Employ quality improvement and knowledge mobilisation methods.

Right Decision Service implementation guide
National

Quality improvement methods

Three key questions need to be answered before starting your improvement process:

  1. What are we trying to achieve? This is the overall aims statement. Teams need to set clear and focused goals with measurable targets. These goals require leadership and should focus on problems that cause concern, as well as on patients or service users and staff. The goals should be relevant to the length of the project and be bold in aspiration.
  2. How will we know if the change is an improvement, ie. what measures of success will we use?
  3. What changes can we make that will result in improvement? These are the initial changes to be tested in Plan, Do, Study, Act (PDSA) cycles; other ideas for changes often emerge during the PDSA cycles.

What are we trying to achieve? How will we know if the change is an improvement? What changes can we make that will result in improvement?

 

Advice for using quality improvement methods in healthcare includes the following:

  • Start on a very small scale, working initially with people who believe in the change.
  • Ensure that there are easy ways to measure if the change was a success for the stakeholders.

Work through multiple cycles of change, using the Plan-Do-Study-Act (PDSA) model and working with larger numbers of stakeholders as the cycles progress

Plan-Do-Study-Act (PDSA) cycle

Plan Do Study Act

 

Plan

    Define:

  • The questions to be answered in the cycle
  • Who is responsible?
  • Where and when will the cycle be delivered?
  • How will success be measured?

Do

  • Run the test, collecting data before and after the change.
  • The data may be quantitative – e.g. number of users using the DSS - or qualitative, e.g. user feedback on how useful the DSS was.

Study

  • Describe what happened during the test
  • Analyse the test results
  • Reflect on how the results deviated from expectations, what this means for future improvement
  • Reflect on the impact of the change and what was learned

Act

  • Describe how to adjust the next PDSA cycle based on learnings from this cycle, or decide to move forward to full DSS implementation based on the learning so far.
  • For details and more guidance on the PDSA model, see this guide.

 

Knowledge mobilisation methods

Knowledge mobilisation methods facilitate the translation of knowledge into practice. Decision support tools are in themselves a key knowledge mobilisation intervention.  Implementation and spread can also be facilitated by a wider suite of knowledge mobilisation methods described below. Knowledge mobilisation approaches underpin many quality improvement and educational methods described below. Your librarian or knowledge manager will often be a key point of contact in helping you with knowledge mobilisation approaches.

All the methods below use social learning approaches to mobilise knowledge. This recognises that learning and change in health and social care are largely social in nature. Change in practice depends very much on the knowledge mobilisation activities of sharing experiences and perceptions. Change is strongly influenced by the connections health and care staff have within communities and networks.

 

Communities of practice

A community of practice is a group of people with a common sense of purpose who think and learn together, share information, build knowledge, develop expertise and solve problems [Lave & Wenger 1991].

A community of practice with a common goal of improving an area of practice – e.g. adopting guideline recommendations in a particular discipline; implementing new care pathways – can play a key role in facilitating implementation of DSS to support their shared goal. Communities of practice are a valuable way of sharing experience of implementation, building awareness, spreading and normalising new approaches such as DSS.

Source: Lave, J. & Wenger, Etienne (1991) Situated learning: legitimate peripheral participation (Cambridge: Cambridge University Press).

 

Other social learning approaches

There are many other social learning approaches. The TURAS Learn section on sharing knowledge provides a useful overview, including:

  • Using social media and social networking tools (e.g. LinkedIn) to spread the word about the Right Decision Service and specific DSS tools.
  • Engaging with influential professional societies and networks to use their communication channels.
  • Peer assist meetings – These are structured, facilitated meetings where colleagues from other teams or organisations are invited to share their experience, insights and knowledge with a team which has requested help. So, for example, you could hold a peer assist session so that new teams considering DSS can learn from a team from another organisation or department which has successfully implemented Right Decision Service tools. Health Education England provides more information on peer assist sessions.
  • After action reviews – An after action review usually takes the form of a facilitated discussion following an event or activity. It enables understanding of the expectations and perspectives of all those involved and it captures learning, which can then be shared more widely. More information on after action reviews is provided by NHS England.
  • Educational outreach – Educational outreach visits aim to improve the practice of health and care professionals through face-to-face visits to deliver educational contents. They have been shown to change some aspects of practitioner behaviour – e.g. prescribing. The opportunity here is to schedule 1-1 meeting with influential practitioners to make them aware of the Right Decision Service and DSS tools and engage them in using and disseminating these tools.