A perspective of Knowledge
Management in the NHS
Dr Jim Hughes
Head of Knowledge Management
Cheshire and Merseyside SHA
Broad questions
What does the Head of KM in Cheshire
and Merseyside SHA do?
A(nother) definition of KM!
NHS KM and Connecting for Health
New role for librarians?
18 week target – using data effectively
What does Head of KM do?
Internal role
IT services and Informatics
Library service
Freedom of Information
Knowledge Management – e-filing, effective
use of tools, technology and people to work
smarter
Job description – cut down
this tree
Tools available
Tools / people required
What does Head of KM do?
‘SOFT’ KM
External
Line manage Health Care Libraries Unit (HCLU)
CfH - knowledge management
North West VLE (e-learning)
Data warehouse
PCT Shared services – Information knowledge
management / contract management
Public Health ; Dr Foster; TIS
KM in – Practice based Commissioning;
Management of Long term Conditions
‘HARD’ KM
So much to
know, so little
time!
A(nother) definition of knowledge
management
A healthy mix of:Tools
Technology
Processes
People
Organisations
Behaviours
Culture
A(nother) definition of knowledge
management
What do we do with it?
Capture
Put it back in!
Code
Store (organise)
Access
Disseminate – MOBILISE – collaborate - share
A(nother) definition of knowledge
management
And of course - the management bit
Strategy
Implement
Monitor
Evaluate
Connecting for Health - KM
Directorate of clinical knowledge process
and safety led by Sir Muir Gray
http://www.connectingforhealth.nhs.uk/delive
ry/serviceimplementation/kps/
The following eleven slides are taken from
Muir Gray’s presentation on the National
Knowledge Service taken from the above
public web site.
The application of what we know
already will have a bigger impact
on health and disease than any
drug or technology likely to be
introduced in the next decade
Muir Gray (January 2005)
The application of what we know
can prevent and minimise the 7
ubiquitous healthcare problems







Errors and mistakes
Poor quality healthcare
Waste
Unknowing variations in policy and practice
Poor patient experience
Overenthusiastic adoption of interventions of low value
Failure to get new evidence into practice
Muir Gray (January 2005)
3 types of generalisable knowledge
Knowledge from research - Evidence
Knowledge from measurement of healthcare performance
- Statistics
Knowledge from experience - Of patients and clinicians
2 types of particular knowledge
Knowledge about this patient
Knowledge about this service
Muir Gray (January 2005)
For good health people
need pure clear
knowledge, just as they
need pure clear water
Muir Gray (January 2005)
The knowledge spectrum before the
internet
Knows
A little
Patient
Knows
A lot
Primary
Care
Secondary
(hospital)
Care
Professor
Muir Gray (January 2005)
The knowledge spectrum after the
internet -1
Knows
A little
Primary
Care
Knows
A lot
Patient
Secondary
(hospital)
Care
Professor
Muir Gray (January 2005)
The knowledge spectrum after the
internet - 2
Knows
A little
Primary
Care
Knows
A lot
Secondary
(hospital)
Care
Patient
Professor
Muir Gray (January 2005)
The knowledge spectrum after the
internet - 3
Knows
A little
Primary
Care
Knows
A lot
Secondary
(hospital)
Care
Professor
Patient
Muir Gray (January 2005)
The mission of the National
Knowledge Service is to ensure
that all decisions can be based not
only on best current knowledge
but also on the needs and
preferences of the individual
patient
Contact Muir Gray- muir.gray@his.ox.ac.uk
1/1/2005
National Knowledge Service
Generation
Question
Answering
Service
Co-ordinated procurement &
Production (£100M)
Organisation
National Library for Health (£50M)
NHS Direct Online
Localisation
Map of Medicine
Mobilisation
NHS Care Records Service
N3
National decision support service
Utilisation
Patient & professional
Education & services
Better Consultations, Better Decisions,
Better Communication
Muir Gray (January
2005)
Ignorance is like cholera;
it cannot be controlled by
the individual alone it
requires the organised
efforts of society
Muir Gray (January 2005)
Delivering the benefits from CfH
Key knowledge management principles
Making knowledge the enemy of disease
Supporting decisions that patients make
Supporting decisions in clinical practice
Creating and mobilising the knowledge base
Using knowledge in the consultation process
Integrating knowledge into learning and
decision making
A vision of using knowledge in the consultation process
Picture Archiving and
Communication
System
Order
Communications
Tests
Care
Records
Service
Assessment
Results
Intervention
Diagnosis and
Decision
1. Existing
knowledge
sources
Choose and Book
2. New
sources
Electronic Transmission
of Prescriptions
4. Suggest
appropriate
decision –
patient
specific
3. Present
Knowledge ‘in
patient’ context
A vision of integrating knowledge into learning and decision making
Knowledge
Delivery
National Specialist Groups
Knowledge
Acquisition
Warranted codified knowledge
Disseminate
knowledge e.g.
Map of Medicine
National learning and dissemination
Knowledge used in the
consultation
Disseminate
knowledge
through existing
local professional
activity
Local learning and dissemination
Knowledge from local innovations
Local healthcare professional
communities of practice
Capture
knowledge from
growing
information base
– eg care
pathways
Capture local
experience
Clinical Knowledge Management
Do Once and Share –
developing clinical
pathways (Sharing)
National Library for
Health (Resources)
Single Search
Environment
(Search and
Retrieval)
Virtual Learning
Environment
(Learning)
Map of Medicine and
national clinical
guidelines (Evidence)
National care record /
Data spine / common
IT / common coding
(Technology)
Communities of clinical
practice (People /
Experts)
And finally from Muir Gray….
“Love your librarian and free her from the
library”
Muir Gray (January 2005)
A new role for librarians?
HCLU review outcomes
Focus on core business
Professional development
New roles for new times
Improved communication
A new role for librarians?
Do Once and Share
50 clinical areas
Developing common care pathways
Communities of interest
Giving context to the technology
Librarian role
active clinical engagement
Access to clinical knowledge resources
Works alongside clinical team
18 week target – using data effectively
Background
NATCANSAT commissioned to develop data
warehouse for SHA
HES
Clearnet data (CDS)
Ambulance
A+E
Diagnostics
Outputs to assist in development of strategic
configuration of services and Monitor diagnostic
18 week target – using data effectively
 Most recently to develop models to understand
pinch points in the 18-week referral to treatment
pathway
 NATCANSAT working with DH and pioneer
Trusts.
 Following slides courtesy of Dr Brian Cottier –
Head of National Cancer Services Analysis
Team (NATCANSAT) – March 2006
Hospital “X” PAS Data
IP Episodes
OP Episodes
AED Episodes
Imaging Procedures
Endoscopy Procedures
331,207
1,010,713
217,756
1,172,398
79,048
Pathology
Endoscopy
Imaging
Book
Another
OP Visit
AED Referral
GP Referral
Referral
Received
Date
OP Visit
(1 to n)
Inter
Consultant
Referral
Discharge
Elective Date
Admission
Procedure
Discharge
Imaging
Book
Another
OP Visit
AED Referral
GP Referral
Referral
Received
Date
OP Visit
(1 to n)
Inter
Consultant
Referral
Discharge
Elective
Pathology
Endoscopy
Imaging
Book
Another
OP Visit
OP Visit
(1 to n)
Discharge
Elective Date
Admission
Procedure
Discharge
Elective Surgery
Frequency of
Procedures
Count Of EPIKEY
Procedure Level 2
Diag.Endo.Exam/Lower Bowel Using Fibreoptic Sigmoidosco
Other Excision of Lesion of Skin
Destruction of Haemorrhoid
Diagnostic Fibreoptic Endoscopic Exam/Upper Gastrointe
Other Operations On Varicose Vein of Leg
Primary Repair of Inguinal Hernia
Excision of Gall Bladder
Diagnostic Endoscopic Examination of Colon
Ligation of Varicose Vein of Leg
Transluminal Operations On Femoral Artery
Injection Into Varicose Vein of Leg
Other Excision of Breast
Diag.Endo.Exam/Sigmoid Colon Using Rigid Sigmoidoscope
Block Dissection of Lymph Nodes
Excision of Haemorrhoid
Excision of Nail
Excision of Rectum
Total Excision of Breast
Trust
Aintree Hospitals
NHS Trust
7,086
5,876
3,456
3,372
3,092
2,781
2,059
1,468
1,445
1,242
1,037
868
851
619
566
513
491
490
Breast Surgery
Elective
Joint Replacements
Hips & Knees
PAS# Op Date
Operation Description (IP)
XYZ2134 4-May-04 Total Prosthetic Replacement of Hip Joint Using Cement
XYZ2134 14-Dec-04 Other Total Prosthetic Replacement of Knee Joint
RAD
Cons
RAD
Spec Procedure
Code
Date
110
11-Jun-03
110
18-Sep-03
110
18-Sep-03
110
13-Nov-03
PAS#
XYZ2134
XYZ2134
XYZ2134
XYZ2134
RAD
Proc
Code
HIPB
KNEB
HIPB
SCRT
RAD Proc
Description
Plain
Plain
Plain
NC
RAD
Consultant
TM
TM
TM
TM
RAD Cons
Spec
(ORTHOPAE)
(ORTHOPAE)
(ORTHOPAE)
(ORTHOPAE)
XYZ2134
XYZ2134
XYZ2134
HIPR
PEL
HIPR
Plain
Plain
Plain
TM
TM
TM
(ORTHOPAE) 110
(ORTHOPAE) 110
(ORTHOPAE) 110
13-Nov-03
28-Apr-04
6-May-04
SHA Analysis
Joint Replacements
Imaging Data
RIS Systems
Radiology Information System Data Extract
Royal Liverpool Hospital
Modality = CT
Mod_Name
CT
Count Of uniqueid
procedure
CT BRAIN
CT ABDOMEN GENERAL ENHANCED
CT LUNGS ENHANCED
CT LIVER ENHANCED
CT LUNGS
CT AORTA (ABDOMINAL) ENHANCED
CT ABDOMEN GENERAL
CT BRAIN ENHANCED
CT SINUSES
CT PANCREAS ENHANCED
CT KIDNEYS ENHANCED
CT PELVIS ENHANCED
CT PELVIS
CT LIVER
CT BIOPSY
CT ABDOMEN COLON ENHANCED
CT CERVICAL SPINE
CT KIDNEYS
year_proc
1998
2,453
717
500
524
800
235
462
253
290
209
96
114
158
176
101
49
53
1999 2000 2001 2002 2003 Grand Total
2,528 2,917 2,942 2,873 3,019
16,732
975 1,343 1,397 1,501 1,548
7,481
750
816 796
915
810
4,587
647
744 789
736
691
4,131
725
740 501
489
380
3,635
281
361 307
378
512
2,074
281
312 277
270
301
1,903
254
323 334
293
392
1,849
211
192 294
284
438
1,709
328
360 211
219
133
1,460
109
148 180
146
149
828
148
152 155
89
61
719
157
103
91
96
112
717
122
104 123
69
56
650
89
115
96
57
54
512
64 166
235
465
40
66
58
82
111
406
61
62
68
56
61
361
Radiology Information System Data Extract
Royal Liverpool Hospital
Modality = CT
Mod_Name
CT
Count Of uniqueid
Spec_Name
General medicine
General surgery
Accident and emergency (A&E)
Geriatric medicine
Gastroenterology
Ear, nose and throat (ENT)
clinical Haemotology
Trauma and orthopaedics
year_proc
1998
Urology
Anaesthetics
Nephrology
Cardiology
Cardiothoracic surgery
Rheumatology
Ophthalmology
General Practice
Clinical pharmacology
2,087
1,507
415
617
327
535
345
288
389
234
209
184
66
191
75
53
64
32
1999 2000 2001
2,096 2,315 1,999
1,722 2,145 2,005
469 618
879
718 752
797
525 740
703
443 469
501
341 309
492
315 415
368
416 356
199
169 220
262
176 269
252
196 241
315
107 135
142
279 137
2
62 113
100
72
63
110
64
89
78
44
60
67
2002
1,749
2,140
1,040
757
642
544
709
391
180
225
237
253
115
1
90
113
70
31
2003 Grand Total
2,063
12,309
2,557
12,076
1,121
4,542
755
4,396
633
3,570
810
3,302
620
2,816
497
2,274
236
1,776
352
1,462
308
1,451
258
1,447
228
793
3
613
87
527
107
518
104
469
234
Lessons from the 18 week exercise
To develop analysis methodologies
Inform PAS system development
Establish a baseline position
National
SHA
Trust
Specialty
To identify “Pinch Points”
Summary and conclusions
You may now open the Knowledge
Management question paper
You have until 2010 to complete all
questions
You may begin 
Did it all sink in? Any questions?