This article is from the November 2002 Issue of Update.

How many times have you heard that modernising the NHS is no easy task? No one argues that recent years have not highlighted the need for a critical overhaul of the NHS, aided by investment and reform. Alan Milburn, Secretary of State for Health, puts it like this: ‘The NHS needs to move from a 20th-century bureaucracy delivering mass-produced services to a 21st-century service industry delivering tailor-made services.’1 Delivering these ‘tailor-made services’ requires a sustainable framework providing vital healthcare choices delivered by frontline NHS professionals forming networks of teams devolved from the largest healthcare system in Europe.

Part of this framework for change is the NHS Modernisation Agency. The agency was created in April 2001 to help local healthcare staff make these types of service changes. It brings together individuals with established reputations for securing service improvements and developing clinical and managerial leadership. However, the agency is more than just a response to the need for clinical change: it offers step change support for organisational change in order to build improved environments for NHS staff and patients alike.

The empowerment reforms intrinsic to the NHS Plan are very much a part of the modernisation agenda and the work of the Modernisation Agency. All of this effort is also part of the Shifting the Balance of Power programme ‘brought about to empower frontline staff and patients in the NHS…the main objective will be to foster a new culture in the NHS at all levels which puts the patient first.’2 Find a better way of doing things

Both the big picture and the small details are crucial to modernising the NHS, argues David Fillingham,3 Director of the Modernisation Agency, who offers five simple rules as an introduction to modernisation:

• see things through the patients’ eyes;
• find a better way of doing things;
• look at the whole picture;
• give frontline staff the time and the tools to tackle the problems;
• take small steps as well as big leaps.

Success demands three sets of changes - the ‘3 Rs of modernisation’. These are:

• renewal: more modern buildings and facilities, new equipment and IT, more and better trained staff;
• redesign: services delivered in radically different ways with a much greater use of clinical networks for better co-ordination of services around the patient;
• respect: a culture of mutual respect between politicians and the NHS, between different groups of staff, and between the NHS and those it serves.

The agency plays a crucial role in ensuring the commitments in the NHS Plan are translated into reality. The five rules bring the ambitious agenda into focus, giving it one mind and one vision. This kind of focus requires the agency to know how to stimulate collaboratives, networks and communities and this framework of activity squares neatly with knowledge management tools and techniques. Finding solutions to knowledge sharing means individuals can become communities. To cite an anonymous commentator: ‘We might not have it all together, but together we have it all.’

The agency is a prime candidate for capturing all the potential of knowledge management. In the agency, the verdict is still out on whether KM is the right term for our goal of more effective knowledge sharing, and other terms are being considered. However, for the moment, KM is taken to mean our programme of knowledge mobilisation or knowledge sharing. To exploit this potential a new programme was recently established within the agency’s Corporate Development Team to achieve three things:

• improve knowledge sharing across the agency’s self-managed teams and capture and exemplify good practice;
• support, encourage and inform NHS organisation-based and person-based knowledge networks;
• facilitate the development of a National Knowledge Service (NKS) for the NHS.

Knowledge sharing across the agency

This internally-focused knowledge programme will be developed by a small central team, supported by a network of knowledge ‘champions’ drawn from across the agency, whose expertise can help identify the agency’s knowledge assets. These champions are a mix of those with KM roles and those who recognise the need within the agency to ‘practise what we preach’ to the NHS about how to spread good practice. There are already innovative knowledge mobilisation programmes with dedicated professional staff in several of the agency’s teams. The central team’s role is to facilitate the dissemination of the learning from these team-based KM projects across the agency, involve all teams in developing the corporate knowledge base, and engage all agency staff in developing a positive environment for knowledge sharing. Initial appointments to the core team include Margaret Haines as Acting Director of KM and Annette Copper as Knowledge Resources Manager.

Initially, by engaging the teams in ‘small steps’ KM projects, we will build a knowledge portfolio of what works, which will help create a knowledge strategy sensitive to the agency’s business plan and cultural condition. The goal is to make the agency one of the top places to work, equipping our people with the tools, techniques and drive to do an exceptional job in a challenging environment.

The bigger picture entails the KM team working with other agency corporate teams, particularly Human Resources, IT and Strategic Communications, strengthening relationships that inform robust policies for the KM trilogy — people, processes and technology.

Although KM as a strategic and operational process is new to some teams within the agency, others have already begun to incorporate it. They may not call it KM but where they are addressing issues of collaboration across teams, accelerating work development cycles through knowledge sharing, harnessing and exploiting tacit knowledge — the knowledge that resides in people’s heads — for improved innovation and decision making, they are implementing KM. It is about connecting people with people, not just people with information. The goal is to see KM percolate throughout the agency, stimulating its own need to improve responsiveness, innovation, competency and efficiency — a coherent response to the need to be seen as a catalyst steering the NHS into a knowledge-based service.

As many of the team members are drawn from the NHS, their time at the agency could prove invaluable. When they return they can take with them the skills they have harnessed to mobilise the local knowledge that can foster organisational development and learning. This will help to answer the systemic questions their work environment poses. They could be the pathfinders, working in teams, reviewing their own service and asking ‘Where do we want to go?’ and ‘How do we want to get there?’ They could help direct others to a tried and tested route of quality improvement.

One of our first projects is a major online and interactive information system for agency staff and NHS communities, throwing into relief the agency’s programmes for reform and projects for improvement. In addition, as a directorate of the DoH, the agency has access to a wealth of DoH information and knowledge initiatives that can contribute to its programme design.

Mobilising knowledge at a local level

A second strand which complements the agency’s internal programmes is its engagement with external challenges, such as the mobilising of NHS knowledge at a local level, including harnessing the knowledge of health service users. Partnership with NHS organisations at all levels will be key to this programme, including the new Strategic Health Authorities and Workforce Development Confederations as well as individual Primary Care Trusts, Acute Care Trusts and their Social Service partners. Work is already under way supporting clinical networks in developing core knowledge systems, and organisational and individual learning through online communities of interest. A key factor in this programme will be learning from our counterparts in other countries, such as the Institute for Healthcare Improvement in the US.5

The agency will also be involved in knowledge and information skills development in the NHS through its link with the NHSU (the proposed NHS University).6 The NHSU will be a corporate university, offering all staff work-based learning, to help them move up the career escalator within the health service, as well as support for lifelong learning of a more general nature. As KM programmes expand through the NHS, plans for career opportunities for those interested in taking on a knowledge role will be drawn up. The KM Team has been supporting the NHSU with its plans for a KM curriculum within the Health Informatics programme currently under development, and the agency’s Leadership Centre is already looking at how it can include knowledge strategy development skills in its senior management programmes.

A National Knowledge Service

The third strand of the KM programme relates to the development of a National Knowledge Service (NKS) and linking this into local knowledge mobilisation strategies. The National Knowledge Service came about as a Department of Health response to the report into children’s heart surgery at the Bristol Royal Infirmary.7 This report recognised that a lack of coherent, consistent, accessible knowledge for both staff and parents contributed to the tragic circumstances in Bristol. The report promised a National Knowledge Service to meet the needs of professionals, patients and the public for up-to-date, evidence-based information by fully integrating the development of existing NHS knowledge systems (NHS Direct, NHS.UK, the National Electronic Library for Health (NeLH), and Department of Health websites, for example). This will ensure that the knowledge base of healthcare is delivered in a co-ordinated, strategic framework, offering common cores of knowledge across all national health and social care priority areas and delivered through multiple channels. These will include new media and the internet as well as local libraries and information centres.

The Acting Director of KM is chairing the NKS Co-ordination Group of key national information providers and will be ensuring that the NKS is as much focused on the local mobilisation of knowledge as it is on developing core knowledge content. Agency resources such as databases of good NHS practice will become part of the NKS framework of services to ensure that lessons learned from those working in health are fed into the NKS. The NKS will thus provide a rich resource for learning support to all those working and studying in the NHS, complementing the learning resources from the NHSU.

A feeling of security

The Modernisation Agency is a response to the long awaited and much needed reform of the NHS. The potential of KM is huge, as is the task of responding to the complex performance management and capacity and demand needs of the NHS. For KM to succeed across the agency and emerge as a fitting response to the needs of the NHS, new tools, techniques, skills and a step change approach are needed to underpin the development of a knowledge-sharing culture which will embed itself into working practices. KM holds the key to intellectual capital creation and investment — as much needed as financial capital. KM is a deliberate means of building and sharing knowledge across the vested interests of the NHS. If allowed to become intrinsic to the NHS it could generate that much needed feeling of security across the service — a feeling that the right decisions are being made and the right actions are being taken at the right time for the right outcomes. If that doesn’t sum up what the NHS should be about, what does?

References

1 ‘Modernising the NHS in Trent’ (www.nhsetrent.gov.uk/modernisation/whatis.htm).

2 ‘Shifting the Balance of Power’. Department of Health (www.doh.gov.uk/shiftingthebalance/).

3 Health Services Journal and the Modernisation Agency, Breakfast with Champions series, ‘Making Modernisation Mainstream’, 7 February 2002 (www.hsj.co.uk/champions/mainpage.htm).

4 S. Nichols et al. ‘Clinical Governance: its origins and its foundation’. Clinical Performance and Quality Health Care, Vol. 8 No. 3, 2000. pp 172-178.

5 www.ihi.org/ and www.doh.gov.uk/nhsuniversity/

6 www.doh.gov.uk/nhsuniversity/

7 Learning from Bristol: the Department of Health’s response to the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984-1995. Cm 5363. The Stationery Office, January 2002.

Annette Copper (annette.copper@npat.nhs.uk) is Knowledge Resource Manager and Margaret Haines (margaret.haines@doh.gsi.gov.uk), Acting Director of Knowledge Management, NHS Modernisation Agency.