Continue the conversation: building a network dedicated to a knowledge-enabled NHS

Connecting with others – we enthuse constantly about how productive it is and why we should keep the conversations going. I relish every opportunity to talk about knowledge sharing and it was great to get the chance to talk to knowledge experts about how KM has evolved over the past two decades in the NHS for the recently published KM report : ‘Building a Knowledge Enabled NHS for the Future’ access here. Their insight into the successes and challenges of developing a knowledge sharing culture in the NHS provided valuable ‘lessons learned’ and informed recommendations for a knowledge enabled NHS now and for the future.

This is just the starting point – it will need enthusiastic champions to make the recommendations a reality and to transform knowledge sharing in the NHS. There is an opportunity to build these connections into a network and carry on the conversation; to identify which of the recommendations resonate most and to develop a plan to implement them locally, regionally and nationally and to share best practice and work from the basis of a shared understanding of what works in KM in the NHS.

Networks are the best way to ensure that the “structured partnerships” advocated in the Five Year Forward View become a reality. A knowledge enabled NHS will optimise knowledge sharing and the drive to “share best practice” recommended in the Rose Review.

Successful healthcare improvement networks have been well-documented, and the essential components of a successful network defined. One of the most important requirements is a compelling shared purpose which resonates with all the network participants and is aligned with the core business goals of the organisation or system. Networks rely on collaboration, and there need to be opportunities for members to contribute to, as well as benefitting from the work of the network.

Although networks are built on peer-to-peer sharing, it is important to have several key players in place: an active facilitator and leader of the network, to nurture the connections; a supportive sponsor to highlight the work of the network to the rest of the organisation; and a core group of participants, often an existing informal network, to establish and build on the activity of the network.

There is an opportunity here to build on the recommendations of the KM report, which are already aligned with the business goals specified in the Five Year Forward View and the strategic aims of the Rose Review. To develop the existing network of KM enthusiasts who contributed to the KM Report and to extend it to include others passionate about utilising knowledge approaches to develop a knowledge enabled NHS.

NetWorkout Resources

About the NetWorkout

On Wednesday 13 January the Networks team held a NetWorkout. Below are presentations from the webinars, a storify of the Twitter activity, useful links and background reading.

UPDATE: All the recordings from the webinars are now available in one place on our YouTube channel and set out in the relevant sections of this post below.

You can follow the conversation on Twitter by following  #networkout  and @networks4health.

If you have any questions, comments or would simmply like to chat more about networks please contact us on

Let us have your feedback

Your views on the NetWorkout are really important to us to help inform the development of future events. If you took part we would really appreciate it if you would take a couple of minutes to complete our feedback survey.

Storify of the Twitter activity

You can see a Storify of the twitter activity here.

Presentations from the Webinars

Becky Maltby – Networks and hierarchies Jan 2016

The ‘new’ NHS models are all about collaboration through networks. The NHS is steeped in a culture of performance management and hierarchy. Can it make the change? What does it take to lead a network. This is an overview that is vital for anyone wanting to, or already taking a leadership role in any health system.

Watch the recording of Becky’s presentation

Dawn Artega – Seven Elements of Effective Networks (see background reading below also)

Participants will learn about seven elements of network design successfully used by non-profits and foundations at local, state and national scales in the United States. This session opens a discussion about the mechanics of network building for social change, offers a framework for discussion, and an opportunity to make sense of it all through a mix of large groups, peer learning and small groups.

Watch Dawn’s presentation

David Evans, CHAIN: “What can the CHAIN network offer me?” (No slides presented but see link to CHAIN website below)

For people interested in loose, multi-professional, mutual-support networking in health and social care, with an emphasis on the implementation of improvements based on sound evidence.

Content: now in its 19th year, and with close to 15,000 members, the CHAIN network has pioneered light-touch online networking as a means of sharing experience, intelligence and aspiration. Designed to cut across the boundaries of organisations, professions and geography, the ways CHAIN can be used are as diverse as its membership. David Evans, CHAIN Founder-Director, will discuss the underpinning principles of the network, and demonstrate the online resource that makes it tick, incorporating real-time questions and issues suggested by WebEx participants.

Watch David’s presentation

Lucy Scarisbrick, Yorkshire and Humber Co-Creation Network – Co-Creation network video

Ben Lee and Sophie Edwards – How do we know we’re making a difference (see background reading below also)

For: anyone currently leading or creating a network

Content: We will lead a walk-through of the Network Maturity Matrix which is one of the tools in the Toolkit.  This is a great simple tool for quickly reviewing your network in terms of purpose, leadership, knowledge sharing, learning and impact.  We will also offer ideas for defining a set of simple outcome measures to track the development of your network and communicate the impact you are making.

Watch Ben and Sophie’s presentation

Andrew Lambe – Enabling continuous improvement and innovation through knowledge sharing in networks(see Learning Handbook link below also)

For: anyone currently leading or creating a network

Content: In this session, we will start by outlining why networks have a major role to play in delivering the NHS of the future by facilitating knowledge sharing.  We will look at a model outlining the basics of knowledge sharing which addresses the relationship between teams and networks.  We will then focus on the role networks play and the actions network leaders can take to maximise knowledge sharing.  The session will conclude with some practical guidance for network leaders and links to further resources and tools.

Watch Andrew’s presentation

Janice Popp and Ann Casebeer – Podcast: Be careful what you ask for: Things policy-makers should know before mandating networks

Useful links

Background reading and resources

General literature


Insights from the Institute for Healthcare Improvement’s 27th National Forum Blog Series – Networks for Knowledge dissemination and translation

Late last year, Knowledge and Intelligence Coordinator Polly Pascoe headed out to the Institute for Healthcare Improvement’s 27th National Forum to learn from experts in the field of Quality Improvement. This blog is the third and final in a three-part series that considers how the knowledge and insight gained at the forum can better support the NHS on their journey to becoming the world’s largest learning organisation. This blog piece focuses on context, specifically, its importance in adding value to knowledge sharing. As always, we welcome comments and feedback!

Networks and knowledge are intrinsically linked; networks are frequently formed and participated in by those hoping to improve healthcare across the globe, share existing knowledge, generate and spread innovative ideas, and support the continuous learning of healthcare professionals. During my time at IHI, I was lucky enough to attend Learning from Networks to Improve Health Outcomes, where Stacey Lihn told us about the network Sisters by Heart, which was formed by a collective of mothers whose children were diagnosed with Hypoplastic Left Heart Syndrome (HLHS). The network was initially developed to enable the mothers to support each other; however it has now grown to include over 1000 families across the US. Examples of the work carried out by the network include the distribution of care packages to parents of those children newly diagnosed, the provision of both emotional and practical support on a local and national level, and a partnership with the National Paediatric Cardiology Quality Improvement Initiative (NPC-QIC) which now consists of over 40 parents, clinicians and social workers, leading to significant improvements in the provision of care as a result. As a knowledge management professional however, the work carried out by the network and its affiliates regarding knowledge translation interested me the most.

What is knowledge translation?

Knowledge translation describes the process of turning the scientific research of academics into practical knowledge that can be used by clinicians, managers, patients and the public in their journey of managing care, improving services or accessing treatments. Activities in this process can be carried out by an individual; however both their subject knowledge and understanding of both the academic and practical aspects of their work must be robust.  Those who attempt to carry out knowledge translation are required to know where to find evidence, how to evaluate its reliability and identify its limitations. While doctors, who share a common language with academics, will have had some training in finding evidence, more often than not patients don’t. They can struggle to find and access the latest findings about the effectiveness and relevance of both new and old treatments.

Can you give me an example?

Recognising these barriers and empathetic to the anxiety a lack of knowledge – and therefore control – can cause many families, the Sisters by Heart network worked in partnership with the health care collaborative to develop research summaries. The summaries have allowed those who access them to understand the latest research findings and their implications. The summaries highlight the limitations of the studies too, supporting families to understand how reliable the findings are, and how they might apply to their own circumstances.

We often consider how we can bridge the gap between patient and provider; however we rarely consider how to bridge the gap between patient and research. We therefore often miss the opportunity to empower patients and their families to become true partners in their own healthcare. By utilising “explained” research, clinicians are able to have open, honest and informed conversations with patients that are not fuelled by ill-informed, inaccurate or incomplete information portrayed by the media.

So what’s the role of networks?

While work is underway in the NHS to support patients to better understand recent research findings through the work of NHS Choices, and research is disseminated in accessible forms for clinicians by NICE, more can be done. These summaries require the time of highly qualified people and this time costs a lot of money, money the NHS doesn’t have. Prioritisation will occur so those clinical and patient communities who face complex or rare conditions are less likely to benefit from these types of reports.

Optimistically, the work carried out by Sisters in Heart and NPC-QIC shows that with a small amount of funding, and the good will and shared purpose of a few patients, academics and clinicians, the rate at which we can translate and share practical knowledge that is applicable to specific groups of people in need can slowly increase. As members of networks, we all have a duty to not only utilise our communities to increase our own knowledge, but those of other healthcare professionals, patients and the public as well.

The opportunity

The movement to empower patients and the public to choose their own care, in their own time, is a positive one. However, simply providing patients access to their own healthcare records, or reviews of their local healthcare providers isn’t sufficient for them to make informed decisions about their health and care.  With the volume and availability of health information increasing daily, it is becoming harder and harder for patients to be able to see the wood for the trees. My hope is that every health care network will adopt similar principles as the Sisters in Heart and NPC-QIC partnership and utilise their expertise to translate the knowledge in their domain to broaden the understanding of those who need it.

A test of patients’ understanding: a community pharmacist’s view on high blood pressure

On average 180-220 people walk into each community pharmacy every day. Working as a pharmacist allows me to have contact with a great number of patients from the local community, and I am able to connect with them in my pharmacy in Cornwall to promote positive lifestyle and behavioural changes.  As more than one in four adults are affected by high blood pressure, as one of the key promotions we took on as a Healthy Living Pharmacy was to highlight the ‘know your numbers’ blood pressure campaign.

A number of local Healthy Living Pharmacies including ours carried out over 250 blood pressure checks, where we advised on physical activity, balanced diet, being a good weight, giving up smoking and reducing alcohol consumption with every patient we check. It was interesting to see the number of patients I met who don’t understand how effective simple lifestyle changes can be in reducing their blood pressure. I advise them that it’s ‘as good as taking medicine’.

Over £1 billion is spent in England every year on medicines to treat high blood pressure and cardiovascular disease (HSCIC 2014). We know that these medicines are very effective at reducing a patient’s blood pressure, and therefore their risk of stroke and heart attack. However, around a third of patients who take high blood pressure medication do not adhere to their medicine regimes. This poor medicines taking is estimated to cost the NHS around £390 million in additional treatments every year (YHEC/School of Pharmacy, University of London 2010).

When I talk to a patient about their medicines I always reinforce the symptomless nature of hypertension, and that not taking medicines correctly can increase their risk of heart attacks and strokes. Some patients will tell me that they were unaware of these fundamental facts of hypertension and its treatment.

These issues show me that pharmacies can play a vital role by providing patients with information and simple interventions. By highlighting the facts about high blood pressure, the importance of good lifestyle decisions and of taking medicines correctly, we can make a massive difference to our patients’ outcomes.

Mark Stone is a community pharmacist in Gunnislake, Cornwall.

Insights from the Institute for Healthcare Improvement’s 27th National Forum Blog Series – Why context is everything when sharing your lessons learned

Earlier this month, Knowledge and Intelligence Coordinator Polly Pascoe headed out to the Institute for Healthcare Improvement’s 27th National Forum to learn from experts in the field of Quality Improvement. This blog is the second in a three-part series that considers how the knowledge and insight gained at the forum can better support the NHS on their journey to becoming the world’s largest learning organisation. This blog piece focuses on context, specifically, its importance in adding value to knowledge sharing. As always, we welcome comments and feedback!

Ever wonder why improvements in health and care just never seem to spread and be adopted at the rate we’d hope? Even on wards that have similar numbers of patients and staff, serve comparable health populations and exist in the same socio-economic environment, learning and improvement just doesn’t seem to be catching on at the scale needed to tackle the increasing challenges we all face.

While the mini-course I attended on the Sunday at IHI, Publishing your Improvement Work, aimed to support attendees to publish their improvement work, interesting themes arose around how we can best share lessons learned to support  the effective spread and adoption of improvement across health and care, whether they are formally published or not.

But I thought improvements were being shared?

You’re right! Head to any healthcare conference in the world and you will find hundreds of improvement storyboards and posters detailing the improvement work carried out by others. Open any issue of BMJ Quality and Safety and there will be quality improvement reports that provide detailed accounts of work undertaken in practice. Additionally, informal methods of knowledge sharing such as The Academy of Fab NHS Stuff are thriving too.

The rate at which improvement stories are captured and shared isn’t necessarily the problem – in fact, the amount of knowledge available can sometimes be overwhelming and assessing what’s relevant to you can often be confusing. Something is missing and we need to tackle it head on sooner rather than later to realise wide-reaching, sustainable improvement.

So what’s the answer?

While there are many solutions we can call upon, the likes of knowledge translation being one (watch out for my blog about this next week!), the best way in which we as individuals or groups can support our colleagues to effectively pick-up and utilise learning from our improvement project is by focusing our efforts on context.

The difficulty with describing context is we often think we’re doing it properly. Typically, we’ll outline the macro elements of our improvement project such as health populations and staff numbers, or we might list job roles when we describe the make-up of our improvement team. However, these factors are unlikely to be the most significant factor in an improvement project’s success.

 Previously we might have said our improvement team consisted of, say, two nurses, a physiotherapist, two administrators and one improvement advisor. However, we might fail to add that our two nurses have thirty years combined experience, one is a specialist, in say infection prevention and control, and the other has been on a measurement for improvement course.  Their experience is significantly more important than their roles!  Equally, statements such as “effective administration” or “engaged leadership” can vary in meaning across contexts and don’t always mean the same thing to different people. It’s the actions that lie behind these statements which are the real nuggets of gold that will enable others to better understand how they can quickly and easily translate improvements of others into our own context.

While these are only brief examples, it helps to demonstrate that without the next level of detail, we aren’t supporting our colleagues in health and care to fully understand the critical success factors that have enabled improvement implementation. Understanding that next level of detail, such as the qualifications or levels of experience of a successful improvement team, can better support other organisations to not just pull together their improvement team, but pull together an improvement team of the right people. Providing context doesn’t just help team members take action, it helps them understand which actions to take – and why. In essence, context is key!

Can I get any more help?

The age old ‘five whys’, whilst not discussed at IHI in this instance, can work perfectly when attempting to pinpoint the critical success factors (or of course barriers!). For example, if effective communication between team members is identified, then analysing further why the communication was effective provides much more useful information for those wanting to adopt those elements into their improvement work.

More formally, if you are hoping to publish your improvement work, the SQUIRE 2.0 guidelines can support you to not only provide better context, but help you to better report your methodology, results and more!

In conclusion, those who wish to share their improvement work should never assume that others see the world in the same way they do – remember, what ‘supportive leadership’ may mean to you can completely differ to what it means to someone else. When sharing improvement work, always as yourself why – messaging will be much clearer and improvements will be much easier transferred from team to team and organisation to organisation.

Insights from the Institute for Healthcare Improvement’s 27th National Forum Blog Series – Why we need to reconnect and recharge middle managers

Earlier this month, Knowledge and Intelligence Coordinator Polly Pascoe headed out to the Institute for Healthcare Improvement’s 27th National Forum to learn from experts in the field of quality improvement. This blog is the first in a three-part series that considers how the knowledge and insight gained at the forum can better support the NHS on their journey to becoming the world’s largest learning organisation. This piece focuses on the importance of middle managers in any large-scale cultural shift.

Earlier this year, Jeremy Hunt, Secretary of State for Health, stated that his ambition for the NHS was for it to become the world’s largest learning organisation. This call echoes those in the Berwick Report, as one example, which placed learning in the spotlight as a main concern for health and care in England. To realise this ambition, and for it to be impactful, the NHS must achieve transformational change away from a culture of blame and fear.

When we contemplate the successful implementation of transformational change, we often think of two staff groups: senior leaders who provide shared vision and front-line or administrative staff who implement “bottom-up change”. However, there’s a third group we very rarely consider as integral agents of culture change: middle-managers.

At the Leadership at the Middle: Building Capability mini-course, practitioners from around the world gathered to discuss how we, as change agents in health and care, can tap into the skills and expertise of middle managers to successfully embed improvement and transformation. The model we focused on during the session outlined four main activities of a middle-manager’s role:  work management, work improvement, team capability building and culture shaping.

Polly's Blog

Utilising this model, I have summarised the main points raised in the session and considered how middle managers may hold the key to delivering the NHS as a learning organisation.

  • Middle-managers determine how successfully work is managed

To be successful, organisational learning must be embedded into the day-to-day work of teams. Learning tools such as Before Action Reviews and Retrospect Reviews should be embedded in everyday work, project management processes and recruitment. Without middle-management support and enthusiasm, learning activities can still occur, but it’s unlikely they will be recorded in a useful way that can shared across an organisation and beyond, missing the opportunity to improve patient safety, experience of care and value for money in a transformational manner. Like all other resources, knowledge needs to be managed effectively and middle-managers are positioned perfectly to ensure this occurs, if provided with the correct training and tools to do so.

Managers should be supported to embed learning in day-to-day processes, rather than be required to incorporate it as a ‘nice-to-do’. They should be provided with training and development and be considered learning champions across organisations.

  • Middle-managers drive improvement work forward

Not only do middle-managers hold the key to ensuring services, projects and programmes are successfully managed, but their ‘birds-eye’ view of their team’s work allows them to not only identify areas for improvement, but drive the work forward in the most effective way.  They are also well-positioned to share learning, collaborate and promote cross-departmental and cross-discipline knowledge sharing. This step is vital to support the NHS to progress from maintaining small, isolated pockets of good practice improvement, to developing coherent, department and organisation wide accelerated adoption and spread of improvement.

Managers should not only be concerned with the improvement of their own area, they should be involved in organisational and regional improvement networks, promoting the sharing of learning across disciplines and departments.

  • Middle-managers play a large part in building improvement capability

While many consider a middle-manager’s role to start and stop with the previous two elements, middle managers also play a large part in ‘setting the tone’ for the day-to day working environment for their staff. Their approach can mean the difference between success and failure in hardwiring learning and sustainable improvement into an organisation. One of the ways in which they do this is by managing the work – developing the team habits – and the other is by building capability – ensuring the habits are done well and with confidence. Acknowledging the requirement to learn requires a great deal of bravery and staff must be supported by their managers to not only share their learning, but embed the learning of others in their work. Middle-managers are the key to ensuring staff are able and willing to improve.  They must cultivate an environment where people feel happy and safe to share.  Equally, middle-managers can encourage staff to carry out tasks beyond their role, sharing learning to support other teams and the organisation generally to achieve their objectives.

Managers should be provided with the training and resources to enable them to coach members of their team to become learning experts, modelling behaviours and promoting open and honest environments.

  • Finally, middle-managers are the cultural compass for their team

Accounting for all that’s been said above, the NHS needs to recognise and respect the middle-manager’s leadership capacity, the fourth aspect of the model. While many consider leaders to sit at the highest levels of an organisation, leadership in its most simple form is a ‘process of social influence’.  Ignoring middle-manager’s influence on their staff is to ignore the impact of the potentially damaging subcultures that can arise. While organisations may spend time and money developing vision statements and organisational missions with the intent that their staff will buy into them, middle-managers must be on board, or they can easily act subversively, influencing their staff in negative ways.

Managers should be considered critical cultural actors and not be over-looked when considering large-scale transformational change. Organisations who continue to see middle-managers as simple ‘doers’ and fail to ignite their essential leadership role will also fail when attempting to learn and utilise knowledge effectively.

In conclusion, as the NHS considers how it works towards achieving its learning organisation ambition, my key take-away from the session is that middle managers have a vital role to play.  They will be at the forefront of the NHS being the learning organisation it so desperately needs to become.

Thank you to David Pugh, David Munch, Margo Karsten and Craig Luzinski for hosting such a fantastic session!

Passionate Pockets of KM Enthusiasm and Expertise

Knowledge management (KM) is not a new concept – it has been around since the early 1990’s – but it is a concept which often suffers from ‘phrase fatigue’. Not only is it over-used, it is often unclear what it actually means. However, the benefits of effective knowledge sharing are undisputed.

Over the decades since KM was established, organisations have benefitted from introducing knowledge creation and sharing approaches. Increased efficiency and innovation, improved customer satisfaction and a motivated and expert workforce are oft-cited benefits of KM and are as relevant to the NHS as to the law firms, consultancies and oil companies in which KM originated.

The Knowledge and Intelligence Team, part of the Sustainable Improvement Team at NHS England, have been developing a suite of KM resources to highlight the benefits of KM for the health care sector. Now, a new KM report which we’ll publish in January, reviews the usage of KM approaches in the NHS since the 1990’s and identifies KM approaches which could benefit the future NHS.

KM is not a new phenomenon in the NHS. In the 1990’s, Sir Muir Gray, Director of the NHS National Knowledge Service, highlighted the importance of knowledge to the NHS:

“Healthcare and public health, we are knowledge industries. I know we have buildings, we have technology, we have medicines but it’s the knowledge that drives us.”

Over the years since then, what role has KM fulfilled in the NHS, and what successes have there been? Can we promote KM approaches to address the current challenges that the NHS is facing?

In order to answer these questions, I spoke to a number of individuals who are passionate about using KM approaches in the NHS and enthusiastically share their expertise with the service. Their observations provided a backdrop to the events of the NHS over the past two decades, and they provided examples of great knowledge sharing.

There are several reasons to be optimistic about the future of KM in the NHS: change is happening, and there is a widespread awareness that utilizing expertise and sharing best practice will enable the NHS to be more efficient and ensure continuous learning is part of everyone’s role.

The sheer size of the NHS makes it challenging to establish the culture of widespread trust and openness which is essential to promote knowledge sharing. However, the NHS is changing: there is now awareness that top-down, enforced approaches are not effective and that individuals have the skills and expertise to influence and support network driven change.

The network of NHS Library and Knowledge Services which underpin evidence-based medicine has developed over the past two decades despite frequent reorganisations. KM skills have become increasingly part of their professional skills’ base, and their focus includes both explicit knowledge sharing – research and evidence – and tacit knowledge sharing – skills and best practice examples. Actionable knowledge is seen as the way to support clinicians in accessing evidence and putting it into practice – addressing the challenge of ‘information overload’.

KM is not a ‘quick fix’ solution: the organisational trust required to promote knowledge sharing takes time to develop, and recent reorganisations have hampered this. However, widespread organisational change is not on the horizon and the NHS is working to a five year forward plan.

KM is most successful when knowledge sharing activities are widespread in the organisation and supported by management. The NHS currently has an aspiration to be a learning organisation and learning activities will ensure improved knowledge sharing. I discovered many examples of great knowledge sharing and these can be developed into a narrative to support learning ambitions.

The support required to develop knowledge sharing skills has often been overlooked in the past. The Knowledge and Intelligence Team have an ambition to support the development of knowledge capabilities. Our learning and intelligence handbooks provide a fund of resources, and the Team support challenges to develop Twitter skills to help the spread of knowledge.

Perhaps the most positive outcome of the KM report has been the new relationships established with KM enthusiasts in the NHS. The appetite and expertise to support knowledge sharing is undoubtedly present, and it would seem that now is a good time for it to move centre stage.

Look out for the KM report which will be published in the New Year and will develop the narrative.