraise, apply and then build on existing knowledge. We will then robustly document the learning from this project – giving as much emphasis to what went right as what went wrong.
We will use different approaches to sharing the knowledge: blogs, videos, webexs and a publish a ‘formal’ journal article. We will take you on the publication journey with us so that you can learn from our experience and our mistakes!
We will do this in writing (using existing communications channels/publications/forums) face to face and virtual meetings. We will also ask for input and feedback using a new online SIG and surveys.
The approach here is very much a draft ‘plan’ which reflects the priorities as we see them. If successful our first step will be to work with Q members and our stakeholders/partners to ratify and develop this.
How you can contribute
- This proposal has been shaped by your comments and follow up telephone discussions with Q members. We want to keep you involved.
- As part of this project we will be asking for your help. Some of the questions we will be asking for your input on are:
- Identifying QI contacts nationally
- Understanding the sources of evidence and current awareness you use now and why
- Exploring what is stopping you using evidence now and what would help you use more evidence
- Identifying what the biggest projects and priorities are for your trust/organisation
- The project team will be made up of individuals from stakeholder organisations who have already indicated that they would be willing to take part (for example librarians and HEE). and any of you who would like to get involved.
- If the idea is successful in being awarded funding we will create an online space/SIG where all Q members will be invited to get involved. We will also communicate with you using the Q idea page and using social media.
Plan timeline
| 13 Nov 2019 | Funding decision announced at Q Conference |
|---|---|
| 2 Dec 2019 | Open invitation to Q members to participate in project |
| 2 Dec 2019 | Survey of Q members/stakeholders re project priorities |
| 27 Jan 2020 | Begin relationship building with local/national stakeholders |
| 3 Feb 2020 | Mapping of QI/(Service) Improvement teams begins |
| 3 Feb 2020 | Mapping of resources begins |
| 7 Feb 2020 | Formal project kick off event/workshop (tbc) |
| 28 Feb 2020 | Invite applicants for 1st cohort of knowledge entrepreneurs |
| 6 Mar 2020 | Begin quarterly calls for NHS Librarians |
| 27 Mar 2020 | Agree system level priority research areas/themes |
| 5 Jun 2020 | First Knowledge Sharing Event (tbc) |
| 4 Sep 2020 | Invite applicants for 2nd cohort of knowledge entrepreneurs |
| 3 Dec 2020 | Launch online 'map' of evidence for improvement resources |
| 4 Dec 2020 | Second Knowledge Sharing Event (tbc) |
Project updates
2 Jun 2020
I just wanted to share a couple of new resources for QI teams with you.
E4QI Pinterest board: https://www.pinterest.co.uk/E4QI/ – contains links to the QI articles, resources, toolkits, and training as recommended by you, all free to access without a pinterest account. This is essentially acting as a project resource library. If you’d like to collaborate on the boards, please send me your username to andrea.gibbons@tst.nhs.uk and I will ‘invite’ you.
QI Evidence Updates: https://fabnhsstuff.net/fab-stuff/QIEvidenceMonthlyupdates – these are updated monthly. This page will always contain the latest version so feel free to link to it on your improvement intranet/internet or library pages.
As ever, we’d welcome any feedback
21 May 2020
Hi all. I hope you are staying healthy in these unprecedented times.
This post will update you on the current position of the #EvidenceBasedQI project, how our plans have changed as a result of the pandemic and next steps.
Background
To recap, this project aims to help QI professionals to use evidence and best practice in their improvement projects. We will do this by:
1) Creating a genuine passion and appetite in the QI community for using and sharing knowledge.
2) Encouraging the QI community to use evidence and draw on the expertise of NHS libraries and other networks including the Academy of Fabulous Stuff.
3) Helping library teams to provide bespoke support to local QI teams.
Pre-Covid
The project started in mid-January. Prior to the pandemic, the focus of the project was on face to face presentations, workshops and training (including in Oxford, London, Gloucester, Taunton). The project team was led by Andrea and Carol-Ann. Plans were in place for presenting at national conferences later in the year and delivering face to face training. In addition, supporting materials were being created. Some of the hard copy materials we created are: https://fabnhsstuff.net/fab-stuff/quality-improvement-essential-reading-list-induction-materials and https://fabnhsstuff.net/fab-stuff/qi-knowledge-sharing-challenge. One of our presentations is here: https://twitter.com/LouWaters_QI/status/1228337507936456707?s=20
The challenges of Covid
The pandemic has required a rethink to the project approach. Our original plan was for 12 months from 15 January 2020 and included a large face to face element and national travel. I presented at national meetings / conferences and met with key stakeholders in January and February. Plans for March and beyond, including our first face to face steering group were cancelled due to Covid-19.
The project team has changed as a result of people being called onto other priorities and people leaving. Carol-Ann Regan, our librarian lead on the project has now retired. From a personal perspective, these have been emotionally and logistically challenging times too. This project is driven by shared passion, and this has sometimes been difficult to draw on when also balancing the uncertainty of working through a pandemic and managing child care responsibilities!
It has also demanded new skills as we move to a virtual world. These are skills which we did not have are needing to learn and develop, for example developing engaging on-line training content. Andrea is currently attending the MOOC school which is really helping with this (for more information about MOOC school see https://www.england.nhs.uk/sustainableimprovement/introducing-mooc-school/)
Next steps and revised project plan:
· Our updated project plan is here: https://create.piktochart.com/output/45494733-driver-diagram-6-4-20
· Subject to Q and stakeholder approval we plan to extend project by 5 months to end 15 June 2021. This will be financed by reallocating travel and event budgets as we focus on virtual delivery of the project.
· Creation of on-line training and videos for library and QI teams. This will replace the face to face training that we had planned to deliver.
· Create suite of materials / e-resources for library and QI teams to complement the training. We had begun creating hard copy materials. These will now be electronic and, where possible developed into videos etc.
· Creation of a virtual QI evidence community of enthusiasts from QI and library world. We have had a number of volunteers already and will shortly send out a new invitation to the Q and Fab Academy communities. All very welcome!
· We will continue producing our QI Evidence Updates. We now share these as a customizable word document so that other trusts can #pinchwithpride. We will be contacting as many library and QI teams as we can to encourage it to be shared locally. All QI evidence updates are shared on the Academy of Fabulous Stuff website and the April edition is here: https://fabnhsstuff.net/fab-stuff/qi-evidence-update-april-2020-including-covid-19-evidence
We would welcome anyone to get involved in the project! Please do contact andrea.gibbons@tst.nhs.uk if this is of interest. And of course follow @Evidence4QI on twitter.
20 Mar 2020
Firstly, I hope that you are all well and looking after yourselves and your families at this extraordinary time. I wanted to give you an update on our Q project and ask for your help.
The #EvidenceBasedQI project aims to connect QI teams with evidence to support improvement. This includes supporting the use of evidence in QI projects and encouraging the sharing of learning and evidence from QI projects.
Over the past weeks I have been meeting with colleagues, firstly from the library and knowledge services community, and then from the QI community. The purpose of these meetings has been to raise the profile of using evidence for QI and to understand the opportunities and priorities. The most recent highlight was presenting at a conference alongside Helen Bevan and Roy Lilley.
I am conscious, however, that we are in extraordinary times. As a result, we are all being called to work in different ways, and with different priorities which we could not have anticipated even a month ago. Clearly, face to face meetings, presentations and training are no longer appropriate. And our audiences – libraries and QI teams – are being called to support the coronavirus efforts.
In light of this, we will be reviewing how best to deliver the aims of the project, and the timescales for doing so. I expect that we will extend the timescales for the project by at least 6 months. And I anticipate that face to face activities and materials that were planned will be delivered electronically instead. Another change is likely to be to how we role this out, we had planned to start in the South regions and then spread nationally. Again we will need to rethink that.
I would be truly grateful for your thoughts on how the project can best support you all at this time. In these unprecedented times, the project can be flexible to the immediate needs – so let us know what you think would add most value to you.
Thank you for your continued support, and for all you are doing in your own organisations.
31 Jan 2020
Hi all,
It’s coming to the end of week 3 of the project. So it seems opportune to update you on what’s been happening. As you’ll know, thanks to you all we were one of the 20 winning projects announced at the Q conference in November.
Immediately after winning we did some work on comms, specifically around branding and creating our twitter handle, @Evidence4QI
Our next challenge was identifying where exactly the money should go. The idea originated from Taunton in Somerset. But our aspiration, and the scope of the project is national. After discussions with the Health Foundation, PHE, our trust and previous winning projects, it was agreed that it should go to South West Academic Health Science Network (SWAHSN) who kindly agreed to ‘host’ the project. As a consequence I (Andrea) am seconded for 10 hours a week to SWAHSN for 12 months for the purposes of the project.
The money was transferred to SWAHSN on 15 January 2020, so the project began that week. So far we have had several team meetings to develop the driver diagram, 2 meetings with the SWAHSN, and several conference calls and meetings with HEE. We have produced a handout describing the project – which includes our draft diagram – to share with teams that we present to.
I’d like to take this opportunity to thank HEE colleagues who have been incredibly supportive during the bidding stage and ever since. Librarians and knowledge specialists are key to delivering this project, and their passion and enthusiasm for helping the QI community is infectious. Sue Lacey-Bryant has been a champion for the project from day 1 and it was a delight to finally meet her in London this week.
Last week I presented to the Library and Knowledge Services teams in the South West, and this week I went to Oxford to present to their counterparts in the Thames Valley and Wessex region. Sue Robertson and Louise Goswami have been instrumental in making this happen.
From a social media perspective, we’ve set up 4 twitter lists for the purposes of the project, as follows:
NHS Libraries: https://twitter.com/i/lists/1220649145700175872
NHS Librarians: https://twitter.com/i/lists/1220649034844725248
NHS QI Teams: https://twitter.com/i/lists/1220653333763051520
NHS QI Community: https://twitter.com/i/lists/1220656463678529537
Here are 5 pieces of learning from the journey so far:
1) The driver diagram has been really great as a communications tool to discuss with different stakeholder groups.
2) Our project is about not reinventing the wheel. It’s been really helpful speaking to winning projects from 2018 about their learning. And I’ve identified similar initiatives that have been successful – not relating to QI but close enough – that we can learn from.
3) It is important to think about what the legacy of the project will be from the very start.
4) It’s been a bumpy ride working through where the money should go to ensure that the project has a platform and support to deliver to a national audience and is empowered to work in an ‘entrepreneurial’ type way.
5) And finally…. Piktochart has been a great tool for branding and producing handouts and materials.
Thank you all for your support. I’d welcome comments, feedback and suggestions – either here or on twitter (@andreadgibbons or @Evidence4QI).
Have a great weekend!
Comments
Thomas John Rose 26 Aug 2021
Hi. Do you have a database of completed QI projects?
Sue Lacey Bryant 26 Aug 2021
I will leave colleagues in teh Health Foundation to answer your question directly as to whether they have nuilt a database of completed projects
More widely, members of this community will want to be familiar with https://bmjopenquality.bmj.com/
BMJ Open Quality is a peer reviewed, Open Access journal covering all content in healthcare improvement work.
Mark Fenton 15 May 2020
Hi, I've just joined the Q Community and this looks like a really interesting piece of work. My background is from outside of Healthcare but I have lots of experience in applying systems thinking to solving complex problems, facilitation of co-creation workshops, and continual improvement. In my last role I integrated data from across multiple disparate systems to gain insights into operational performance. I'd love to contribute to this activity if there is the opportunity to do so.
Kind Regards,
Mark
Andrea Gibbons 15 May 2020
Hi Mark. Your timing is perfect as we are just identifying the first enthusiasts to join the (virtual) team - we started with the library community! Could you drop me an email so that I have your contact details. Mine is andrea.gibbons@tst.nhs.uk
Looking forward to working with you! Have a great weekend.
Andrea Gibbons 9 Mar 2020
I just wanted to share the February 2020 QI Evidence Update.
https://tinyurl.com/QIFeb20
You are very welcome to 'pinch with pride' and shape this for your own organisations. An editable version is attached for this purpose.
If you would like to retweet it to your followers, the link where it was posted is here: https://twitter.com/andreadgibbons/status/1234430266304815104?s=20
Andrea Gibbons 31 Jan 2020
Hi all,
In case you haven't seen it, the January QI Evidence Update is now available. The pdf version is here: tiny.cc/QIJan20
An editable version is available on the Fab Website which you are welcome to edit and make your own (for guidance, see the end of p2). The link is here: http://tiny.cc/fabjan20
Please do share generously with your teams.
Many thanks for your ongoing support.
Matthew Drewicz 9 Jan 2020
Hi, like this idea very much. Happy to get involved.
Just to note, the link in the proposal - http://www.libraryservicemusgrove.nhs.uk/media/702637/September-2019-Improvement-Evidence-Update-Q-v05-.pdf doesn't seem to be working (at time of writing, at least).
Thanks.
Matthew Drewicz 10 Jan 2020
Hi Andrea, the non-working links actually look like a problem with our Trust's internet policy! Sorry! (Rather ironic given some of the literature underpinning this whole idea ... http://etheses.whiterose.ac.uk/19826/ ) Cheers.
Andrea Gibbons 9 Jan 2020
Hi Matthew.
Thanks for flagging this, it's much appreciated. I will follow up on this. For reference, these are always shared via twitter from me @andreadgibbons and also on the Academy of Fab Stuff website (https://fabnhsstuff.net/fab-stuff) and on the following page (http://www.libraryservicemusgrove.nhs.uk/services-and-support/current-awareness/bulletins/)
. The latest update is here: http://www.libraryservicemusgrove.nhs.uk/media/713963/Dec-2019-Improvement-Evidence-Update.pdf
I hope this is helpful and thanks again for your comment.
Andrea
Andrea Gibbons 15 Nov 2019
Hi all. A massive thank you for your support and for making this project a reality! It's been a whirlwind of a week and it was especially wonderful meeting so many of you in London. If you'd like to contribute / keep up to date on the project, please follow me on twitter, @andreadgibbons (https://twitter.com/andreadgibbons)
The first stage of this project is (1) scoping the project - so in QI speak, what is the problem we are trying to solve. We need your help to shape this.
Where should we focus? Who should we connect with? How could the project help you? Who do you think knowledge management best? What does best practice look like, in healthcare, in the world?
Hesham Abdalla 15 Nov 2019
Hi Andrea,
Congratulations on your successful bid.
As a starter for 10...
I was facilitating a QI session today for an ED team who are keen to improve on the poor experience of patients using their service. As we worked through the Model for Improvement, they established their SMART aims and started to come up with change ideas. I noticed that their suggestions followed the same channels that had previously failed to deliver improvement- New forms, stickers, leaflets, posters, educational sessions. What they needed was a framework for improvement ideas and way of easily finding examples of these to adapt. I think the IHI Change Concepts listed in The Improvement Guide are a good start for this, but even that is not easily accessible or updatable: http://www.ihi.org/resources/Pages/Changes/UsingChangeConceptsforImprovement.aspx
Joe Croombs 20 Oct 2019
This is a great idea, the more evidence we have to use to help make informed decision or suggestions the better. It can be difficult at times getting started, especially when there are so many other pressures to move things forward and get results – “improve” - best of luck.
Sue Lacey Bryant 20 Oct 2019
Dear colleagues
This focused project will be very worthwhile to extend and complement NHS funded library and knowledge services that can bring improvers the evidence to support their work.
I encourage people to reach out and contact your health library and knowledge service, have a chat, find out how the team can better connect you to the evidence base for AMillionDecisions
Sue
Sue Lacey Bryant
national lead force
Lis Edwards 10 Oct 2019
Hi Andrea, this is a great idea, totally agree with the view that sharing what works and the evidence around it is where we need to get to. The value of the evidence to support QI projects is a subject very close to my heart! I'm working to get the expertise of our library team embedded in the Improvement work within my Trust.
Thank you so much for sharing your evidence update, we have a network of Improvement Champions within our Trust, would you be ok if I share this with them? How frequently do you produce them, it would be great to see future editions.
Wishing you all the best with this project, and if there is any scope to be involved with this in the future please let me know.
Andrea Gibbons 11 Oct 2019
Hi Lis,
Many thanks for your message - do feel free to share as widely as you wish. We produce them monthly. They are shared by me on twitter @andreadgibbons and on the Fab website if you search for 'Improvement Evidence' (https://fabnhsstuff.net/)
If anyone would like to be added to the email distribution list, just get them to drop me a line andrea.gibbons@tst.nhs.uk
We are hoping that as part of the bid we can have a proper home for these, and distribute more systematically (as well as have a mechanism for electronic sign up)!
We'd love to get you involved in the project - I'll be back in touch if we get funding!
Have a great weekend!
Andrea
Robin Davis 3 Oct 2019
This is a great idea the more we can look to the evidence of what works the better. Part of the challenge is knowing where to start with that evidence collecting, coupled with a sense of urgency to get things fixed means we often just jump in and start "improving" without looking at others have tried or the evidence of success.
Andrea Gibbons 4 Oct 2019
Thank you so much Robin for joining the conversation. We are really excited about this - there really is so much potential, and it's great to see so much enthusiasm around using and sharing knowledge. Would you like to join the project if / when it kicks off? Have a great weekend. Andrea
Andrea Gibbons 1 Oct 2019
Hi Karen,
Thanks so much for your kind offer to get involved! That would be great. It sounds like there is lots that we can learn from your experience at Healthcare Improvement Scotland and the research at Dundee University. I suspect there is lots of other great work going on elsewhere too that we don't know about yet. Pulling this together (and building on it) is part of the rationale for the project. I will get in touch directly with yourself and Suzanne to schedule a call with Carol-Ann and myself. Thanks again! Andrea
Karen Ritchie 26 Sep 2019
Hi Andrea
As our ex-colleague Suzanne Wilson has commented already, please make contact with us at Healthcare Improvement Scotland where our Knowledge Management and Evidence and Evaluation Improvement Support Teams have been providing information and knowledge support to our QI colleagues for many years through a range of approaches. We have developed methods for rapid evidence review, and formal reflective practice approaches and are working with colleagues in QI to define a knowledge sharing toolkit.
I'm also part of a team of researchers primarily from Dundee University who are testing an approach to integrate research methods with QI methods that you might be interested in.
We think we have been reasonably successful in getting evidence embedded in much of the QI work HIS leads but we know we have loads more to learn. It would be great to be involved in your work!
Andrea Gibbons 24 Sep 2019
Hi All! Welcome back to #EvidenceBasedQI
Firstly a massive thank you in getting us to this stage. Your enthusiasm for the project and debate around it is invaluable.
I also wanted to share with you this month's Improvement Evidence Update - link here: http://tiny.cc/ybwadz which is hot off the press.
If we get funding we will be putting more effort into creating resources like this that are freely available and accessible to you as improvers, and the library community so that they can better support your needs.
Finally, it would be great if you could follow and use the #EvidenceBasedQI on twitter to like and share any QI related posts you think your network / other Q members might find useful.
Thanks again for your ongoing support! I look forward to (hopefully) working with you all!
Sue Lacey Bryant 12 Jul 2019
This work has so much potential, Andrea (and colleagues). It is great to see the energy and enthusiasm and watch the ideas building and broadening.
It strikes me that there are different strands emerging, each of which might be a focus and that there will be benefit in narrowing this down to something achievable within the time and resource. And at the same time identifying other related reserach projecst that might be pursued over time, potentially drawing on different funding streams and sometimes simply as part of the work.
Amongst these are the following:-
- Modelling: "how we do’ improvement"
- Building a community of 'QI' knowledge entrepreneurs; upskilling them; connecting them to healthcare library and kniowledge services and resources
- Evaluating the benefits of the model of the embedded QI librarian role - to build the evidence for this role
- Upskilling NHS librarians and knowledge specialists in QI skills. I will share with you the approach already being outlined for this and it would be good to see our approaches and resources dovetail
The proposed survey will yield further ideas I am sure. So, this is just a start! I see the potential for a much broader programme. That said, I am keen to see a focused piece, prioritised. I would advocate thinking about the most helpful order in which to sequence these various potential workstreams. Sometimes I find it helpful to think about what is the 1 thing we would most regret Not having done with 30K to make progress on this?
Andrea Gibbons 2 Jul 2019
Hi all. I was wondering whether any of you had seen the attached 2016 article 'Increasing the impact of health services research on service improvement: the researcher-in-residence model'? It makes me wonder whether perhaps we should pull universities into this too (perhaps the teams responsible for 'impact' / health....?
https://journals.sagepub.com/doi/pdf/10.1177/0141076816634318
Andrea Gibbons 1 Jul 2019
Wow! A massive thank you to you all for engaging in this discussion! Apologies for the delay in replying... I was on holiday in beautiful Montreal.
I would really like to involve as many of you as would like to be involved in shaping this.
A first step will be to try and understand what already exists and what the gaps are (and hence where effort / funding would have the maximum impact).
I will follow up with you each individually in the first instance to have a chat about your thoughts and insights.
In the meantime, please do share any particular priorities for your own teams, what would help you, what is missing... and how we can ensure that this gets the traction it needs to really help it take off!
Thanks again!
Sue Lacey Bryant 27 Jun 2019
Andrea, this is an exciting discussion. Please sign us up; we want to make you aware of the various elements of work underway to bring Knowledge for Healthcare and imporvement..
We do indeed need to make sure as improvers that we draw on the various strands of evidence - from data, from research, insights from the practical experience of staff and of patients or service users. We ignore any one at our peril.
Louise Goswmai and I will connect with Matthew direct as he suggests; we are happy to organise a Zoom video call around tools and techniques for knowledge mobilising, helping fellow members to share their know-how etc. Maybe this could be just the start of a series?
We would be happy to do another, on the Exec team/ Board self assessment tool. We are further developing this as an online tool, and think it will be of interest.
In focussing on tools and techniques for sharing knowledge, we do not want to overlook access to the research literature. Health is a knowledge industry and we are always keen to partner with others to ensure the NHS can optimise their their skills and mobilise the evidence base for improvement.
Also happy to explore the idea of a SIG if helpful - though we would want to avoid a silo /echo chamber since the need for evidence is pervasive rather than a specialist sport.
Sue
PS. Matthew - I took the hint - and have just tweeted about your 'Working Out Loud' programme
Joanne Naughton 27 Jun 2019
Hi Andrea,
In the North East, we have set up a Community of Practice called STEMClub: https://kfh.libraryservices.nhs.uk/the-stem-club-in-the-north-east-of-england/
Our aim is to use knowledge mobilisation skills to ensure that decision-makers at the system-wide level have access to the latest best evidence. We have already linked in with Integrated Care System/STP work streams in key priority areas. We have been thinking about how we can share learning and evidence across the whole system and this ties in well with your project aims. I would be very happy to discuss this more and to be a link person between the two groups.
Sue Lacey Bryant 26 Jun 2019
Mobilising the evidence base is a key strand of HEE’s strategy to work with Library and knowledge specialists across the country to deliver Knowledge for Healthcare. Louise Goswami and I would love get involved.
we would love to develop your thinking further, so that I provers are tapping into the expertise of health librarians and knowledge specialists, and so that the community has access to the appropriate knowledge resources- not forgetting the necessary skills.
When can we talk?
Meanwhile, we would also be delighted to offer to the Q network a webinar on tools and techniques for knowledge mobilising, helping members to share their know-how.
The NHS has more than a million interactions with patients and carers every 17 hours. We invite all members of the community to get behind our campaign that #AMIllionDecisions should be based on best evidence.
Sue Lacey Bryant, Senior Advisor, Knowledge for Healthcare, HEE
sue.Lacey- bryant@hee.nhs.uk
And
Louise Goswami
Lead, Mobilising evidence and knowledge work-stream, Knowl3dge for Healthcare, HEE
,
Matthew Mezey 26 Jun 2019
Hi Sue,
I'm happy to help some of our knowledge professional Q members to work with you to organise a Zoom video call around tools and techniques for knowledge mobilising, helping members to share their know-how etc.
It would be more straightforward if there was a Q SIG related to this (who could be the hosts), but I guess we can do it without one.
Best to communicate via e-mail matthew.mezey AT health.org.uk
Matthew Mezey
(Q Community Manager)
PS Actually, we have a learning circle starting next week on one of the most transformative tools in the knowledge management toolbox, 'Working Out Loud': https://q.health.org.uk/event/energise-your-work-and-connections-join-the-introductory-6-week-working-out-loud-circle-with-helen-sanderson/ - do let people in your network know about it.
Elizabeth Angier 26 Jun 2019
I like this idea would be good for CCGs and primary care to be involved as with primary care networks lots of QI to do in primary care and hard to find QI examples in that context as most work traditionally done in secondary care. So if this could be extended to make it easier to find information across the system or help link up ideas across the system with an aspect of what has been done in primary care would be helpful.
Andrea Gibbons 1 Jul 2019
I totally agree - it would be great to take a system wide view about how we support teams to (1) create and (2) find / use evidence, that is inclusive of the different staff groups too.
Another barrier is of course that typical academic / scientific articles and journals are not best suited to improvement evidence - in part because rigour of that evidence for improvement projects is quite different to that for clinical work and also because the formal 'publishing' process is typically very slow.
For improvement projects, teams almost want to know what others are doing here and now. So we may need to think about the needs and preferences of different teams / staff groups involved in improvement - and think more about access to reports, blogs, posters, youtube videos etc.
Anna Burhouse 26 Jun 2019
I think this is a really relevant point Elizabeth. I saw a great presentation by Helen Crisp about her work as editor of BMJ Open Quality last week and Helen showed stats about the submissions to the journal. There was a plea to have more articles about primary and community care and to broaden the professional background of authors. I found it fascinating data, especially about how few nurses were writing up their improvement work, when in my experience, nurses are hugely involved and often lead improvement.
Nicola Ballingall 25 Jun 2019
Hi Andrea,
Everyday I coach people on some brilliant, small-scale improvement projects that stay within the service and could have such a great impact if only we had this type of forum to share what we learn.
Thank you for sharing your evidence bulletin, there's some great stuff that I've not come across before. If anyone is looking for the previous bulletins, I found them on Twitter... @andreadbarrow
Nicola
Andrea Gibbons 1 Jul 2019
Apologies Nicola - not sure why this post came up as as reply to you. But a massive thank you for your kind comments about the evidence update. Our teams find it really useful, but there is absolutely no reason why it shouldn't be available nationally, and I would love to see it evolve. The feedback we tend to get is that it works well because it is short (never more than 2 pages), not too frequent that people lose interest, and everything is one click and free so it's quick to dip in and out of.
Andrea Gibbons 1 Jul 2019
Wow! A massive thank you to you all for engaging in this discussion! Apologies for the delay in replying... I was on holiday in beautiful Montreal.
I would really like to involve as many of you as would like to be involved in shaping this.
A first step will be to try and understand what already exists and what the gaps are (and hence where effort / funding would have the maximum impact).
I will follow up with you each individually in the first instance to have a chat about your thoughts and insights.
In the meantime, please do share any particular priorities for your own teams, what would help you, what is missing... and how we can ensure that this gets the traction it needs to really help it take off!
Thanks again!
Nikki Davey 24 Jun 2019
It sounds great AND massively ambitious for £30k. I note that Simon has highlighted the problem of overbig projects - so encourage this one to be scaled to something deliverable in 1st year.
The evidence base for QI itself is still emerging and has quite a long way to go. Work by NWLCLAHRC gives some good insights into the theory into practice - but it is just the start of much more that we can learn.
I'm interested to hear of librarians who are using QI and applying it in their own work - maybe the whole of this project could be around work between librarians and QI practitioners to learn more about the assets that people actually use right now.
Suzanne Wilson 24 Jun 2019
Hi Andrea
Matthew has already signposted to some useful resources, so I won't duplicate. As you suggest, as NHS librarians we already act as 'knowledge brokers' in many NHS Trusts to connect all disciplines with knowledge and evidence in all its forms, including bringing people together and encouraging the application of knowledge to practice. The existing Knowledge for Healthcare framework (https://www.hee.nhs.uk/sites/default/files/documents/Knowledge_for_healthcare_a_development_framework_2014.pdf) is currently being reviewed.
The AHSN needs assessment looks interesting - thanks for sharing.
My former colleagues at Healthcare Improvement Scotland produce a QI current awareness bulletin via a blog at: http://hisqibulletin.blogspot.com/
Happy to contribute to this project where possible, look forward to seeing how it develops.
Simon Dodds 19 Jun 2019
Hi Hesham, thanks for signposting the BMJ artricle. This does illustrate the effectiveness of a community of agents who share useful information with each other and co-evolve together. It also illustrates the gulf between knowledge and understanding. If I hear of something that has delivered an improvement I now know about it ... and I could copy what I see with the intention of replicating the improvement ... and if I do achieve it I have learned little ... and if I don't achieve it I have learned little too. The "cut-and-paste" method of improvement does not work reliably enough. We need understanding not just knowledge. And to develop understanding means we need to dig deeper ... a lot deeper ... beyond the "what" level, through the "how" level to the "why" level. And that is emotionally uncomfortable - but worth it because that is where innovation springs from. The method for diagnosing and treating safety issues is well known outside healthcare - is called FMEA (failure modes and effects analysis). I have yet to find anyone in the NHS who has been trained to use it.
Andrea Gibbons 22 Jun 2019
Hi Simon. Thanks for so heartily engaging in this discussion! I'm really interested in the issue around networks and co-production. The Scottish Knowledge into Action (K2A) Strategy concluded that "the most critical enabler of Knowledge into Action... is the growing sense of co-production, community and shared ownership among librarians and the wider multi-agency network of knowledge brokers". This absolutely resonates with your comments about a community of agents who co-evolve together. This is certainly something to look at as part of the project! Have a great weekend.
Hesham Abdalla 19 Jun 2019
Hi Andrea, yes happy to offer my support and connect to others who are also hosting or searching for evidence.
Can also share my experience from the Q Timebank, last year's winning Q Exchange idea https://q.health.org.uk/get-involved/q-exchange/winners/
Andrea Gibbons 22 Jun 2019
Thank you so much Hesham. It would be wonderful to involve you in shaping this. Have a wonderful weekend!
Simon Dodds 19 Jun 2019
For a exemplar of an organisation wide QI capability feedback loop I recommend:http://www.qi.elft.nhs.ukIt does not matter what QI method is used so long as it is effective for the types of issues that need improvement. All the improvement methods have strengths and weaknesses and, as with all complex adaptive systems, the emergent sum can be greater than the component parts ... but is not guaranteed to be.
Simon Dodds 19 Jun 2019
Hi everyone, this is a great discussion. I sense everyone sees the value for a "repository of knowledge" in improvement which is not the same as research because it is more pragmatic and is about applying evidence-based (i.e. validated) principles in the much messier real world. The comments about "expensive consultants" rings a bit of a warning bell for me because the issue is not just cost ... it is also competency. The question I ask is "Does this expert offer value for money? Where is there portfolio of successful projects? Are they prepared to share the unsuccessful ones?" And if we are going to apply that yardstick to others then, to be credible, we have to apply it to ourselves first. The diversity of improvement methods is actually a good thing because in a complex adaptive system that is the fertile ground in which the seeds of innovation germinate ... and new ideas are the life blood of improvement. The danger is to slip into the "Which is the best method?" trap. Anything that shows evidence of effectiveness is worth keeping ... so that,IMHO, is the yardstick ... evidence of effectiveness (i.e. value). And given that healthcare cost has been top of the agenda for decades (and I agree ... expensive and ineffective experts are a waste of money) there is a bit of a desert in the QI literature on the pragmatics of delivering improvements in cost-effectiveness. That would seem to me to be a worthy focus of attention.
Andrea Gibbons 22 Jun 2019
Hi Simon. Just to come back on your point about consultancy. Interestingly, consultants are a really fabulous example (in some cases) of sharing knowledge and evidence well. They know who their subject matter experts are, are clear about their 'products' (ie domains of expertise), archive project deliverables so that they can be reused... so I certainly wouldn't embrace the 'expensive consultants' view, quite the opposite. There is plenty we can learn from consultancy! Re QI methods, I think this project needs to be flexible enough to support multiple QI methods, rather than being tied to just one. Have a great weekend.
Hesham Abdalla 18 Jun 2019
Hi Andrea
Yes, a repository of QI learning would be highly valuable and I would suggest that we need tobbuild on what already exists, where people already go for help and focus on quality of information, rather than quantity.
Another challenge you may want to address first is developing a taxonomy that is easily accessible by the naive improver, who doesn't know what they don't know.
For instance, www.Hexitime.com provides a searchable "library" of resources in the form of access to those with experience or expertise in QI.
One risk is that we could fall into the same governance trap that we did with incident reporting as described in this excellent critique: https://qualitysafety.bmj.com/content/25/2/71
Anna Burhouse 19 Jun 2019
What a valuable article Hesham. thanks for sharing I hadn't read that before.
Andrea Gibbons 18 Jun 2019
Hi Hesham. Thanks so much for sharing the Macrae article. It's great and I hadn't seen it before. And Hexitime looks a great - I hadn't seen that one before either.
I agree re building on what already exists. From my experience part of the issue is that we don't know what exists within the NHS so can't find it.
So that will be part of the challenge - just figuring out what is out there (and the quality of it), and where the overlaps and gaps are.
It would be great to have you involved!
Simon Dodds 17 Jun 2019
Hi Andrea,I agree 100% with your observation that we seem to find it difficult to learn from each other when doing improvement in healthcare. In my experience there seems to be a number of drivers/causes (a) many QI projects are over-ambitious (in retrospect) (b) many use only qualitative measures (c) many treat the symptoms rather than diagnose and treat the causes (d) few are written up and shared other than as a poster and (e) conventional journals are not designed for the narrative style that is required to share a warts-and-all improvement story. So to address some of these issues, a few years ago Kate Silvester and I created the Journal of Improvement Science ... a free online eJournal, and just a couple of weeks ago the 50th JOIS case study was published for anyone to read and download for free. So, do we need to re-invent the wheel or maybe just improve a wheel that has already been invented and validated?
Andrea Gibbons 18 Jun 2019
Thanks Simon. It's great to hear from you. You may recall I worked with you in Taunton (but I was Barrow then)!
For those that haven't seen JIS, it's here: https://www.improvementscience.co.uk/jois/
You may also be interested in the evidence bulletin from the team in Taunton here: https://tinyurl.com/y38867kl
I agree with your points. I also think part of the problem may be not knowing all of the various wheels that are out there. So part of the challenge may be mapping these out. Equally, part of the solution may be signposting.
I absolutely do not have all the answers on this, but feel very passionate that there is an opportunity here. It would be great to have you involved in this as I'm sure you have many, many ideas from your own experiences working at different trusts nationally!
Anna Burhouse 17 Jun 2019
I think this is a fab idea. I’m sure this is a very valuable service, I’d love to be able to use it as it can be so hard to be systematic about this step. I’m really interested in what you think you would need to scale this up from Taunton and what challenges this would bring as it grows?
I’m also trying to picture this in my mind. Are you thinking of a network, learning collaborative, consultancy service for other trusts or training? Does anyone know if anything similar is out there in other Trusts? It’d be interesting to hear from other people.
I can see you’ve thought about how to link it to ideas that have evolved from past NHS Change days, the Academy of Fabulous Stuff, winners of national awards, the ANSN network of network atlas of improvement, the THIS institute at Cambridge University and journals like BMJ Quality and Safety for instance, but how does this work in practice? I also agree with Andrew’s point that thinking outside of health would be great.
Andrea Gibbons 18 Jun 2019
Hi Anna. Thanks for the enthusiasm and passion. I hope we can work together in some capacity on this.
I envisage this project being a national initiative to put some energy and resource behind taking evidence based improvement to the next step. I'm totally open in how we do this in practice but totally convinced it will only work if we co-design it and work collaboratively.
As a first step, we will need to identify and tap into the available resources, networks and organisations who are active in this space - in the NHS and beyond (so other industries and countries).... So I would envisage a 'map' of what's out there (and relative strengths, opportunities, interfaces etc). Then we can start building on it together...
Here in Taunton we have introduced some bespoke tools (checklists, modified SBAR) specifically for improvement projects. We have also made the use of evidence a part of our QI process, so all of our projects now consult 'evidence' as part of their scoping phase. We have a dedicated improvement librarian who is embedded in the QI team.
Our improvement librarian has sent out a survey to all NHS libraries nationally to understand how improvement is supported across the country. She is also trying to set up a community for librarians with an interest in improvement. She has run some virtual training for other librarians.
Matthew Mezey 17 Jun 2019
Hi Andrea,
Some really fabulous aims - very in tune with what Q is keen to support and enable. (I think Sue Lacey-Bryant was planning a call about the role of Librarians in the Q Community).
Have you followed the QI Capability mapping project that was one of the Q Exchange winners last year? It's very much about enabling connections to be made with the right 'go to' people/organisations, for the right knowledge.
You can keep up with the latest developments here: https://q.health.org.uk/community/groups/improvement-capability-framework-project/ - we held a workshop in Birmingham recently, to build the underlying framework (and built on Joy Furnival's PhD about the very many QI capability frameworks out there, and what best practice emerges).
Sounds like there'll be some strong overlap. As I've mentioned, Chris Collison - who leads it - wrote a book 'No More Consultants - We Know More Than We Think' about how organisations (like the NHS) have most of the answers already, but rarely use methods to make this visible to all, instead relying on external consultants etc (at great cost). His project is trying to remedy this situation...
I'm intrigued about whether LifeQI plays a role in your evidence-based librarian service....? When I saw figures in 2018 it had 5,000+ projects and 12,000 members. It feels like a major resource to reduce reinventing the wheel (eg finding people who've done your QI project before) etc.
BTW, have you looked at the 'Evidence and Knowledge Self-Assessment Tool' that Rachel Cooke and others developed recently: https://kfh.libraryservices.nhs.uk/knowledge-management/evidence-and-knowledge-self-assessment-tool/ - seems to be really helping with spotting strengths and gaps, influencing at Board level etc.
Andrea Gibbons 18 Jun 2019
Hi Matthew - thanks for your suggestions and feedback. It's really helpful. I know Chris is moving down to the South West in the next couple of months so I had secretly hoped to involve him! As you say it's a subject close to his heart and experience, and this would complement the existing project.
Yes, we've been looking at how Life QI could fit into this. And there are other tools that library services and projects use as well (I'm repeatedly reminded to be careful about copyright and of course the quality / robustness of the 'evidence' so this will be something we may need to tackle in due course).
Thanks for flagging the Evidence and Knowledge Self Assessment tool. It's from our library colleagues - you'll be delighted to hear we are joined up with them and they have been incredibly supportive and enthusiastic about the work we've been doing.
In terms of need for this project, not sure if you've seen: https://www.ahsnnetwork.com/wp-content/uploads/2014/12/National-survey-of-local-research-and-innovation-needs-of-the-NHS.pdf
Done well, hopefully this project will help address the issues / findings in section 4.
Andrew Ottaway 17 Jun 2019
More than happy to offer my input, Andrea.
Andrea Gibbons 17 Jun 2019
That would be brilliant. You have a wealth of experience in gathering evidence and insights and I'm sure there's plenty that we can learn from that. Thank you!
Andrew Ottaway 17 Jun 2019
I can see the need to avoid reinventing the wheel, Andrea, particularly when there are processes that have been in service for decades in other sectors with a public-safety remit, and where the study of human factors has a long history.
Andrea Gibbons 17 Jun 2019
Absolutely Andrew. And you make a really important point about sharing and drawing on evidence from outside of the NHS too. Would be great to have you involved in this!
Comments are now closed for this post.