This article was first published in Volume 16, Issue 3 2005/2006 of the Inform newsletter.
For more information please go to www.ifmh.org.uk

The article is being republished by kind permission of the author and the committee members of the Inform newsletter, represented by Rosalind McNally -
rosalind.c.macnally@manchester.ac.uk

MKNs go from strength to strength in Scotland

This is the final report of the Managed Knowledge Networks (MKN) project for Cancer, Coronary Heart Disease (CHD) and Mental Health in the West of Scotland, plus a look at future plans. The NHS Scotland e-Library (http://www.elib.scot.nhs.uk) now has six Managed Knowledge Networks supporting and being supported by six subject portals, the original three plus Stroke, Diabetes and Healthcare Associated Infections (HAI).

Background

The project ran for two years from January 2003 to December 2004. The developments are integrated into the NHS Scotland e-Library. The project explored some of the ways the library service could support the changes in the delivery of health care in Scotland with managed clinical networks, the joint futures agenda for cross boundary working, and was made possible with developments in technology.(1)

The concept of Managed Knowledge Networks is integral to the strategy published by NHS Education for Scotland in February 2004 ‘Exploiting the Power of Knowledge in NHS Scotland - A National Strategy’(2). This vision applies knowledge management principles to support the patient journey across boundaries of geography and discipline. This strategy has been followed by an implementation plan ‘From knowing to doing: transforming knowledge into practice’ (3) NHS Education for Scotland Draft for consultation April 2005 to translate the vision into a working reality. This plan sets out four development areas, one being the development of Managed Knowledge Networks for the clinical priority areas. In addition the ideas of communities of practice, which are the building blocks of the MKNs, are considered to support collaborative working, linking people and technology encouraging access to resources and knowledge sharing.

Aims and Objectives

The project aimed to improve the management of knowledge by providing tailored access to the resources and services and to encourage communication and sharing of knowledge in subject specific areas.

The three objectives were:

1. Subject portals
   To develop subject portals within the NHS Scotland e-Library for cancer, coronary heart disease and mental health. These were launched in May 2004 and provide access to e-Library resources for each subject with services to help manage and use the resources.
2. Mapping of services
   To map the information provision for the three subjects in the West of Scotland. Maps for each subject and each Health Board in the region were produced. This was reported in detail in Inform (4).
3. To develop Managed Knowledge Networks (MKNs) for each subject to support and be supported by the portals.

Developments since the launch of the portals in May 2004.

Promotion and outreach

The launch was followed by of promotion, outreach and training around the health boards in the west of Scotland organised in conjunction with the library services. We also attended various subject specific groups and managed clinical network meetings.

Evaluation

This was carried out in October and November utilising:

1. Statistical evaluation tool
2. Web based short questionnaire
3. 5 Focus Group/Facilitated Learning Sessions

1. Statistical evaluation
   We used the statistical reporting tool available on the e-Library which captures the number of page views. It also displays the actual searches keyed into the simple search box. Numbers accessing the portal has gradually increased month by month with peaks around the time of outreach.
2. Web based short questionnaire
   The questionnaire was available on the portals and the link was sent to our contact list. The aim was to investigate the purpose or reasons for needing information. We provided free text space for examples, comments and suggestions. 104 responses were received with many claiming that the portal had saved time and had a positive affect on patient care.
3. Focus Group/Facilitated Learning Sessions
   Five sessions were organised focusing on Cancer, CHD, Mental Health, GPs, and Public Health SpRs. A total of 38 people attended.
   
   The sessions consisted of:
   • Pre-session questionnaire.
   • Scenario with related questions followed by discussion on approach and the results.
   • Experience and attitudes to using the alerts and personalisation services.
   • Information diaries were given to participants to be completed over two weeks. Only a small number were returned but they provided interesting additional information on the types of questions, the methods and resources used, that was, if they were answered at all.

Evaluation results

Acknowledging the constraints of the online questionnaire and the group sessions, the statistical analysis were used as a basis for any conclusions drawn, supported the other findings. Many of the recommendations in the final report have already been addressed and further developments are expected in March 2006 with changes to the interface.

• Search & Browse
  We were able to establish general patterns of use. Interestingly the topic directory and browse by subject were used more on the portals than the general e-Library. This was supported by the experiences of the group sessions, indicating a difference of approach to searching within a defined subject area.
• Knowledge services
  This is a menu providing access to alerting services, expert searches, current awareness and tools to aid the sharing of knowledge with colleagues. The statistics showed a low use of the autoalerts and expert searches. In the sessions the people who found these services interesting were those who did a lot of searching and wanted to manipulate the saved searches.
• My Knowledge Space
  This facility enables users to access the personalisation pages to setup alerts to new content, allocate specialist homepages and manage saved favourites. It was not well used at the time but was well received in the training. Currently we are considering the best way to promote and highlight these features.

Directory - mapping of services

The Library and Information Services Directory available on portals includes details of the information services gathered from the mapping of all the sectors. In addition there is a link to the NHS Health Scotland database of support groups. Users highlighted the need for information on self-help groups and the inclusion of additional databases could be helpful. Further investigation and evaluation is required with users.

Managed Knowledge Networks (MKNs)

Managed Knowledge Networks are large groups of healthcare staff who need to access, share and apply knowledge in a common broad area of interest - e.g. cancer, coronary heart disease, mental health and MKNs support a variety of communities with narrower subject focus. MKNs reflect the fact that we frequently consult colleagues for information before using electronic or written resources. The knowledge and experience held by healthcare staff represent a significant resource if captured and used properly.

The development of the MKNs has been the final outcome and although they were launched in May 2005 after the end of the project, the MKN project team did much of the preparatory work. The conference ‘Managed knowledge networks: working together to bridge the knowing–doing gap’ was the launch of a further three knowledge portals, Diabetes, Stroke and Healthcare Associated Infections and explored the principles of the management of knowledge in communities of practice. Etienne Wenger, an international expert in knowledge management and consultant in the field of learning systems who coined the term communities of practice, gave the keynote speech to set the scene for the discussion in the workshops around how NHS Scotland staff and the organisation could benefit from this way of working.

The overall aim of developing MKNs is to ensure that knowledge is managed effectively across boundaries of discipline, organisation and sector to support patient care and delivery of health services.

Managed knowledge networks have two interrelated objectives:

• The development of communities of people involved supported by the portals.
• The development of the resources and services on the associated portal.

The major tool for communities to share and communicate is the Knowledge Exchanges which provide virtual workspaces.

Management of MKNs

To ensure the resources on the portals reflect the needs of users, each has an editor working a few hours a week supported by a panel of people recruited from the service, to evaluate resources, identify gaps and suggest ways to fill these with resources and services.

We also have a steering group with representation from a variety of stakeholders to ensure the direction of the MKN and its associated portal. These groups will approve network development plans for the ongoing sustainability of portals and communities.

Future Developments

Network development plans

These plans are to provide focus and direction over the next year for both resources and community building for each MKN taking into account feedback from further user consultation and evaluation.

Examples of the recommendations include:

• Amendments to user interface to highlight the personalisation tools.
• Links with continuing professional development (CPD) opportunities and the Knowledge and skills framework.
• Interoperability and cross searching with local information providers.
• Investigating access to resources via stages within the patient journey.

In addition the knowledge exchange tool which has proved so popular will be reviewed for development in early 2006.

Cancer Knowledge Services

Over the coming months a strategy for Cancer Knowledge Services will be developed which will also be key to the future direction of the MKNs.

I would like to thank Lorraine McLeod, Information Manager on the project for all her hard work and support.

References

1. Thain, A. e-Library in Scotland: managed knowledge networks for cancer, coronary heart disease and mental health in the West of Scotland. IFMH Inform. 2003/2004; 14(2).
2. ‘Exploiting the Power of Knowledge in NHS Scotland - A National Strategy’ NHS Education for Scotland February 2004.
3. ‘From knowing to doing: transforming knowledge into practice’ NHS Education for Scotland Draft for consultation April 2005.
4. Thain, A. Knowledge Networks: Use of concept mapping to support library and knowledge services effective collaboration to meet user needs. IFMH Inform. 2004; 15(1) Summer.

Annette Thain
MKN Project Manager
Annette.thain@nes.scot.nhs.uk