Quality and Improvement Outcomes Framework

It forms part of the requirement of placement provider organisations in receipt of funding through the NHS Education Contract to “ensure that there is a proactive, high quality knowledge and library service that is available to all staff and learners” (NHS Education Contract 2021-24).

The Outcomes Framework also enables NHS organisations to demonstrate their commitment to working with and enabling high-quality NHS knowledge and library services to equip the organisation, staff, learners and patients to make decisions informed by evidence from research and knowledge mobilised by knowledge and library specialists

The quality assurance and service improvement dimensions of the Outcomes Framework underpin the strategic framework for NHS-funded knowledge and library services in England, Knowledge for Healthcare 2021-26. The Outcomes Framework will integrate policies for NHS knowledge and library services and updates to ‘Knowledge for Healthcare’ over time.

Introduction

Organisations within the NHS in England have a duty under the ‘Health and Care Act 2022’ to facilitate and promote “the use in the health service of evidence obtained from research”. NHS knowledge and library services enable NHS organisations to fulfil this duty and to do so in ways that add value and save money, with a benefit of £2.40 for every £1 invested in NHS knowledge and library services (‘The Gift of Time’, 2020). NHS knowledge and library specialists “take the ‘heavy lifting’ out of getting evidence into practice and give the ‘gift of time’ to healthcare professionals. Taking the ‘heavy lifting’ out of getting evidence into practice to improve the quality of care.” (‘The Gift of Time’, 2020).

This document, the 2nd edition of the ‘Quality and Improvement Outcomes Framework’ (Outcomes Framework), is part of the wider Quality Framework for NHS organisations in receipt of funding through the NHS Education Contract. It forms part of the requirement of Placement Provider organisations in receipt of funding through the NHS Education Contract to “ensure that there is a proactive, high quality knowledge and library service that is available to all staff and learners” (‘NHS Education Contract’, 2021-24). The Outcomes Framework also enables NHS organisations to demonstrate their commitment to working with and enabling high-quality NHS knowledge and library services to equip the organisation, staff, learners and patients to make decisions informed by evidence from research and knowledge mobilised by knowledge and library specialists.

The quality assurance and service improvement dimensions of the Outcomes Framework underpin the strategic framework for NHS-funded knowledge and library services in England, ‘Knowledge for Healthcare 2021-26’. The Outcomes Framework will integrate policies for NHS knowledge and library services and updates to ‘Knowledge for Healthcare’ over time. Policies at the time of publication are summarised on pages 10-11 and include: the number of knowledge and library specialists in an organisation (the staff ratio), the development of libraries as learning spaces, indicative funding guidance and emotional support for librarians working in clinical settings.

The Outcomes Framework acts as a maturity model, enabling NHS organisations to work with NHS-funded knowledge and library services to demonstrate progress over time across 6 Outcomes. There are 5 levels for each Outcome, from Unmet to Excellent. The 16 essential indicators within the framework are the core elements for delivery of an NHS knowledge and library service. The national NHS knowledge and library services team provides guidance and training to facilitate the ongoing development of high-quality NHS funded knowledge and library services.

We welcome the engagement of NHS organisations working with knowledge and library services to develop services aligned both to organisational strategic goals and to ‘Knowledge for Healthcare’ principles and priorities.

Outcome 1

The organisation resources and champions a proactive knowledge and library service for all staff and learners, aligned to organisational priorities and ‘Knowledge for Healthcare’ policies and priorities.

Scope

This covers the organisation’s strategic approach to the provision of knowledge and library services, and how the organisation is supporting their delivery and promoting their services. It also covers how the organisation invests in these business-critical services.

Levels and indicators

Not Met

Established

1.1 The organisation has identified a member of the Board or the Executive to engage with the knowledge and library services team to ensure that the needs of the organisation are met. (essential indicator)

1.2 The organisation has agreed the performance reporting it requires of the knowledge and library service and established routine performance reviews.

1.3 The organisation has an approved and documented strategy for the knowledge and library service that is aligned to the ‘Knowledge for Healthcare’ strategy. (essential indicator)

1.4 The organisation has agreed and implemented a knowledge and library service Improvement Plan that meets organisational goals and priorities and is aligned to ‘Knowledge for Healthcare’.

1.5 The organisation ensures that there is an established identifiable budget to fund knowledge and library services staffing, services and resources for users. It is managed by the knowledge and library services manager. (essential indicator)

Good

1.6 Delivery of the knowledge and library service Improvement Plan is regularly reviewed by the line manager and other senior staff with the knowledge and library service manager. (essential indicator)

1.7 The organisation ensures that service and education leads are consulted about strategic developments in delivery of the knowledge and library service.

Very Good

1.8 A member of the Board, or Executive team, champions the role and value of the knowledge and library service.

1.9 The organisation works with the knowledge and library service manager to realise and articulate the benefits of their services using performance, qualitative, and cost data.

1.10 The organisation encourages the knowledge and library service to take opportunities to bid for funding or resources and supports the preparation of business case.

Excellent

1.11 Champions from across the organisation, including at Board or Executive level, advocate use of knowledge and library services.

1.12 Resources are assigned by the organisation to fully deliver priorities enabling a business-critical knowledge and library service.

Outcomes 2 to 6 define the indicators of a well-supported, proactive, knowledge and library service.

Outcome 2

Decision making across the organisation is underpinned by high-quality evidence, provided by the knowledge and library services team, working with the organisation to facilitate the use of knowledge.

Scope

This covers how the organisation optimises the expertise of the knowledge and library services team, and the range of knowledge products and services they deliver to inform decision-making.

Levels and indicators

Not Met

Established

2.1 The organisation and the knowledge and library services team advocate the use of clinical decision support tools. (essential Indicator)

2.2 Knowledge and library specialists provide evidence and literature search services to clinical staff. (essential indicator)

2.3 Knowledge and library specialists provide evidence and literature search services to non-clinical staff. (essential indicator)

2.4 The knowledge and library services team proactively offer opportunities for healthcare staff to use a knowledge mobilisation tool or technique to capture and share learning or manage organisational knowledge.

Good

2.5 Knowledge and library specialists provide evidence summaries for healthcare staff. (essential indicator)

2.6 Knowledge and library staff work with one or more organisational teams to identify and plan for their knowledge mobilisation requirements.

2.7 Knowledge and library staff work with one or more healthcare teams to collaborate on meeting evidence needs.

2.8 The knowledge and library services team enable healthcare staff to use tools and build skills to address low levels of health literacy.

2.9 Knowledge and library staff promote and deliver personalised alerting services from a range of sources. (essential indicator)

Very Good

2.10 Healthcare staff use evidence and knowledge provided by the knowledge and library services team to inform decisions.

2.11 Organisational policy or guidance or procedures are informed by evidence and knowledge provided by the knowledge and library services team.

2.12 Patient information is based on evidence provided by the knowledge and library services team.

Excellent

2.13 The Board has agreed an organisational approach to manage and mobilise evidence and knowledge incorporated into relevant strategies.

2.14 Board decisions are informed by evidence and knowledge provided by knowledge and library specialists.

Outcome 3

The knowledge and library services team works with the organisation to identify its knowledge and evidence priorities and the needs of its staff and learners, and designs and delivers services to meet those needs.

Scope

This covers how the knowledge and library services team works with the organisation, stakeholders, partners and target audiences to identify knowledge and evidence needs and to develop and promote knowledge and library services.

Levels and indicators

Not Met

Established

3.1 The knowledge and library service is promoted to all staff and learners. (essential indicator)

3.2 The knowledge and library services team use knowledge and evidence needs analysis and feedback from users to consider changes to services and/or resources. (essential indicator)

3.3 Adjustments are made for individuals or groups with differing abilities or aptitudes.

Good

3.4 Staff, learners and educators are consulted regularly to inform service development.

3.5 The knowledge and library services team work with the organisation to take a targeted and planned approach to marketing the service. (essential indicator)

3.6 The knowledge and library services team use their understanding of the wider user base to inform marketing and promotional activity.

Very Good

3.7 The knowledge and library service manager works with the organisation to introduce new services and/or innovative ways of working to meet needs.

3.8 The knowledge and library service adopts technological solutions to extend and/or personalise service provision.

3.9 The knowledge and library service collaborates with partners to develop and expand services to meet identified knowledge needs.

Excellent

3.10 The knowledge and library services team demonstrates that it is meeting the needs of the organisation, staff and learners through qualitative and quantitative evaluation.

3.11 The knowledge and library service demonstrates the success of partnership working in meeting the knowledge and evidence needs of the organisation.

Outcome 4

The organisation ensures that the knowledge and library services team has the right roles, capacity and skill mix to meet the needs of staff and learners and deliver on its strategic goals and ‘Knowledge for Healthcare’ priorities.

Scope

This covers ensuring that the knowledge and library services team has the right roles, expertise and staff, aligned to the principles and strategic direction set out in ‘Knowledge for Healthcare’ and national policy recommendations for NHS-funded knowledge and library services.

Levels and indicators

Not Met

Established

4.1 The organisation ensures that the knowledge and library service is led and managed by a qualified and experienced knowledge specialist, librarian or knowledge manager. (essential indicator)

4.2 All members of the knowledge and library services team are enabled to participate in opportunities for continuing professional development.

Good

4.3 Plans for service development and improvement incorporate a review of the capacity, strengths and skill gaps within the team. (essential indicator)

4.4 Members of the knowledge and library services team are supported to engage in reflective practice.

4.5 The organisation encourages and supports members of the knowledge and library services team to pursue professional registration.

Very Good

4.6 Improvements are made to the knowledge and library services team’s capacity and/or skills mix, based on priorities agreed between the organisation and the knowledge and library service manager.

4.7 Members of the knowledge and library services team can demonstrate that they act on reflective practice to inform service development.

Excellent

4.8 The organisation works with the knowledge and library service manager to ensure that the team has sufficient capacity and skills to meet changing service needs over time.

Outcome 5

The knowledge and library services team use and contribute to the knowledge base of the profession and relevant disciplines to develop and improve knowledge and library services.

Scope

This covers knowledge and library staff: keeping up to date; reviewing the literature of the field to inform service improvement; applying evidence; adopting good practice and innovation to improve knowledge and library services: and contributing to the evidence base of the profession.

Levels and indicators

Not Met

Established

5.1 The knowledge and library services team keep up to date with good practice, innovation and evidence obtained from research.

5.2 Current evidence, good practice and innovations are discussed within the knowledge and library services team or with colleagues to identify service improvement to introduce locally.

Good

5.3 Members of the knowledge and library services team share their experience, good practice and know-how in professional networks.

5.4 Developments and improvements of the knowledge and library service are informed by the evidence base. (essential indicator)

Very Good

5.5 Members of the knowledge and library services team contribute to the knowledge base of library and information science or knowledge management.

5.6 Members of the knowledge and library services team collaborate on conducting knowledge and library research.

Excellent

5.7 The knowledge and library service is supported by the organisation to be research active in the fields of library and information science and/or knowledge management.

5.8 Formal research outcomes are published by members of the team within the knowledge and library services evidence base, for example, peer-reviewed journals.

Outcome 6

Services provided by the knowledge and library services team demonstrate positive impacts on the delivery of healthcare and on organisational priorities.

Scope

This covers ways in which the organisation with the knowledge and library services team gathers, assesses, demonstrates and promotes the value and impact of the service. Impact is defined as “the difference or change… resulting from the contact with library services” (BSI 16439).

Levels and indicators

Not Met

Established

6.1 The knowledge and library service can demonstrate specific instances of its impact on individual members of the organisation’s staff.

6.2 The knowledge and library services team collect qualitative or quantitative impact data for at least one activity or service provided by the knowledge and library service.

Good

6.3 The knowledge and library services team promote the service using evidence of impact that is analysed and reported. (essential indicator)

6.4 Clinical, managerial and/or educational leads advocate the value and positive impact of the knowledge and library services.

Very Good

6.5 The knowledge and library services team systematically collect and evaluate qualitative and quantitative impact data across a range of knowledge and library activities and services.

6.6 The knowledge and library services team shares impact case studies locally, regionally and nationally.

Excellent

6.7 Champions, including at Board or Executive level, promote the value and positive impact of the knowledge and library service on the organisation and healthcare.

6.8 The knowledge and library services team works with healthcare teams to identify its impact on healthcare delivery, including improved productivity and/or cost savings.

Role of the outcomes

Why are these Outcomes important for the organisation, learners and staff?

Policy context

The NHS has a duty, under the ‘Health and Care Act 2022’, to facilitate and promote “...the use in the health service of evidence obtained from research.”

“A strong scientific tradition of evidence based decisions about care is among the organising principles which have stood the test of time for the NHS.” (‘NHS Long-Term Plan’, 2019).

Healthcare is a knowledge intensive industry. “It is not enough to have the right teams in the right place, collaborating to deliver high quality, efficient patient care. It is essential that they use the right knowledge and evidence at the right time.” (‘Knowledge for Healthcare’ strategy, 2021-2026).

NHS knowledge and library services “take the ‘heavy lifting’ out of getting evidence into practice and give the ‘gift of time’ to healthcare professionals. Taking the ‘heavy lifting’ out of getting evidence into practice to improve the quality of care.” (‘The Gift of Time’, 2020).

People should be cared for by “competent and capable staff, receptive to innovation and able to use evidence from research. All NHS bodies and their staff should be able to access the expertise and resources offered by healthcare librarians and knowledge specialists.” (‘NHS Knowledge and Library Services Policy’, 2016).

“It is essential that the workforce use the right knowledge and evidence at the right time to support decision making and best practice.” (‘Knowledge for Healthcare’ strategy, 2021-26).

“Health literacy is underpinned by information literacy and digital navigation skills. These skills are essential for interaction with increasingly digital health and care services. Knowledge service teams make an important contribution in improving health literacy.” (‘Knowledge for Healthcare’ strategy, 2021-2026).

Requirements for NHS knowledge and library services

The ‘NHS Education Contract 2021-2024’ specifies.

• “The Placement Provider will ensure that there is a proactive, high-quality knowledge and library service that is available to all staff and learners.”
• “The Placement Provider will ensure that the clinical decision support tool, funded and provided nationally for all learners and NHS Staff, is actively promoted to underpin clinical decision-making.”
• “The Placement Provider will ensure that there is an appropriate level of Funding, both from education tariff and matched employer contributions, to support delivery of proactive, high-quality knowledge services.”

Recommendations and policy guidance for NHS knowledge and library services

‘Indicative policy guidance on funding’ (2022) recommends that Placement Providers in every setting:

• commit a minimum of 2.4% of the placement fee paid through the NHS Education Contract to the knowledge and library service
• ensure that, as a minimum, funding allocated to the knowledge and library service from the placement fee paid through the NHS Education Contract is matched by an employer contribution

‘Library and knowledge services staff ratio policy’ (2019) recommends:

• one qualified librarian or knowledge specialist for every 1,250 WTE staff in an NHS organisation

‘Learning space within NHS knowledge and library service policy’ (2020) recommends library space for all staff and learners that provides: self-directed learning; staff wellbeing; innovation and collaboration; and the library as a technology hub.

‘Emotional support for embedded knowledge specialists working within clinical settings policy’ (2020) recommends that psychological wellbeing support provided to members of multidiscipline is extended to embedded librarians working within clinical settings.

The ‘Topol Review’ (2019) recommends:

• “NHS Boards should take responsibility for effective knowledge management to enable staff to learn from experience (both successes and failures) and accelerate the adoption of proven innovations.” (OD5) page 16
• increasing “…the numbers of ... knowledge specialist posts, with dedicated, accredited time to keep their skills up to date...”. (AIR5/DM4) page 57