KnowledgeShare: access to evidence for NHS staff
In 1999 Brighton and Sussex NHS Library’s KnowledgeShare project set out to support the library team’s ability to facilitate evidence-based practice (EBP) and knowledge management within the local healthcare population. It now serves over 200 health organisations across the country.
Eight years ago Bastian et al indicated the scale of the problem facing those who wish to practice evidence-based healthcare. They suggested that 75 randomised trials and 11 systematic reviews, the best evidence we have for therapeutic interventions, were being published every day of the year.1 Policy documents, guidelines and case studies of innovative practice add to this plethora. For a clinician or manager to keep pace, services and tools that bring this new evidence to their attention in a timely, accessible way have become crucial to patient care and health service improvement.
Knowledge for healthcare
Health libraries address this need through the provision of in-depth evidence reports to answer uncertainties. They also provide information skills teaching so that healthcare staff can find the best evidence online. And in order to keep colleagues up-to-date, they provide current awareness services alerting them to new publications in their field.
Traditionally, these current awareness services have taken a blanket approach, distributing relatively long, broad bulletins to large numbers of recipients. They have usually failed to match a member’s specific interests, and to “save the time of the reader”.2 These bulletins, produced by individual health libraries across the country, draw from many of the same sources and therefore represent a significant duplication of work. For these reasons, the provision of individually tailored current awareness services was an important component of the Knowledge for Healthcare Development Framework for NHS library and knowledge services.3 The framework established that standards should be set for current awareness services and that provision should take a do-once-and share approach in order to extend reach to the whole of England.
Highly targeted evidence updates
The KnowledgeShare project began in 1999. Its aim was to increase our team’s ability to facilitate evidence-based practice (EBP) and knowledge management within the local healthcare population.We created a website signposting staff to EBP resources, increased evidence searches for management decision-making and started teaching staff to critique research papers. We also introduced highly targeted evidence updates informing colleagues about new research and government publications in their field.The system created to automate the production of these emails for thousands of local staff, with each email personalised and specific to the recipient, was unique.By 2005 it had grown to incorporate the management of our team’s evidence search requests and information skills teaching and had become a single portal to streamline and manage the three core services of health libraries.
Do once and share
For a number of years, KnowledgeShare remained an off-line system used only in Brighton and Sussex but there was growing interest from other health library teams in making use of it to enhance their own searching, teaching and current awareness. In 2012 we partnered with Maldaba, a software development company, who worked with us to rebuild KnowledgeShare as a web-based application. Moving KnowledgeShare online meant that we could support a collaborative approach to evidence updates and searching across NHS library teams, allowing them to save time and standardise their processes.
Connecting librarians with their members… and with each other
When members sign up to a library that uses KnowledgeShare they list their professional interests, being as broad or specific as they like. The evidence updates can encompass every aspect of clinical care, from emergency medicine to mental health. They can include public health content or focus on management topics such as patient experience, clinical risk, staff education, etc. Members are categorised according to their interests, publications are categorised according to their content, and KnowledgeShare matches the two together, sending personalised emails that tell library members what they need to know and no more.
It was important to preserve the connection between an individual librarian and their members and so the evidence updates arrive directly from a local
colleague. Members can also log into KnowledgeShare to update their professional interests, request a search for evidence or book onto teaching. Evidence search reports are collated within KnowledgeShare meaning that they can be easily shared with other librarians (for peer review) or shared with other NHS staff in order to widen the impact and reach of library work. Members can also evaluate the results of a search request, or a teaching session through the system, and KnowledgeShare will remind them if they forget.
Communities of practice
KnowledgeShare is still developing and will soon be expanding further into knowledge management through the creation of online communities of practice. NHS staff will be recommended by colleagues who share their interests and will be able to form groups through the system, from a virtual journal club in a single hospital to cross-organisational forums. Groups will request and share evidence searches to support their work and discuss the results through KnowledgeShare. The system will become an NHS-specific network, mediated by library and knowledge professionals.
KnowledgeShare continues to expand across the country, and there are now 82 services licensing KnowledgeShare.
Sharing knowledge across the country
In 2013, KnowledgeShare was made available beyond Brighton & Sussex, initially to other health libraries in the South and, over the next two years, 28 NHS LKS teams had signed up to use it. The system continues to expand across the country and there are currently 82 services licensing KnowledgeShare who between them serve over 200 health organisations.
Most teams begin by using the updates function to provide current awareness to their members. Almost 250,000 tailored evidence updates were sent by the system in 2017, to around 21,000 individual members. The
number of teams using KnowledgeShare to manage their teaching provision increased by 63 per cent this year. The number using it to record their evidence searches increased by 75 per cent.
User feedback informing
KnowledgeShare was initially designed to meet the needs of the Brighton and Sussex NHS Library and Knowledge Service, however not all health libraries work in the same way. The system now supports a wide variety of teams and is constantly evolving to satisfy their needs. From the initial onsite training to answering support queries in established services, we maintain a conversation with health librarians to discover potential development opportunities and adaptations. The indexing that powers KnowledgeShare is also updated based on changing requirements, for example the introduction of a specialist orthopaedic trust has led us to refine the musculoskeletal categories to better meet the needs of their members.
KnowledgeShare user communities of practice are a fertile area for exploring future directions for the platform and give librarians a chance to share ideas on promoting and evaluating the system.
Evaluations coming from library members in teams across the country include: “KnowledgeShare updates generate new ideas and initiate group discussion within the team thus introducing new changes in practice. The updates have the potential to
initiate such a change!” (Heart of
England NHS Trust) and “KnowledgeShare is very helpful and leads me to read things I wouldn’t normally – it expands our viewpoint on all kinds of commissioning work” (Whittington Health NHS Trust).
Case study: Tom Roper, Clinical Librarian, Brighton and Sussex Hospitals
CLINICAL librarians provide information at the time and place of need, on ward rounds and in departmental meetings. I work with the Abdominal Surgery and Medicine, Acute Floor and Musculoskeletal directorates. With access to KnowledgeShare on my iPad, it makes it easy for me to add new requests for evidence searches as they come up by the bedside or in a meeting. I can quickly find past evidence search reports, book people onto teaching sessions and set up or tweak their current awareness profiles. It makes it quick and simple to manage my workload, to share or reallocate searches to other members of the searching team. I don’t have to spend time worrying about formatting my search reports consistently. KnowledgeShare produces everything in a standard format, and even adds a model citation, if the search requester wishes to cite the search in published work. It allows me to add summaries and syntheses of search results, saving the time of the user. And I can share searches with colleagues, and, with permission, with any KnowledgeShare user anywhere in the NHS.
Case study: Stephen Ayre, Library Services Manager, George Eliot Hospital
THE William Harvey Library team at George Eliot Hospital is fairly small (3.8 whole time equivalents). Although we had a management bulletin and posted regularly to social media, we were aware that our current awareness offering could be improved. Licensing KnowledgeShare in February 2017 has allowed our users to receive current awareness personalised to their interests, which we would not have been able to provide in any other way. As of March 2018, 105 of our users are receiving alerts, and appreciate the service. One said “With so much information on the internet, using KnowledgeShare is a strategic way to work. It helps you establish what you are looking for, filter out irrelevant or bad content and helps you to explore information in a directed way”.
Having introduced KnowledgeShare for current awareness, we also took advantage of its other features. The literature searching module allows us to assign search requests to a librarian, which is useful in ensuring searches are completed in a timely way, especially complex searches involving more than one librarian. Ensuring the output of search requests is professional and user-friendly is important but sometimes difficult when multiple sources are used. Therefore the ability to combine results into an attractive format is very useful. In addition, the training module allows us to see who has received what library training and manages their feedback.
1 Bastian H, Glasziou P, & Chalmers I. “Seventy-five trials and eleven systematic reviews a day: how will we ever keep up?” PLoS Med 2010;7:e1000326
2 Ranganathan, S. R. The Five Laws of Library Science. Bangalore: Sarada Ranganathan Endowment for Library Science; 1957.
3 Health Education England. Knowledge for Healthcare: a development framework for NHS library and knowledge services in England 2015–2020.
London: HEE, 2014. https://bit.ly/2ljkNj0