Mobilising Evidence and Knowledge: a retrospect
Reflecting on the Mobilising Evidence and Knowledge workstream
As 2020 draws to a close it is a traditional time for reflection, and we could not reflect on the Mobilising Evidence and Knowledge workstream without at the same time using some of the techniques from the NHS Knowledge Mobilisation Framework – The Retrospect
What was the objective? What did or didn’t we achieve and why?
Emphasising the critical role played by NHS knowledge specialists and librarians to mobilise evidence and knowledge across the NHS was a main objective. Much has been achieved in the first five years, mainly due to how well NHS library and knowledge staff across England have embraced this work, building their confidence and developing their skills to mobilise evidence and knowledge.
What were the successes?
#AMillionDecisions
#AMillionDecisions raised our profile. It calls on government and health service providers to meet their statutory obligations to ensure the million decisions made every day in healthcare are informed by evidence. It encourages healthcare staff to work with and use the expertise of librarians and knowledge specialists to get evidence into practice.
From this work evolved a bank of impact case study vignettes and endorsements from a range of senior leaders across healthcare.
Extending Reach
Using a range of evidence and tacit knowledge to inform and respond to system level healthcare has been delivered by the “bottom-up” partnership approach of the STEMClub (Sustainability and Evidence Mobilisation) in the North East of England. Adopting models similar to STEMClub are likely to increase in 2021 with the announcement from NHS England that Integrated Care Systems (ICS) are to have more statutory functions, potentially taking on a commissioning role in 2021. See the blog post on the STEM club in the North East of England
Skills development – workshops and study days
In February 2020 thirty library and knowledge service staff attended a two-day knowledge mobilisation course facilitated by knowledge management consultant Chris Collison. This core group of individuals work as a reference group for future mobilising evidence and knowledge work.
Tools and Techniques
- The Knowledge Management Task and Finish Group developed the Knowledge Management Toolkit to share techniques and stories about how knowledge management has been used in practice.
- Publication of the enhanced NHS Knowledge Mobilisation Framework E-learning introduced the concepts of learning before, during and after and demonstrated the benefits of using 11 simple knowledge mobilisation techniques. The accompanying postcard sets were expanded in 2019 to include additional techniques of Appreciative Inquiry and Fishbowl Conversations. Feedback has been positive with Dr Farzana Hussain, GP of the Year 2019 commenting on the After Action Review technique that
“It has changed my staff meetings and significant-event analyses, the non-judgemental approach supporting a no blame culture”.
- The self-assessment tool for organisations to consider opportunities to develop how they are using external evidence and organisational knowledge. A series of modifications were made to the tool and the current version has been used by several organisations to help plan and prioritise activities. We are currently working on developing a digitised format for this tool with the help of our knowledge champions.
- A space to share ideas, resources and ask questions has been developed with the Knowledge Management Community of Practice. It is a great way to encourage learning, develop a knowledge base and build confidence to practice some techniques.
- The Policies Procedures and Guidelines Toolkit was developed to capture and share good practice around supporting the production and management of these vital knowledge assets.
- Connecting people to people, people to research and raising the profile of an organisation by exploring different ways to promote locally produced research are explored in the Institutional Repository Toolkit which presents an ideas bank and hints and tips for implementing a local repository.
Learning lessons from Covid-19
Rapid learning, spread of knowledge and use of evidence was essential for the response to the Covid-19 pandemic. CILIP held a virtual conference in May 2020 exploring the role of knowledge management in a time of crisis. Perspectives were shared from knowledge specialists working in various sectors including the NHS. A series of thought-provoking questions were raised, including how we take learning from a crisis and apply to our everyday practice.
This topic was explored further by Holly Case Wyatt who shared tools to rapidly share learning from Covid-19 including a framework from Collaborate for Care.
We also produced a short recorded presentation about the Before Action Review, After Action Review and Retrospect as a suite of tools to encourage the sharing and re-use of lessons learnt.
Video: Learning the lessons techniques to capture and share the learning
When learning takes place rapidly there is a need for simple yet effective techniques to be adopted to enable the capture and re-use of knowledge and learning. With this in mind Health Education England Library and Knowledge Services have created a short video outlining some simple techniques that can be easily incorporated into daily work activities to help the spread of good practice and avoidance of pitfalls so new work can get off to a great start.
Female voice: Hello. How often do we start on a piece of work and think someone else must have done this before, and wish we could tap into the lessons they learned the hard way to save our time and effort? Equally have you ever been in a situation where you have discovered some key learning or insights from experience that would benefit someone else, but you just don't know how to capture that and share it do. If these sound familiar to you then please take 5 minutes to watch our short video and like our colleague, General Practitioner (GP) Dr Pothana Hussain, you too can start to use some simple techniques in your everyday working practices to help capture and share learning, saving time avoiding pitfalls and improving healthcare outcomes.
You can use the techniques within the NHS knowledge mobilisation framework to effectively gather and share lessons learned from any piece of work. By using the lessons learned from others you can replicate good practice and avoid pitfalls, helping you to fast-track your own piece of work.
Here are a few techniques you may like to try.
After-action reviews are a quick and simple technique based around 4 basic questions. What was supposed to happen? What actually happened? Why was there a difference? What can we learn from this? After-action reviews are an ongoing review tool that teams can use during an activity or whilst work is underway. Usually facilitated by one of the team members, the trick is to invite everyone involved in the action to participate. In the after-action review you only need 10 to 15 minutes to capture lessons learnt that can be put into practice immediately, so this is not about waiting to pull things apart at the end of a very large project but for really taking stock after a relatively short term activity that could be part of a much bigger program.
We introduced this technique at a workshop for colleagues working across primary care. GP Dr Fiona Hussain put the after-action review technique to work straight away.
Dr Fiona Hussain: I would recommend that everyone learns the after-action-review. It has changed the way we run our all-staff meetings, especially the significant event analysis. The non-judgmental approach and the no blame culture is really useful. Not bad for 4 points of learning in under 20 minutes.
Farzana particularly favors in her words the golden question "why was there a difference" as it is much less judgmental than the question "why did it happen". It shifts the conversation away from blame and instead the focus is on learning.
Another simple technique are the 4 questions that form part of a full retrospect. It is a more thorough review of work undertaken and the experience gained after a particular phase or close of a piece of work, so you can capture the knowledge before the team disbands. You would usually invite a beneficiary of the knowledge and lessons being learned to participate. The questions to ask are "what was the objective", "what were the successes", what were the disappointments". Particularly powerful is the final stage of the retrospect which asked participants to rate the whole project a score out of 10, and then to consider what key change would have made the project score a full 10 marks.
Project Nightingale (London) used an adapted form of the after-action review and retrospect questions to conduct a daily debrief to accelerate rapid learning. The questions they are using are "what have we learnt today", "what do we still not know", "what are we going to do to find out", and "what are we going to do differently tomorrow".
Key learnings collected during an after-action review or retrospect are lessons that have been learned by the team throughout their work. For these lessons to be really useful they need to be expressed in a way that is meaningful for others to use in their own work. To do this you need to check that your lessons are not just a historical recount of all that has happened, but instead are framed as advice or recommendations for others to put into place next time. These need to be specific and have clear actions about implementation. Once you have gathered these recommendations and learnings together with supporting documents templates and other outputs, you will need to make them available to other teams - accessible at any time and from any location. Depending upon your organisation, this may be an official lessons learned log or this may be a SharePoint or intranet site, a wiki, blog, newsletter, or a simple spreadsheet or PowerPoint file. Your local knowledge specialists will be able to assist with this.
At the start of each new piece of work team should consider holding up before action review to ensure they have reviewed the lessons learned from previous work that can then inform and fast-track their own work. This this can be a quick 15 minute check using the questions of a before action review - "what are we setting out to achieve", "what can be learned from similar situations and past projects from elsewhere", "what will help deliver success," "what are the actions we need to take to avoid problems and apply good practice". Your local librarian or knowledge specialist can help you to locate relevant published research evidence and gather best practice examples from other teams inside and outside of the organisation to inform your own work. To find out more take a look at the knowledge mobilisation framework e-learning which is available on the Health Education England elearning for healthcare website. We'll look at the postcards which accompany the e-learning.
Your local librarian or knowledge specialist will be pleased to help please get in touch with either Louise or Alison if you require any further information.
Media last reviewed: 12 December 2023
Next review due: 12 December 2024
KNOWvember
KNOWvember is an annual celebration and showcase of the work by NHS library and knowledge staff to mobilise evidence and knowledge. The aim of KNOWvember events is to share practical examples of how library and knowledge service staff have used techniques to encourage more widespread use of evidence and sharing of know-how across the NHS. This in turn generates ideas for more knowledge mobilisation to take place.
Four virtual events were held in KNOWvember20 featuring work by various library and knowledge specialists coupled with opportunities to experience a variety of knowledge mobilisation techniques. We were also joined by external speakers including CILIP Trustee Karen McFarlane, who provided an overview of the BSI/ISO 30401 Knowledge Management Systems Standard and CILIP’s Knowledge Management Chartership and Dr Nicola Millard, Principal Innovation Partner at BT who shared insights into the digital workplace. Presentations from these events, plus summaries of discussions and recorded conversations between knowledge specialists, can be found on the Knowledge for Healthcare KNOWvember20 YouTube Playlist.
What could have been even better?
We know that terminology has at times proved challenging.
As the ISO 30401:2018 Knowledge Management Systems Standard says there is no single accepted definition of knowledge management and our preferred term is knowledge mobilisation emphasising that knowledge needs to be used and not just managed. David Stewart’s reflection considers this change in terminology and presents a long view concluding that knowledge management is no longer a “nice to have” trend but that KM will become the every-day core of what we do” – delivering Knowledge and Library Services to ensure that organisational knowledge and best evidence are mobilised to achieve excellent healthcare and health improvement.
Marks out of 10 for the work as a whole? What would have made it a 10?
The work to date deserves at least an eight as demonstrated by the range of mobilising evidence and knowledge work showcased at the recent KNOWvember20 events. It will become a 10 when even more NHS staff routinely use evidence and share knowledge to inform their decisions.
A big thank you to all who have contributed to this work, and in particular to our knowledge champions. We wish you time for your own reflection over the festive break and look forward to working with you on the next chapter of this story in the new year.
To read more about the mobilising evidence and knowledge work see Day A and Goswami L (2020) Driving change with evidence and knowledge: Transforming knowledge services for the NHS across England. Business Information Review Volume 37, Issue 1 https://doi.org/10.1177/0266382120909240
Page last reviewed: 2 September 2022