better intelligence boosts quality
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Better Intelligence Boosts Quality. Sir Muir Gray CBE 23 March 2009. The future is not a destination like Cheviot Hills , waiting for our arrival; it is something like Durham Cathedral that we have to imagine, plan and build. The future is here; it is just not evenly distributed. - PowerPoint PPT PresentationTRANSCRIPT
Better Intelligence Boosts Quality
Sir Muir Gray CBE
23 March 2009
The future is not a destination like Cheviot Hills, waiting for our arrival; it is something like Durham Cathedral that we have to imagine, plan and build.
The future is here; it is just not evenly
distributed
William Gibson
Great innovations of the first and second healthcare revolutions
MRI and CT scanning Statins Antibiotics Coronary artery bypass
graft surgery Hip and knee
replacement Chemotherapy Radiotherapy Randomised controlled
trials Systematic reviews
Gower Street - Doll & Hill
Broad Street - John Snow
First Second
21st C health and healthcare problems
Safety Errors
Quality Substandard clinical practice Poor patient experience
Failure to maximise value Waste Overenthusiastic adoption of low value interventions Failure to get new evidence into practice
Inequalities Failure to prevent disease
The drivers of the third industrial revolution
Citizens
Knowledge
I T
Manuel Castells
Generalisable knowledge
Explicit Tacit
From research:
evidence
From data:
statistics or information
From experience:
casebook
Knowledge
VALUES
THIS PARTICULAR
KNOWLEDGE CHOICE DECISION
Knowledge: the enemy of disease
The application of what we know will havea bigger impact than any drug or technology likely to be introduced in the next decade
“Evidence from recent trials, no matter how impressive, should be interpreted with caution”
Claims made in 45 highly cited reports were subsequently contradicted (n=7) or weakened (n=7) for 14 of the interventions
Ionnidis JPA (2005) Contradicted and initially stronger effects in highly cited clinical research JAMA 294; 218-228
Researchreports
NICEguidance
Who is responsible for…
1. What a new GP in Hartlepool knows about indications for referral for hoarseness?
2. What a citizen in Gateshead knows about PSA screening?
3. What a Year 1 SpR in geriatrics in Darlington knows about fractured neck of femur?
4. What a teacher of children with learning disability in Newcastle knows about epilepsy?
Someone on the Board of every healthcare organisation, directly responsible to the Chief Executive, will be given the responsibility of acting as Chief Knowledge Officer
Public Health is a knowledge business
The application of what we know from research, from data analysis and experience, will have a bigger impact on health than any drug or technology
Librarians Information scientists Chief Knowledge Officers Clinical epidemiologists Public health professionals
“most patients were not given clear information about the survival gain of palliative chemotherapy… in most (26/37) consultations discussion of survival benefit was vague or non-existent”
Audrey S et al (2008) What oncologists tell patients about survival benefit of palliative chemotherapy and implications for informed consentBMJ 2008; 337;a752
www.bettervaluehealthcare.org
Informing Healthier Choices
Box 1
Workforce capacity and capability
Better workers
Box 2Improved data and
information Cleaner clearer
knowledge
Box 3
Stronger organisations
Stronger teams
Box 4Health information
and intelligence portal and systems
Better pipes
Box 1
Workforce capacity and capability
Better workers
Improving public health information and intelligence skills and capacity across England for all levels of the public health workforce
PH Specialists PH Practitioners Wider PH workforce
2 objectives Developing a career pathway and supporting
infrastructure tools Developing training resources to build competencies for
all those using information and intelligence
Suite of Job Descriptions and Person Specifications for information and intelligence staff
10 e-learning modules (5 at specialist and 5 at practitioner levels)
13 modules with .ppt slides, tutor notes and workbooks
www.healthknowledge.org.uk hosts training resources for all public health competences
Box 1Available now!
Box 1
Box 2Improved data and
information provisionCleaner, clearer
knowledge
Reliable data on key health challenges
Special surveys eg well being dental health exercise levels
Surveillance systems eg child health systems disease registers
Centrally from providerdata eg general practice smoking raised BP
Box 2 data workstreams
Health Profiles 3
Primary care data development
Prevalence modelling
Child height and weight
Dental survey data
Drug misuse data
Nutrition & dietary data
JSNA dataset
Local health surveys
Sexual health data
Other initiatives e.g. basket of health inequalities indicators
Box 2
CHD: expected prevalence in people over 16
Box 2
CHD: observed over expected prevalence in over 16s
Box 2
Competencies for WCC, inc JSNA Skills to use intelligence for Public Health and
commissioning Health Impact Assessment
Government Impact Assessment (national) Specific proposal impact (regional, local) Training
Strategic Environmental Assessment
Box 3
Stronger organisations
Stronger teams
Policies for action on WDH
Better presentation and accessibility of data to professional public health people
Better use of information systems and tools by networks of people
web-based improved ease of use interactive
Examples and inspiration to promote more productive use of information
Box 4Health information
and intelligence portal and systems
Better pipes
Projects
NLPH – online, free to access
APHO, IC, DH, PHAST development work Data analytic tools Knowledge management systems Single portal for accessing PH intelligence
Plus social networking? Other Web 2.0 resources?
Box 4
Box 4Public health casebook proposal
Expedites shared learning All public health practitioners must submit 1
(or more) report pa Reports contain
Outline of problem Why prioritised Objective of PH investment Project impact Lessons learned Signpost to full documentation Contact details
PHINE meeting
• NLPH – busy online library with monthly newsletter (>7500 hits per month)
• National guidelines• Systematic reviews• www.library.nhs.uk/publichealth• National knowledge weeks (synthesised for quality)
eg HIV/AIDS Dec 2008, drug misuse Jun 2009
PHINE meeting
• Capacity development: posts and courses• Better understand networks of practitioners, networks of
information, networks of quality observatories, relations to wider networks beyond NHS (esp PHOs) eg GOs
• Distinct role of PHOs• Commissioning competencies within PCTs esp
competency 5 (NEPHO workshops with SHA on knowledge management) All PCTs aiming for level 3 in coming year, using DOAS
• CKO group self assessing knowledge management
PHINE meeting
• Comp 5: CEOs across Region have started group led by CEO N Tyne
• NE Regional Information Partnership with John Carling leading – good online resource
• Centre for Population Research – UKCRC set up 5 centres of excellence. In NE 5 universities collaborate (quoted by CMO)
• Has attracted funds for research on 10 important themes (social group – economy environment and mh; lifestyle - tobacco, alcohol, obesity, phys activity; prevention fair and early treatment – provision of healthcare not prioritised in other work stream; life course – early years, good life, good later life, good death
PHINE meeting
• Individual universities tackle specific areas
• Feedback from pairs – what can IHC do for you?
• ONS birth – gestational age please• ONS website design, hard to find what you want• Rationalise web access• Provide digests (but NLPH does this)Train CEOs in PH knowledge management – show
them the benefits
Feedback from pairs
• Data from OGDs and IC easier to find• Access for PHOs to PPA data and NHS
central registry for GP registrations at a national level – use a single issue to highlight, maybe statins
• Promote imp of PH to commissioning – demonstrate risks of not having PH info central to commissioning decisions
• Help PH people use media their partners use