Information Scotland The Journal of the Chartered Institute of Library and Information Professionals in Scotland ISSN 1743-5471 Issue contents | Journal contents | About the online edition of the journal October 2005 Volume 3 (5)

ICT: NHS Scotland

Transforming knowledge into practice

The NHS Scotland e-Library combines long-established skills with leading-edge approaches to knowledge management. Dr Ann Wales describes the service.

The NHS Scotland e-Library is a national online knowledge service which aims to support all NHS Scotland staff in their clinical and managerial practice, lifelong learning and research. Initiated on its current scale as a pilot project in January 2003, the e-Library is now provided by NHS Education for Scotland as a core service, attracting some 55,000 users per month. Increasingly, its remit is broadening to include partners in care in the local authority and voluntary sectors, and the role of patients, carers and the general public in shared decision-making.

The e-Library serves as a primary vehicle for delivery of NHS Education’s strategy for knowledge management, as outlined in Exploiting the Power of Knowledge in NHS Scotland and From Knowing to Doing: transforming knowledge into practice in NHS Scotland.[1] This strategic framework is designed to ensure that knowledge support becomes an integral part of improvements in patient care and the health of the people of Scotland. The e-Library represents the technology arm of the implementation pathway, working hand-in-hand with development of the culture, skills, and values necessary to realise the full potential of accessing and sharing knowledge and applying it to practice in the healthcare context.

The e-Library framework of resources, services and knowledge-sharing tools is designed to integrate knowledge support with the overarching business objectives of the NHS by:
>>Improving patient experience and patient outcomes, including involvement of patients, carers and the public in shared decision-making.
>>Promoting and protecting the health and well-being of individuals and the population as a whole.
>>Developing workforce capacity to meet the needs of the changing healthcare environment
>>Supporting Scotland’s national clinical priorities – e.g. cancer, coronary heart disease, stroke, diabetes, mental health, healthcare associated infections.
>>Service redesign founded on coordinated, partnership working across boundaries of organisation and sector.

e-Library resources and services
The founding strength of the e-Library is its comprehensive range of knowledge content, providing access to:
>>Over 5000 full-text electronic journals
>>Over 100 bibliographic databases
>>Over 5000 electronic books
>>Many thousands of evaluated websites and information sources for health and social care.

The principle of equity of access to the knowledge base is central to the service. The basic aim is to ensure that participants at all stages of the patient journey have access to the knowledge they require to deliver optimal patient care. Content selection policy therefore aims to address the needs of the full range of clinical and non-clinical disciplines, and the social as well as the medical model of care. Consequently, the e-Library provides not only peer-reviewed scientific information for doctors, nurses and allied health professionals, but also, for example, for Estates and Facilities, Admin and Clerical, social care and health promotion staff.

However, the e-Library has aimed from the first to be more than a passive content repository. It supports the mobilisation of knowledge through a suite of interactive services – including updating services; predefined expert searches; user guides and e-tutorials, and a directory of local library services in NHS and other sectors guiding the user to sources of virtual and human support. A personalisation tool (‘My Knowledge Space’), enabling users to define their individual preferences for key resources and alerting services.

Managed Knowledge Networks
The importance of working as teams and networks to deliver effective patient care is recognised throughout NHS Scotland. Multidisciplinary teams focused on the needs of individual patients play a vital role in the current model of care. Increasingly, these teams are required to work across community and acute care boundaries and to encompass social care and other local authority agencies. At a broader organisational level, a variety of new and emerging healthcare configurations reflect the network principle, such as: regional service planning; integrated care which converges health and social care management; Community Health Partnerships which bring together NHS and Local Authority service providers for service planning and delivery; and Managed Clinical Networks which operate as virtual teams focused on particular healthcare conditions, spanning healthcare organisations and sectors.

The e-Library supports this transition to a networked model of care by providing resources, services and tools to support knowledge access and knowledge sharing within Communities of Practice, which form the building blocks of Managed Knowledge Networks.

‘Managed Knowledge Networks’ (MKNs) are extended groups of healthcare staff who need to access, share and apply knowledge in a common area of interest. MKNs acknowledge the documented reality that healthcare staff frequently turn to colleagues to support their knowledge needs as well as using printed resources. The knowledge held by healthcare staff represents a significant resource if captured and used properly. The aim of developing MKNs is to ensure that tacit and explicit knowledge alike are managed effectively across boundaries of discipline, organisation and sector.

MKNs are founded on the Communities of Practice model of simultaneously building knowledge-sharing communities and developing knowledge resources.
MKNs build communities by:
>>Providing tools and support to enable communication within and across groups and teams.
>>Encouraging healthcare staff to be active in accessing and sharing knowledge.
>>Creating a network of experts and specialists committed to sharing of resources and expertise across boundaries of discipline, organisation and sector.
>>Working with local and national organisations in NHS and other sectors, Managed Clinical Networks and Community Health Partnerships.

MKNs manage knowledge resources by:
>>Identifying, evaluating and creating resources and services that will support the delivery of patient care – e.g. resources within e-Library Portals
>>Promoting development and use of resources, tools and services provided by e-Library and Portals.
>>Assuring quality of resources and relevance to the knowledge needs of Network members.

The e-Library provides subject-focused Knowledge Portals incorporating resources and interactive services designed to support MKNs in the national clinical priority areas of cancer, coronary heart disease, mental health, healthcare associated infection, stroke and diabetes.

One of the most innovative and popular tools offered by the e-Library to support sharing of knowledge are the Knowledge Exchanges, which provide communities of healthcare staff with a collaborative virtual workspace where they can share documents and work in progress, hold online discussion and create web pages. Since its launch in May, over 50 communities have established Exchanges, with purposes ranging from journal clubs to mental health teams to management planning.

Sharing knowledge across services
The information architecture of the e-Library has been designed from the first to facilitate sharing of resources across organisations and services. National and international standards for information management and information sharing are deployed. Metadata is applied in accordance with the Government Information Framework (e-GIF) and the Dublin Core standards. Indexing is based on refinements of e-GIF authority files. Subject indexing draws upon the Government Category List, the Medical Subject Heading System (MESH), and the Caredata controlled vocabulary for social care literature.

This investment in standards-based design has paved the way for the e-Library to share resources with services in the NHS, Higher Education and commercial sectors, based on Z39.50 and Web Services-based interoperability protocols. Currently the e-Library shares resources in this way with eight cross-search partners. The intention is to extend this approach to ensure that open, seamless information flow further facilitates partnership working across boundaries.

Future development plans
NHS Education’s implementation plan for 2005-2008 defines the following objectives for the e-Library in each strategic area:
Patient Focus
>>Creation of a Patient Focus Public Involvement Portal, to serve as a model for designing a public interface to the NHS Scotland e-Library.
>>Extension of e-Library knowledge architecture to: a.) articulate more closely with the needs of the patient journey; b.) facilitate context-sensitive access to the knowledge base from electronic patient record systems.
>>Development of strategic partnerships with library and knowledge services in NHS, Local Authority and voluntary sectors to promote access to health information.

Knowledge Networks
>>Development of existing Portals and MKNs to support national clinical priorities; creation of new Portals and Networks for maternal and child health and elderly care.
>>Continued promotion and development of tools to support sharing of knowledge within communities – e.g., a Knowledge Network for remote and rural care will provide opportunities for analysing how best to support communication and collaboration across distributed communities.
>>Extended utilisation of interoperability technologies to facilitate sharing of knowledge resources across healthcare organisations. Specifically, the development of a unified online catalogue for NHS Scotland Library Services.

Workforce development
>>Development of an information literacy competency framework to support definition and application of the skills for effective use of knowledge in the healthcare setting.
>>A new competency framework and a training programme to support the developing role of the NHS Librarian in enabling uptake of these new systems of knowledge support.
>>New role-focused Knowledge Portals will provide resources and services for those staff groups whose knowledge needs have not been fully addressed to date – most notably, primary care and non-clinical disciplines, and new staff groups emerging as a result of service modernisation. A more central focus on personalisation within the e-Library will enable individual members of healthcare staff to tailor resources and services to their unique needs.
>>A key objective is integration of e-Library resources and services with the Knowledge and Skills Framework which is to form the future basis for personal development planning for all NHS staff.

The NHS Scotland e-Library strives to balance the strengths of traditional and ‘leading edge’ approaches to knowledge management. The familiar, long-established librarian skills of managing and organising information enable the e-Library to serve as a comprehensive, reliable collection of resources and interactive services for a large and diverse audience. These traditional skills are overlaid with a new emphasis on the role of knowledge management in facilitating communication, partnership working, and integration of knowledge support with lifelong learning. Overall, this convergence of the best of both worlds is creating a service with the combination of stability and dynamism necessary to support the continuous transformation of knowledge into practice in the rapidly changing healthcare context. IS

Dr Ann Wales is Head of Knowledge Services Group, NHS Education for Scotland.

References
1 From Knowing to Doing: transforming knowledge into practice in NHS Scotland. Draft for consultation. NHS Education for Scotland, 2005.

Information Scotland Vol. 3 (5) October 2005

Information Scotland is delivered online by the SAPIENS electronic publishing service based at the Centre for Digital Library Research. SLAINTE (Scottish libraries across the Internet) offers further information about librarianship and information management in Scotland.