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SoWhoCaresAnyway E27 The Penalty of Ignorance · SoWhoCaresAnyway

• 0:04
  Hi, I'm Ruth Germaine, and this is, so Who Cares? Anyway, a podcast shaped by my deep curiosity about who cares, what do they care about, what do they do, and why does it matter? My aspiration is to build a community that listens with intention and explores care from every angle, from the North Yorkshire malls to behind clinical doors.
• 0:27
  Each episode invites people to share their stories, their ideas, and talk about what matters to them.
• 0:34
  Together we reimagine what care could be and how we might shape health and wellbeing through the assets, values, and the lived wisdom of our communities.
• 0:44
  And why does it matter? Because for too long, health and care have been treated as things to be delivered, often depleting systems and the people around them.
• 0:54
  And it's time to rewrite the narrative to center everyone as a contributor, not just a recipient, to offer joy, hope, and meaningful belonging to invite each of us to shape the future of health and wellbeing with courage, with creativity, and with care.
• 1:12
  So who cares? Anyway, find out more about me.
• 1:16
  Head over to my link tree.
• 1:18
  Do for Reflective Ruth.
• 1:20
  Here you'll find links to my website, my LinkedIn profile, and in the future, my Facebook page.
• 1:25
  So now for another episode of So Who Cares? Anyway.
• 1:31
  So for many of you, you probably won't know, but one of the things that I'm doing at the moment is I've, um, received funding from the, uh, local applied Research collaborative through the National Institute of Health Research as a knowledge mobilization fellow.
• 1:45
  And part of that funding I had to show my own investments.
• 1:47
  So I said I was going to invest in four of my podcasts being directly around either knowledge mobilization or around the actual project itself that I'm doing.
• 1:56
  So I'll be coming to some of those at later date.
• 1:58
  But today I'm really delighted through this that I am got in touch with, uh, Sue Lacey Bryant, who's leading on some of our supporting or leading.
• 2:07
  I'll let you explain in a moment, uh, Sue, what your role is on these knowledge mobilization fellowships, which are happening across the country.
• 2:14
  Um, and Sue is a visiting, uh, professor for knowledge and information mobilization at Manchester Metropolitan University.
• 2:23
  So that was a bit of a mouthful, but I got there in the end and I'm gonna come over to you, Sue, to introduce yourself please.
• 2:28
  Thanks so much, Ruth.
• 2:29
  So, um.
• 2:31
  It's a glorious title, isn't it? What a delight.
• 2:34
  Uh, and after a long career in the NHS and before that, in academia, it's actually a bit of a pleasure to be able to step back and look at what some of these terms, um, uh, mean across sectors where I've focused in healthcare, um, through my years.
• 2:51
  Um, what should I say? So I've got a number of roles.
• 2:55
  I'm, uh, heavily involved in my professional, which is based librarian Manager.
• 3:02
  So I'm currently president with C, which is Ton Institute in our field.
• 3:07
  Um, and I'm involved in a whole load of other things.
• 3:11
  So, uh, most of them in a voluntary role.
• 3:14
  I did do a bit of KM consultancy, but for example, uh, I'm involved in, um, mentoring some, some bottom up health and courses, um, projects through complete care community program.
• 3:28
  So things that I think are really worthwhile.
• 3:31
  Giving, sharing experience really from, from using all checks, had quite an eclectic career.
• 3:37
  And, um, one of the things that I do now is, uh, support, help Mission Network in Ken, sorry, Sussex.
• 3:46
  Uh, so I'm one of the fellows there.
• 3:48
  I've got a particular interest in, uh, learning health systems and particular interest in the applications of ai.
• 3:57
  My background in the health sector was in, was predominantly in primary care, um, probably 20, 30 years in primary care.
• 4:06
  Uh, but I was able to come back to my initial discipline and spent my last decade in the NHS heading Up work.
• 4:14
  Around knowledge localization might rich artist Chief Jefferson at the Chance Vulnerable a year ago.
• 4:22
  Thank you.
• 4:23
  And yes, when I was, um, talking to you before and as I said just now before we came on, I looked at your, um, LinkedIn profile and there's definitely quite a lot of things there that you are doing and they sort of link in a lot with sort of my previous episodes and the sort of work I'm doing anyway.
• 4:38
  So I feel that whilst I'm doing this, particularly around knowledge mobilization, I think that there's so much that, that you are doing that links in with my passion and drive if you like.
• 4:46
  And I'm interested, what was your role when you were in primary care? Well, it was an interesting route into primary care.
• 4:52
  I was still working with Corin Health Authority, but part-time I've got, uh, a small child that we'd moved town and um, a request went out for somebody to come and advise local training practice, medical training practice on their training resources for GP registrars.
• 5:13
  So I went into a practice by invitation, came out unexpectedly with a part-time job.
• 5:20
  All the practices went out to dinner with each other.
• 5:23
  Um, within about 18 months, I was working for seven general practices and I was helping teams find the evidence they needed, managed staff resources, development patients, librarians.
• 5:34
  I was a patient librarian.
• 5:36
  No such thing had really existed.
• 5:38
  And then as the internet came in, I was helping them use the internet to find high quality information.
• 5:44
  10 years on.
• 5:45
  I was the knowledge manager primary care group in which they all sat.
• 5:50
  And then the primary care choice in which they all sat, uh, roll on another 10 years of my career had developed.
• 5:56
  And I become Chief Knowledge Officer for NHS Milton Keynes.
• 6:01
  Um, and then there's a whole saga around what happened through government reorganization of primary care.
• 6:09
  And I advanced through a whole series of roles, roles.
• 6:12
  Um, through that new clinical commissioning group and became the director of Corporate Affairs and Partnerships.
• 6:18
  So there was a whole series of roles there in primary care.
• 6:22
  Well, I just wanna go on to ask what led you into a career in information work? So information, knowledge, um, and that area.
• 6:30
  Um, I grew up in, uh, my, my secondary school years were in Midway Towers, which, uh, had and continues to have, uh, Dickensian poverty and poverty within.
• 6:44
  Um, when I was about 14, my uh, dad took me along to an exhibition, a local public library, and it was about bus routes.
• 6:55
  So the 1 4, 1 bus was very important in my life.
• 6:58
  My mother didn't drive, she had a form of epilepsy.
• 7:01
  And, um, so not only going to school, but my social life was driven by the 1 4 1 bus.
• 7:07
  So I was really interested in what they were gonna do with this bus.
• 7:11
  The routes gonna change.
• 7:12
  But the thing that dawned on me, and it could have left, it led to lots of different types of careers.
• 7:17
  But what dawned on me as I walked around knowing the layout of the towns and where, uh, perhaps our most disadvantaged population lived, I could see that the people who were gonna be most influenced by this, impacted by this change of asters weren't there looking at this.
• 7:34
  So they weren't getting involved in that discussion, didn't have that in information.
• 7:41
  At the same time school, I was learning about charity.
• 7:43
  Laura, have you heard of Chara? No, I haven't.
• 7:45
  Reverend Chad, Laura, for an older generation of men, particularly, not entirely, but particularly, it was the guy who launched the Eagle comic, uh, and wrote stories and was a designer for the Eagle.
• 7:58
  Um, but he was also Vicar.
• 8:00
  And the first church service he took was for a 14-year-old girl.
• 8:05
  And when her period started.
• 8:07
  Her complete ignorance of what was happening to her body felt some terrible visitation has Trump pulled her and she must have done something terribly sinful.
• 8:17
  She was completely bewildered and have no one to turn to.
• 8:21
  And she took her own life.
• 8:23
  And Chad Vara stood over her grade and said, I didn't know you little girl, but I'm not gonna let your death be in vain.
• 8:32
  And he went on.
• 8:34
  Who just says but impactful story.
• 8:39
  I know.
• 8:39
  It's absolutely, I mean, it was gut, the gut drenching story.
• 8:43
  And, uh, he went on to do a lot of work around sex education later in his career.
• 8:50
  Um, he was very involved in, in the launch of the parent Thick Ins Trust, but eventually he also launched the Samaritan.
• 8:58
  Um, took, became about 20 years after her death to do that.
• 9:01
  So you had a monumental figure in, in a mental health, her thought.
• 9:07
  Social education.
• 9:09
  Um, and I was just so struck by the cost of not knowing the penalty and um, not having someone you could trust to speak to.
• 9:24
  Um, and that really fueled my interest in, in coming into information work and information science.
• 9:30
  And I suppose underpinning that thing about, um.
• 9:35
  And just informed decision making, whoever we are, whether that's a board or of ward, you know, in primary care in a clinic or at home.
• 9:44
  You know, do we have access to reliable, trustworthy information and is there someone we trust who we can, uh, approach whether that's a healthcare professional or indeed a rare.
• 9:54
  So that's what fueled my career.
• 9:57
  I started on academic libraries, did some research, worked with the professional body on education and training, um, but was very keen to roll my hands back and get into practice.
• 10:06
  Uh, so after those first maybe four years, um, I took up a new post in what would now be a public health role, uh, was then a health education realm and, um, uh, joined Cardinal Health author as a health education and information officer.
• 10:25
  I'll follow up story through with just another piece really.
• 10:28
  I worked there for seven, eight years.
• 10:32
  During that time while I was on the one hand, uh, providing evidence to public health, health and the medical director and so on, as they were planning initiatives, um, I was also getting information out, whether that was through public libraries or the center of, uh, for our unemployed locally or through things advice bureau.
• 10:54
  It's a healthy lifestyle type information.
• 10:56
  But what happened was people started sending me patients for information, and I'm driven by that.
• 11:03
  I launched something called CRO and Health, which is one of the first telephone health information services in, in company.
• 11:09
  So there you go.
• 11:10
  We launched that in 87, a few months earlier than we'd intended because, um, because the scale of misinformation and coin it, uh, around HIV and AIDS was creating a mega problem for, uh, for the public in, in understanding how to respond.
• 11:30
  That health challenge.
• 11:31
  So, so we launched it earlier, literally with a dozen tapes around different aspects of HIV, uh, and aids, and then broader, the whole collection.
• 11:40
  So that, that flight, first 10 years, 12 years of my career, um, carried on doing, had my babies carried on, doing a little bit of part-time work for the health Authority.
• 11:52
  And then my invitation went into a general practice one day, came out with a part-time job in 1990 and through a very secure tourist route, left the health service in 2024 as its Chief Knowledge Officer.
• 12:06
  But I worked in primary care for many, many years, and this is where we start to come to some of the points about knowledge and knowledge mobilization.
• 12:13
  What I realized was that providing people with information will only enough, and that it didn't have the impact on decision making that I wanted to see.
• 12:24
  And so, uh, a whole series of roots came outta that.
• 12:28
  But one of those was becoming interested in human factors and change.
• 12:32
  One of those has become more interested in quality improvement, um, approaches and large scale change techniques, tools and techniques.
• 12:41
  Um, and I suppose in the sort of fundamental essence of making it easier for people, um, to do the right thing and to use evidence as part of their workflow and easier for people to, to access information just as a natural part of what they were doing.
• 12:58
  So, I guess that was my driver.
• 13:00
  But my career through primary care led me on to, um, become a director of clinical commissioning.
• 13:07
  And then through that, as part of those commissioning board divisions, really making sure that the board was, um, able to receive high quality information, good quality analytics int intelligence.
• 13:23
  Full coloring what was coming forward.
• 13:25
  Um, uh, but also informed by patient experience and what patients were telling us.
• 13:32
  So a broad breadth of knowledge.
• 13:34
  That was only one part of my role as a director of course.
• 13:37
  But um, you know, I had particular focus and all back of my mind around, and I headed up this contentions as part of a much broad.
• 13:48
  Wow.
• 13:48
  And what an incredible career and some amazing stories that you've told on the way, and I'm sure that's only touching on a few of them to be fair.
• 13:56
  But quite, I impact impactful and the bit that's sticking in my mind was that penalty of ignorance.
• 14:01
  But actually you moved on from that to say, actually, even though you are providing all of that information and all of that evidence that's out there, that wasn't, that on itself wasn't enough.
• 14:11
  So is that what sort of steered you to that? I, I know you took the director role and, and you used that there, which obviously was very important and as you say, probably wasn't part of your role, but so important to listen to people's voices and, and to understand what people need and to think about that in a much broader context.
• 14:26
  I'm probably making it a lot smaller in saying that, but what were the next steps? So what, where did you go from the director role, uh, and what are you doing now? That would be nice to know.
• 14:34
  I done a lot work in general practice, um, and was working nationally, um, supporting primary care public health by.
• 14:44
  But Post did by Primary Care Trust because it was already difficult to be a freelance just already again, 2001.
• 14:54
  Um, and through that relationship, I foot called an idea around, uh, with throat quality improvement program that would drive evidence with clinical leadership and public and paper involved roads.
• 15:13
  Uh, and the end of that was that week, um, in Milk Kings gained us the money for the Health Foundation for a three year program quality and came, which was a lo I think a key thing for me might have allowed me to, um, take a two year call in leading for causing improvements and back be whole.
• 15:38
  Uh, it's a proper.
• 15:40
  Quick bag of tools and pet robs around clause and strategic filing.
• 15:46
  Understandable around scale challenge.
• 15:48
  And I think that that toolkit became very important in the next stage, which is why I'm mentioning it now, but also because I think when people think about any of these things, ization ledge, organization, leadership, organization development, actually you need quite an array of tools.
• 16:05
  Um, one of the challenges is that people focus on one segment, uh, and already bring the band, for example, implementation of science on side, the other work be able to do in mobile I knowledge and in my experience, you need it for all stable, uh, of tools, little techniques and vocabulary actually to get other people on board.
• 16:26
  So, um, it's just a lesson there is, when I came out of all that experience as a director, I did bring those group as part of that experience and I'd used those in primary can.
• 16:38
  So I left, um, I left the CCG to, um, workforce was then Health Education England, and initially in a primary care development role.
• 16:49
  Uh, and I was doing some freelance work as well.
• 16:52
  Um, ported quality ment and primal chair.
• 16:55
  But very quickly I was invited to, um, sort of return to my roots and, and be a strategic advisor on the development as strategy for knowledge and library services in Overland.
• 17:07
  I've kept my contacts with those knowledge specialists through my career and I facilitated them on a away day room.
• 17:16
  That kind of thing.
• 17:17
  So I had contact there, I was approached to come and health, uh, and that led to the 10 years focused on delivering, um, a strategy which we call knowledge for healthcare strategy, which at one level was about the transformation of knowledge and library services.
• 17:32
  Which one level This strategy was about the transformation of NHS knowledge and library services, which have been seen very much in an educational model.
• 17:42
  And we wanted to drive that towards people understanding that the same knowledge was to underpin a whole range of decisions that needed to be made and not just for learning.
• 17:58
  And that knowledge needed to be of, is most critical heart of the work of the NHS.
• 18:03
  It was extraordinary really.
• 18:04
  'cause you go into business indeed and healthcare industries, they will understand that knowledge is an ly fundamental fact.
• 18:11
  Some times in the NHS.
• 18:14
  People take that knowledge for granted sometimes I think they think you will score everything that needs to be known into the brain of a new professional as they learn and then send them off for a 30, 40 year career without really appending to their ability to, uh, find critique, information, knowledge, and bring it to the party as a normal path.
• 18:41
  There were, um, and to embed it into the electronic facial record into.
• 18:48
  Yes, of course they're teaching, but into their practice day by day.
• 18:52
  So there's a lot of issues there around how you drive the uptake of water ORs.
• 18:59
  So one of the things I want to ask, and perhaps I should have asked this a little bit earlier for people listening, is would you be able to give us a definition or to talk about what knowledge mobilization is? Because I know from my conversations that many people, this will get the idea, it's about knowledge.
• 19:15
  It's, and then sort of mobilizing it, you know, it can sound a little bit, um, difficult or a little bit wooly.
• 19:22
  Yeah.
• 19:22
  So sometimes what is it, what are we doing? And um, and then perhaps sort of talk a little bit through you.
• 19:29
  You mentioned that, you know, there's a need for an array of tools, but talk about some of the things that people really need in order to make this happen.
• 19:36
  So if somebody's thinking, well, what is it? Why do I need to do it? And then how.
• 19:41
  Do I do? It would be really useful.
• 19:43
  I'll tell you how I describe it, what I believe it is, and then I'll, I will, um, quote a couple of, uh, of definitions too.
• 19:50
  Thank you.
• 19:51
  For me it's a simple A, B, C, D.
• 19:54
  I used to talk about it as a simple A, B, C, but I added do, so you'll, you'll see.
• 20:00
  So, A, for applying knowledge, B for building knowhow, C for continuing to learn.
• 20:07
  And as I went through my time, in my last role, I added D for driving innovation.
• 20:12
  And by innovation I don't mean, um, something necessarily completely new, an invention, but something that we need to spread from one service to another service or from one part of the country to another part, part of the country.
• 20:28
  So for me, knowledge about mobilization spans those things.
• 20:32
  Applying what's actionable, building our own know-how and sharing that across the system, continuing to learn.
• 20:40
  Supporting others to continue to learn, uh, and driving innovation at the very least by disseminating, but more actively finding, helping people uptake it.
• 20:51
  So that's how I approach it, that that was what I saw as the world.
• 20:55
  Uh, and to come back to what I mean by knowledge, at the one end, you've got data, you've got evidence from research, which is sadly poorly.
• 21:04
  I'm so sorry.
• 21:04
  But, and then you've got what the staff known from their Columbus sound, uh, and from their experience and then what patient known and that find a twofold.
• 21:16
  There's the experience, there's patient experience of care, uh, and how we respond as a system to that.
• 21:25
  But interestingly, also involved in putting together a proposal at the moment around working with, um, some of our underserved communities to, to try and elicit what they know but haven't articulated.
• 21:39
  So the unknown nose really is governing that knowledge and wealth understanding that held in a community for some reason, the army chef.
• 21:52
  So that variety knowledge mobilization and, and that and the breadth of knowledge that I have seen.
• 21:59
  So I, I'll emphasize that because I think we also to talk about a data-driven N chest.
• 22:03
  And I'm not looking for a data, whichever on our chest.
• 22:05
  Some people feeling intelligent n chest can use that breath of long.
• 22:10
  Um, but I'll give you a few definitions.
• 22:13
  So there's a couple from tra ol talks about Ron mobilization as leveraging scientific evidence to inform and transform policy and practice.
• 22:25
  So seeing it as the bridge between research and practical application, um, Calgary talks about it, uh, you know, says knowledge mobilization puts simply as the process of moving evident into action.
• 22:39
  And they go on to say it can involve building awareness, disseminating findings, enabling the use of research knowledge to create positive impact and benefits.
• 22:50
  And then it can happen at any point in the research process.
• 22:52
  It's not necessarily an end point of research, but at any point that engagement in research, um, others talk about it as a two-way process.
• 23:02
  NIHR.
• 23:04
  So there's knowledge mobilization.
• 23:05
  What, which are funding? You are, you are studying at the moment, isn't it? The work that you are doing project, yes.
• 23:10
  The process that PAs the way to impact and they emphasize via collaboration with key stakeholders throughout your research.
• 23:19
  This includes working with the people and organizations who use or benefit from your research.
• 23:23
  But when I think about knowledge mobilization, the research bits all done and the research evident is just one content.
• 23:30
  Um, and for me there's a re one of the reasons I so welcome the NIHR work.
• 23:37
  It's because I think knowledge mobilization needs to be considered way upstream in the research process so that you are really thinking as you go through the research, how this may impact and through which channels and mechanisms this may impact users rather than a, an intellectual, scientific piece of study that you throw out there and said, catch it if you will.
• 24:01
  So it sort of starts with thinking about how you're going to mobilize in the early age from the moment that you start the research.
• 24:07
  Is that what you're saying? Absolutely.
• 24:09
  And I just wanted to come back to the bit that you were talking about when you were saying about research, um, and it's about what staff know and what patients know.
• 24:18
  And then you went on to talk about what the unheard the people that are unheard know, and I've always got this thing.
• 24:25
  Uh, I try not to use the word patient because I say the patient is the person who's presenting in the room.
• 24:31
  Actually, they're a person anyway, so when do they become a patient? But actually there's so many people out there that we miss and, and that knowledge.
• 24:39
  So it's really interesting to think about actually, how do we find out that knowledge from our communities and all of that information because otherwise people turn up at the NHS or are brought to the NHS on an ambulance or whatever it is.
• 24:52
  And then, then we just have to deal with it at the time and then, but never learn all of those things.
• 24:56
  I think it's a really important point that you've brought up there.
• 25:00
  And I like your, your d the addition of the D was definitely, definitely struck with me, you know, about that driving innovation.
• 25:06
  'cause that's what it's about, isn't it, sort of doing you in different things.
• 25:09
  So I think what I asked you earlier on was what is it? And the next bit was, um.
• 25:14
  I have to remember the order.
• 25:15
  Why do we need to do it? And then, and then how, how do we make that happen? So sort of some the why and the practical tips.
• 25:23
  So there's a paper bike break wage, which is, um, one of the s that's called I worked with on Corium K very much.
• 25:32
  Um, and he's talks about the 60, they talk about the 60, 30 10 challenge.
• 25:38
  So on average, um, 60% of healthcare is in line with evidence from research or consensus based guidelines.
• 25:50
  30% of care is some form of waste or a low value.
• 25:54
  And if you follow, uh, the mere gray, you'll hear him regularly on long term talking about his more on waste.
• 26:02
  He not doing all these procedures, not doing these tests that are, are wasteful of low value.
• 26:10
  Have all sorts of costs associated with, that's our 30 and then 10% of care is now.
• 26:16
  Those, uh, figures have been resistant to change for 30, 40 years.
• 26:23
  So we are simply not having the impact with new, uh, new evidence that we would want to have.
• 26:33
  There's research talking about the point involved in, um, in getting research into practice and sometimes people talk about 17 rules and sometimes people talk about 15 rules.
• 26:45
  So there's a paper by Ballas Island Forum that was out in 2000, and they talk about a 17 year time gap between the publication of high quality evidence from rigorous studies and its implementation into routine care.
• 27:03
  A paper much more recently, 2021 by calm, um, calm.
• 27:12
  And someone else is the average time from publication to routine uptake of, and they're looking at five evidence-based cancer control practices really well evidenced.
• 27:26
  And they say it takes 15 years to get to 50% of out 10.
• 27:32
  So those are some of the reasons as to why it matters, and then you need to put that in the context of, um, the acceleration of scientific research and, um, just the phenomenal rate of publication.
• 27:50
  So, um, based on papers, by a paper, by dent, this is a challenge to medical education, but it's obviously really a challenge to practice and to healthcare.
• 28:01
  Um, uh.
• 28:03
  They reckoned that by 2020 the rate at which medical knowledge was doubling was gonna be 73 days.
• 28:11
  Um, actually there was a presentation at an AI board in the States last year, which reckons it's now every 60 days.
• 28:21
  Now.
• 28:22
  We could talk about that.
• 28:23
  There's a huge pace.
• 28:25
  There is a huge pace of accelerated scientific investigation and discovery.
• 28:30
  We know that there might also be said that there's a proliferation publication from each research study, you know, by the incentives and the requirements within higher education to be seen, to publish, publish, publish.
• 28:44
  So once a time you might have had one or two papers of that.
• 28:47
  About a piece of research and now you're getting it.
• 28:49
  We're gonna do it.
• 28:50
  We've nearly done it.
• 28:51
  Some of it might be interesting, some of it might not.
• 28:54
  We haven't finished the work, oh look, now we have finished the work and now we can produce three or four papers.
• 28:59
  So there is a proliferation of publication for, for multiple reasons, but the notion that anybody can navigate this confidently is ludicrous.
• 29:09
  And they can't do that without people actively seeking to mobilize actionable knowledge without using digital.
• 29:19
  Without using ai, in my view and without using, um, knowledge services tailored to it and knowledge services and solutions that bring, uh, information to their, probably to their mobile, um, at three in the morning as well as three in the afternoon.
• 29:37
  So there's a huge imperative to start really getting clever around how we mobilize know.
• 29:45
  All the time not affect, not, not forgetting that for, um, the public, there's a whole chunk of people who are not online and if they are online, don't have the skills to use information safely.
• 29:59
  Um, and then not forgetting human factors and change.
• 30:02
  You've talked about, you know, the delay in getting knowledge, um, into practice.
• 30:07
  You've talked about the fact that actually only 60% of practice is based on knowledge, and yet we're accelerating the rate that we produce knowledge.
• 30:16
  It's covered through so much quicker than they ever done before.
• 30:19
  And then you've talked about actually how do we make sure that that knowledge is there so that people can actually use it, use it quickly, including, um, our public who may have, you know, if we are using digital solutions, which seems to be the way forwards, then actually they may, may be digitally literate, they may not.
• 30:38
  But they might also not have access to that digital tool as well.
• 30:41
  But you've really made it important as to why we need to make sure that that knowledge is out there and that we can actually access it really quickly and to think about, you know, how do we do this? So I think you've given quite a good bit there.
• 30:54
  So I wonder if you want to move on to the, how do we make it happen? What do we need to do and who needs to do it, I suppose? 'cause there's probably different actors within that, isn't there? Yeah, there are different actors.
• 31:05
  So at a national level, I believe there ought to be a knowledge mobilization strategy.
• 31:12
  Um, for the NHS, uh, we have players all the way across the system.
• 31:18
  One of the things that I used to do, and I know my successor is Chief Knowledge Officer for the NHF England continues to do, is to bring people together in a, in a round table sharing.
• 31:29
  Um.
• 31:30
  Sharing information.
• 31:31
  I don't mean by that, that there, there's a presentation.
• 31:33
  They will have to talk about it, although they are invited to talk about it.
• 31:36
  But actually bringing to the table, um, a whole series of different aspects.
• 31:41
  So you might have somebody, um, let me go back one.
• 31:45
  So, so what we bring to the table is national organizations where people are involved in generating information, knowledge, for example, research or chart and so on.
• 31:58
  People are actively involved in disseminating it, for example.
• 32:01
  Nice.
• 32:02
  And then people are actively involved.
• 32:04
  Uh, well, nice.
• 32:05
  And also places like the NHS, um, gateway that producers provides information for the public too.
• 32:13
  Um, and then people who want to use it Now, some of those people who want to use it specialists, they might be a.
• 32:19
  Extent to focus on health equity and they're wanting to bring information on particular aspects.
• 32:25
  Um, but also, you know, the library leads who are working at trust level, is it gateway to information or knowledge for people either for learning or for practice or for policy on site? Um, so, so a broad spectrum of people involved across the piece.
• 32:42
  So there's a piece about those people working in ways that are more coordinated.
• 32:47
  Uh, uh, one of the things I often talk about when, about knowledge and uh, and actually those players across the system, we haven't even talked about social care yet.
• 32:59
  Integrated care, um, is that people become very specialized and they do amazing work, um, around standards or around computable knowledge or around.
• 33:13
  Information on health literacy, but the golf course has got 18 holes on it.
• 33:17
  And they might be working in three and they may think they've cracked it, whatever it is.
• 33:23
  But actually there's this huge, much bigger golf course.
• 33:27
  And one of the things that Round Table is designed to do is let people meet from all across the green, uh, and then build relationships, of course, sort of to wind, let me work with you.
• 33:38
  So a very informal, soft approach to getting people to share, um, and exchange knowledge.
• 33:46
  And what I'm really underpinning there is that there's a huge piece about relationships in effective knowledge mobilization and helping people forge effective and strong hardships.
• 33:56
  So there's that piece nationally that there's also procedural stuff.
• 34:01
  I mean, how do you get the right information, uh, flowing through? So if you look at.
• 34:08
  One of the things I ultimately, I'm member of steering group is something called the Mobile and Computable Biomedical Knowledge Steering Group in the UK has allied to a bigger, uh, international unit that started in the States now.
• 34:23
  So, so we've dug into who are very active in oral steel, we go into the kind of work we've nice saying, well, if you take a, a nice recommendation, it's produced as a PDF with 27 recommendation.
• 34:39
  Say, um, how do you take that and feed those recommendations, for example, into an electronic patient record? And when you study it, you find that perhaps, uh, and there'll be people who've got more up to date data on this.
• 34:55
  I haven't talked to this people involved for about 18 months, but you know, perhaps 30, 35% of that stuff is based on hard evidence from research.
• 35:06
  Another chunk is based on a consensus.
• 35:11
  You know, what are the, what are the experts in this field finding experience and understand and consider as best practice? Um, uh, so they're surprisingly hard to computerize into knowledge solutions.
• 35:25
  And there's all sorts of knowledge solutions, you know, clinical division, support systems, um, you know, aspects of electronic patient records, aspects of gp, computer systems of choice, for example.
• 35:38
  So to flow knowledge to where people, um, are working, you've really gotta think about what technology can reach them.
• 35:50
  So one of the things that I was very proud to do actually, was to introduce a national clinical.
• 35:56
  You will know that in England, everyone, every staff for alone world chest access critical BNJS practice shows very deliberately because it.
• 36:05
  Um, very suitable for primary care as well as a range of other healthcare professionals as well as, uh, medics in their first, um, properly gained people in their first 5, 6, 7 years of practice.
• 36:20
  Um, so a universal tool, so equity of access to information is an issue for healthcare professionals as well.
• 36:28
  Some trusts are much better off than other trusts.
• 36:31
  Um, some trusts plays more emphasis on knowledge commissions than other trusts.
• 36:35
  So one of the things we are doing nationally is to at least establish a core equitable service offer to every study while they practice advising policy in the NH s.
• 36:51
  So, uh, clinical physician support is one tool.
• 36:55
  You sort of talked about it on that sort of very national level and talking about, you know, the fact that, you know, I, I've got a little picture of a couple of flags to show the golf course.
• 37:04
  You know, people are only playing on a part of it and forgetting the other holes.
• 37:06
  There's so much else that's out there.
• 37:08
  Um, and you've talked about some of the things that, that are happening and could happen or perhaps are happening in one area or not another, and perhaps not happening in another area.
• 37:18
  People are doing different things and you've talked about sort of that, that gateway nice, um, gateway being information for people out there and nice being for obviously for the clinicians and those clinical support tools.
• 37:30
  But as we know that a lot of the presentations and the people we see, not everything is completely clinical.
• 37:35
  So how that's used and how that works, you know, that varies when people are working.
• 37:41
  But I wonder if there's something as well, sort of thinking about, for instance, myself on the knowledge mobilization fellowship or maybe who's somebody who's got some knowledge Sure.
• 37:49
  That they're thinking actually this is really important and this could change the way.
• 37:54
  Our service works.
• 37:55
  How do we, how do we do that on a day-to-day basis? And I think the bit that I'll go back to, as you spoke a little bit about earlier on, about that sort of, um, improvement science, but also go back to that bit about how there's that research of what's happened.
• 38:11
  But there's also all the information when we are mobilizing the knowledge about what the staff know and what the people know, whether they be what we call patients or people in our community.
• 38:21
  Because, you know, I know that I've sat in front of people when I, when I worked in primary care myself, and I'd say, this is the evidence and this is what you need to do.
• 38:29
  You need to, you know, the diabetes c you need to eat like this, not do this and, and do plenty of exercise.
• 38:34
  But actually, if they left the room and actually done that, that varied.
• 38:39
  That person and perhaps on the way that I presented it to them.
• 38:43
  So actually implementing knowledge or mobilizing knowledge, getting that knowledge working is such a complex thing.
• 38:50
  So I've sort of brought it right down to the bare bones there.
• 38:53
  So perhaps we don't need to visit it at that level, but for somebody who's thinking, well, there's this knowledge, how do I use it? And how do I make it work for my team, for my community? What do we do? So I'm, I'm really interested in, um, you know, what are those dimensions of, of knowledge mobilization? And I think for fellows coming through, taking this work forward, or for anyone with a passion to do this work, anyone who's.
• 39:20
  Redesigning a clinical pathway, current cell calls, a lot of what they're doing, fact taking knowledge and trying to get that through into the pathways.
• 39:27
  So I think there are a number of dimensions.
• 39:30
  So if you, if you read that knowledge mobilization, knowledge management literature, you'll, you'll find people talking about, um, creating knowledge, curating it, connecting, collaborating, collecting, you know, five Cs that Stan Garfield talks about.
• 39:46
  What I've tried to do is put that into, I break that up.
• 39:50
  Um, if you look at the learning health cycle, which is another theoretical model, you are talking about taking data into knowledge, knowledge into practice.
• 39:59
  Practice reduces the data that goes around the cycle again.
• 40:03
  And yet research, knowledge and kind of knowledge we're talking about that of staff experience are not so well talked about.
• 40:12
  So another way to think about this, which partly follows the research process, but partly not, yeah.
• 40:17
  Is to think about, um, knowledge mobilization going through sort of six stages.
• 40:24
  So there's your discovery piece.
• 40:25
  Now that, that might be a full or research project or it might be a question you have.
• 40:30
  So for example, in primary care, um, you may actually, this is changing 'cause this condition's becoming more, um, more frequently diagnosed.
• 40:42
  But for example, you might come into practice, uh, really good therapeutics.
• 40:48
  Your diagnostics will be not a within five years that will be reversed.
• 40:54
  We diagnose patients, you know, uh, very fluently.
• 40:59
  Um, but already the medicines and therapeutics wouldn't change.
• 41:03
  So you might get somebody come in with Parkinson and you may not have seen anyone with new presenting to you.
• 41:11
  Three, four years, um, or increasing, whichever it is, so that that kind of timeline may not be the same.
• 41:21
  But when I work directly in practice, people would say it was about four years before they saw the next.
• 41:25
  So they clearly have a knowledge need at that point.
• 41:29
  They clearly need to look it up.
• 41:30
  That may not be instant.
• 41:31
  It's not like an instant crisis at three in the morning, which is in the acute setting, but most people are seen in primary care and, and that's where most interactions happens.
• 41:42
  It's really important we think about that aspect, uh, of sharing knowledge.
• 41:47
  So, so new questions come up all the time.
• 41:50
  And the other thing that comes up, which is a very favorite phrase of mine when we talk about this knowledge, uh, discovery stage is, you know, constructive dissatisfaction.
• 41:59
  I'm sure we could be doing this better, which obviously can go on to drive quality improvement, but, um.
• 42:08
  But at the very least requires an answer.
• 42:11
  Um, some of the kind of knowledge management tools, knowledge mobilization tools you might use at the knowledge discovery stage is looking for impact stories and also lessons learned.
• 42:25
  Now we have become, I think, um, unconsciously perhaps weighted to the idea of lessons around events as either being very routine or very cathartic.
• 42:37
  But actually what they're really designed to do is elicit learning.
• 42:40
  You can take health work, uh, and have that learning express.
• 42:44
  So when I come on in a little bit to talk about tools and techniques or knowledge will pick up on that since own piece and how you can create it.
• 42:53
  So you've got the knowledge discovery stage that may lead to a knowledge generation piece.
• 42:57
  The kind of research that you are doing now, Ruth.
• 43:00
  I want to know more about this, and then I want to help get it into practice.
• 43:04
  So that's your actual research piece.
• 43:06
  And at that point you are creating content.
• 43:08
  You might also be creating tools and methods, um, and extrapolating new knowledge from data.
• 43:15
  For example, you might be co-producing content with healthcare professionals or within communities.
• 43:23
  So that's at your generation stage.
• 43:26
  Um, and you may well be leveraging technology there.
• 43:31
  And, and just another point, because it's another issue I have around our knowledge process.
• 43:36
  When you look up research being published now the essence of research is it should be general.
• 43:41
  You know, it should be repeatable, reproducible.
• 43:44
  Now.
• 43:44
  In fact, if you've got a research project where you go away and create a particular tool.
• 43:50
  Particular analytical tool or uh, data analytical tool, and you don't make that available too, then nobody can repeat your research.
• 43:58
  Just notice that, because I think increasingly people are producing an app or they're creating an algorithm, and if they don't share that as well, that research isn't, isn't reproducible.
• 44:08
  Mind you, the standard there is not as high quality as others.
• 44:12
  So, you know, again, I'm, I've tried, I, I'm encouraging people as they listen to think about how this relates to them and the work they're doing.
• 44:21
  Uh, what can they do to strengthen knowledge mobilization? And that's at the knowledge generation stage.
• 44:28
  The knowledge management stage is often about working with other people, and it's about co-defined curating knowledge, organizing it, um, uh, how many data websites are there, you know, if you're gonna create all your knowledge, it's lovely to go and do a project.
• 44:48
  Up your results and said, this is a lovely website of who's gonna maintain it when you finish your product.
• 44:54
  You know, what's the longevity of this, either in terms of its content, or even if it's a standalone, you know, valuable in its own right.
• 45:03
  Who's going to look after it? Uh, and will it still be there in years to come? And is that what you want? Or is this just a temporary piece? In which case, take the damn thing down.
• 45:14
  Don't leave it lurking on the internet without ownership, uh, and being looked after.
• 45:20
  So knowledge management is an important piece.
• 45:24
  Actually, many of you doing research at this time will be one thing.
• 45:28
  Your knowledge to be integrated into business as usual, into our, uh, standard operating procedures in whichever health setting or ritual, community setting in which you're working.
• 45:41
  So making sure that you work with others so that it.
• 45:45
  Um, made available on internet.
• 45:47
  Very important for, that's just violence instance.
• 45:50
  How do you might do waiting out alerting people needs to really go into al patient record and the negotiation around that is that make a piece of word, you know, it's not good enough to say I need it to go in there working or with, you know, the stakeholders that are involved in that is a very complex operation.
• 46:10
  So it's very easy for knowledge, um, to be really excellent work to get so far and not implemented.
• 46:18
  And I guess you saw that with the research on, uh, that I mentioned earlier, where you've got really robust data and evidence supporting various forms of cancer screening that maybe uptakes 50% InterSystems.
• 46:32
  So then we come into some of sort of softer connecting, collaborating relationship pieces, which again, are really crucial in, uh, as you take forward.
• 46:42
  Knowledge mobilization at every aspect.
• 46:44
  So there's really genuinely knowledge exchange, you know, that you, you share that people are, you know, that two-way process that, um, I mentioned earlier in some of the definitions.
• 46:57
  Um, and, and I think learning communities either around, you know, often around particular subjects, particular clinical areas have have proven a very valuable way.
• 47:09
  So really building a strong community of practice, which will genuinely exchange trust each other, um, share ideas and critique each other's ideas.
• 47:20
  Being a critical friend is a very important part of refining and expanding our knowledge, uh, and making sure that it can be made relevant into different settings and taken into different settings.
• 47:33
  And that's the knowledge transfer piece, which is.
• 47:36
  Which is the next, um, dimension that I tend to look at now.
• 47:40
  That's the piece that often research has always done.
• 47:43
  You know, how will you disseminate your findings? How will you path them on? Um, in my view, uh, knowledge brokerage, a role which might be taken by a whole range of people, but it's also taken by knowledge managers within the NHS is really, is a really crucial way of knowledge transfer.
• 48:05
  And now all those things I spoke about earlier, those automated, uh, clinical FIC support systems are a fabulous way.
• 48:13
  But on the human aspects of that, the networks, the learning communities, um, and fundamental to all of that is, is to shift away from it wasn't made here syndrome and to really be able to learn from others.
• 48:31
  Um, just broadly in life.
• 48:33
  I, I always say if you can learn from your own mistakes, that's really magnificent.
• 48:38
  If you can learn from somebody else's mistakes, you've made it.
• 48:42
  And, and that is such an important part of knowledge.
• 48:47
  That means that's why the learning community is so important.
• 48:50
  You have to be able to be honest enough about what didn't work.
• 48:54
  You know, we write up our research saying, I went to A to B.
• 48:57
  Well, we didn't, we went to A and then we went to B and then we went to Z and then we went back to B.
• 49:03
  'cause we thought that might still be right if we changed another version of it.
• 49:07
  And then, and eventually we're at about N before we get anywhere near writing something.
• 49:12
  But we very rarely write up, um, that exploration of what didn't work and why we often don't pause to really understand.
• 49:24
  Which fits worked and which fits didn't because understanding doesn't work is actually what makes you a skilled operator and skilled knowledge mobilizer, in my view.
• 49:33
  And that's the bit then that comes to the, the final stage of this for me, which is not as translation, which is really seeing that actionable knowledge coming out of research and experience, putting it in context and, um, ensuring that implementation allows it to be sustained.
• 49:58
  You know, that it be, that it moves into workflow actually.
• 50:01
  I mean, interestingly, I think, um, there's a, a huge alignment between knowledge management, knowledge organization, quality improvement, and if you look at the quality improvement cycles of the way that they work, or if you look at, um.
• 50:17
  The NHS change model, which is not so much talked about now with its dimensions.
• 50:22
  One of the pieces that I think is missing is actually workflow engineering.
• 50:27
  Um, and I think that's becoming, uh, a missing piece as we think about redesign of pathways, which is becoming so, so crucial.
• 50:37
  Before we move on, and I don't want to distract you with what you were gonna say next, uh, 'cause I know I've sort of come in there, but I think workflow engineering is something that people often, um, it is missed, but it's because people don't understand what that is or they're not quite sure the context and how to use it, how to actually put it into practice, if you like.
• 50:56
  So I wonder if you'd just describe that a little bit before we move on to what you were going to say and I hope you haven't lost that one.
• 51:02
  Of using quality improvement techniques and teaching it, we would do our process.
• 51:09
  Mapping and we did what things were like, now we would be able to, to draw up how do we, what would it be like in its future state if it was ideal.
• 51:18
  Um, and we would be able to see the handover points, which is where most of the Cru couples.
• 51:23
  But what I think we weren't good at was really mapping process and what does that actually mean for how the data of a patient works, works through the tracking and the coordinating of the task of the actual work, uh, and where at what stage things need to happen, the sequencing of the work in order that it all lands in the right place at the right time, gets a patient into theater at the right time.
• 51:56
  And I think that analysis, um, was a bit more than process mapping of actually following the actual work.
• 52:04
  All the way through.
• 52:05
  And it comes from an engineering mindset.
• 52:07
  Um, you see engineers bringing in, but it's about that sort of task piece, uh, and the documentation that goes at each stage, for example.
• 52:18
  So, um, I'm not a clinician as, as you know, but if I'm thinking back to, um, when I worked in a primary care trust, I'll, I'll tell you the story from my experience in primary care, in a primary care trust wanted to, um, improve, uh, and streamline as far as we could our commissioning process.
• 52:39
  So we were able to commission new services as quickly, effectively, and costly, effectively to the greatest benefit as possible.
• 52:49
  So we wanted to map the process.
• 52:51
  So first of all, we brought everybody in the room and very kindly said, we'd like to map the process of commission.
• 52:58
  Uh, and we, these very experienced, very excellent people, said to me, I'm very sweet.
• 53:03
  So if job wrong, how to do so that's marvelous.
• 53:09
  'cause we've set aside a morning on this room.
• 53:11
  But if you only need 20 minutes, that's great.
• 53:13
  You've got time back.
• 53:15
  So, uh, what we've done is, is, is split this process into these five stages.
• 53:21
  That's difficult because there was a lot of publications around, around the time, around describing those five stages and we could use those.
• 53:29
  And I said, so I break into groups if you going to be a stage where you think you did the most work, and if you just like to map that up and then off you go, there's coffee if you'd like.
• 53:39
  So three and a half hours later they would still each arguing on their great stretch of great hey, uh, and we started to unp huge areas where people thought somebody else was doing the work, where somebody else thought it was somebody else's job to do the work.
• 53:57
  Where the work hadn't even been understood or perceived at all.
• 54:01
  Um, and you started to see why commissioning proposals were being sent back, uh, and not a division not made.
• 54:09
  So that was the be that's the process mapping court.
• 54:14
  As we went forward, we produced an online commissioning handbook and at every stage you could drop down and say, this is the information you'll need here.
• 54:24
  This is the knowledge you need to hear.
• 54:26
  These are the stakeholders you'll need to con consider.
• 54:29
  These are the documents you will need to produce that can then go on to the next stage.
• 54:34
  So that involved the people in, in that work, doing a really detailed understanding of workflow and then producing a system that meant that everybody could take a whole view of it, but they also knew what they needed to expect before they could do their bit and what they needed to deliver before it could go on.
• 54:57
  And everybody had an overview.
• 54:59
  Now that was the.
• 55:00
  As I, as I understand it, and in my interpretation of it, that's the detailed workflow.
• 55:06
  Uh, and if you don't have that, um, you don't have a streamlined process of your huge state that you desire.
• 55:16
  Uh, and equally, um, if you try to computerize a process, you will fail because you'll take the gaps with you into the computerized system.
• 55:29
  It's, it's really helpful and I'm just gonna bring it back to, um, I can remember going to a study day one time, but it, I think it's quite obvious, you know, working.
• 55:37
  Um, well I've worked in various places, but particularly when I was in primary care, you know, there was this gap between myself and community and a gap between myself and the hospital trust and, and various other things.
• 55:47
  And it was the person that came to see me that would fall into those gaps, you know, whether it was getting them into hospital, making sure they came home safely.
• 55:55
  And actually I think taking it into a sort of more clinical thing.
• 55:58
  It isn't always just the process of what we are doing, but it's making sure actually how do we make sure we iron out those gaps.
• 56:05
  They're not quite the same thing, but it just made me smile.
• 56:08
  I saw this picture and I remember somebody drawing, people falling off, you know, as they went from the ambulance service back home again and home didn't have everything and the district nurse didn't know they were coming.
• 56:18
  And so this, this process work mapping and actually there's probably so much knowledge at every point that needs to be known.
• 56:25
  And I hadn't thought about knowledge mobilization of that.
• 56:27
  Well, that's right.
• 56:28
  And that, I mean, that's just, it's a commissioning example, but you can apply it equally to.
• 56:33
  Musculoskeletal pathway, although becomes hugely complex there because you've got so many roots in and so many roots out.
• 56:39
  So I've tried to talk about what individuals might do and also what the system might do.
• 56:45
  You can see that collaboration becomes really crucial to almost any of this.
• 56:49
  Um, but there are some roles you can think about, um, if you're looking at your team or your organization or your project.
• 56:59
  Um, even, um, there was the work done by A HRQ in the states, which talk about the roles to mobilize knowledge.
• 57:10
  So they think about, um, evidence generators, which reflect some of the, the things that I've been talking about.
• 57:18
  Now.
• 57:18
  They might be data analysts, data scientists, researchers, um, using a whole series of data systems.
• 57:27
  Then they talk about the curators.
• 57:30
  Now there's an huge issue here about searching, uh, and summarizing evidence.
• 57:36
  You know, not just putting it in a box, but how are you gonna find it? And there's a whole series of, um, technical knowledge management skills, uh, behind making stuff retrievable, findable, um, but also around summarizing.
• 57:51
  And you can see that currently there's huge amount of discussion about where AI is a hub tool generating AI are helpful tool to summarize or even to search, talk about separately.
• 58:03
  But you definitely, expert summarizing is, is very important if you're gonna help a multidisciplinary team to lead change, um, which brings you to the evidence adopters.
• 58:18
  Um, so, and that's really about a systematic approach.
• 58:24
  So.
• 58:26
  That may start with, um, that might start with people, uh, reviving or wanting to customize clinical guidelines into their setting and make them available, um, within their trust or their integrated care system.
• 58:45
  It might, um, it might come from the learning process.
• 58:52
  So for example, um, Tom Foley, who's a, a, a leading figure in, in understanding and helping a frame and developing a framework of learning health systems.
• 59:06
  Um, I have the pleasure of joining his, um, address and psychiatric and psychology team a while ago.
• 59:13
  And they have, they have learning sessions, learning community sessions, I think every month or so where they're really digging into the evidence and also sharing their own staff.
• 59:25
  Knowledge and experience.
• 59:27
  So well genuine learning approach that evidence adoption often requires the piece about looking at variation in practice.
• 59:37
  So one tool you can use to support evidence adoption is, is indeed to use the data on activity.
• 59:44
  Will say, well we've got, um, and you can use that in multiple ways, you know, we'll, so you might look at at general practices in your patch or you might look at, um, other trusts in coastal areas or other trust in urban areas that you know, what does the data tell you so that you're really questioning, you'll perform the what might be better and then seeking to learn from them, well, how have you done that bit? You know? So that sort of evidence adoption.
• 1:00:14
  And then the evidence adopters and the evidence disseminators, which I've spoken about before.
• 1:00:19
  You know, where really for me, that's.
• 1:00:22
  Clinical decision support systems are absolutely crucial, where you are taking high quality evidence that's been, um, really pulled together, whether that's by nice or by sign in Scotland and, you know, bringing that to bear, uh, into a tool that you could look up and draw down on.
• 1:00:46
  So, um, so as I say, they, they talk about evidence, generators, evidence curators, evidence adopters, evidence disseminators, evidence managers.
• 1:00:55
  So as we've been talking, I pulled out a number of ways in which you could look up your own work as an individual and see where is this happen in, where those who are senior leaders could look at their organization or their directorate or their practice and say, how are we doing it? Who do we think? Is leading organization, is that mobilizing evidence? There's something about the resources they've got available, there's something about the leadership of that, these kinds of roles being recognized as important.
• 1:01:29
  And then something about the skills, uh, that everyone needs to have to be able to operate.
• 1:01:35
  So one of the things that the NHS National Knowledge and Library Services team has is a, is a framework for assessing how effective you are as an organization to, to mobilize knowledge.
• 1:01:47
  And then at the individual end, one of the things they have is, um, uh, that we develop as a, a knowledge mobilization framework, which is a set of, I think a dozen 15, um, really facilitation tools by which you can help people articulate and share and record knowledge.
• 1:02:08
  Um, and that the, the design there is the idea that you would.
• 1:02:13
  What knowledge do you need before you start something? What do you need to learn before you start? What's useful while you're going through the work? And then what do you need to do at the end? So, um, when we think about that challenge of taking best practice from one part of the country to another, you might be looking at, say, a peer assist.
• 1:02:33
  You might get people from the team that's done it with the team that hasn't done it together.
• 1:02:39
  Uh, and what can you learn? Uh, and the tools are really simple.
• 1:02:43
  The answer is genuinely on the postcard.
• 1:02:45
  Each piece has four stages.
• 1:02:47
  Uh, the postcard will tell you, um, you know, you need, you can do this in 15 minutes, or this one needs half a day.
• 1:02:55
  It's really, we've really made that easy from that team.
• 1:02:59
  Um, I'll put the link over to you after, so perhaps you won.
• 1:03:02
  Share it.
• 1:03:03
  Um, so those tools are, are really valuable.
• 1:03:07
  And then so that's a clear assist at the beginning.
• 1:03:10
  After action reviews, we talk about as if it, we do them at the end.
• 1:03:13
  Actually.
• 1:03:13
  You're very often doing them in a, if you're doing a large scale phased program, you do a series of after action reviews, recognizing that this piece of work was focused on delivering that intervention, which we believed would help.
• 1:03:27
  It's often what you're doing is just a hypothesis.
• 1:03:29
  It's just you're believing it might help.
• 1:03:32
  Um, and, you know, testing that and pulling out lessons from it before you go into the next stage.
• 1:03:38
  And then at the very end you might do a retrospect on whole piece and they won't work in particularly if you are wanting to work with, actually it's true of everything.
• 1:03:47
  It's true of anything, but I fear it is less used when we are looking at, um, how we can be more effective in working with our underserved communities.
• 1:04:01
  Um, are we really, are we really checking what we did and what digital didn't work and hearing from.
• 1:04:09
  Community, um, their perspective, which could help us get it right.
• 1:04:14
  That's time.
• 1:04:15
  Thank you.
• 1:04:16
  And yes, definitely we can share the resources.
• 1:04:18
  I think there's a number of things where I've written, you know, made little notes of different articles and resources that you've mentioned would be really useful to share.
• 1:04:26
  Um, and there's so much that, that you've given us and as you say, from that sort of various levels about what we need to do and, and how this can, you know, make a difference, needs to make a difference.
• 1:04:38
  So thank you.
• 1:04:39
  Is, before you go, because I'm really conscious of time is how, um, is there anything particularly that you want to say? Is there a key message or is there a challenge or a call to action that you have? Or maybe all three.
• 1:04:51
  There's one practicality I mention and then perhaps I'll get you to repeat that request.
• 1:04:56
  Um, the practicality is not to assume that everything's been done in the last five years.
• 1:05:02
  Um, and particularly now.
• 1:05:06
  We've got the COVID effect on research and so on.
• 1:05:10
  But more generally, other generations of healthcare professionals have been around this stuff before.
• 1:05:16
  And, um, actually, I, I do believe that one of the challenges of organization is that some aspects of this work, people have to do themselves.
• 1:05:29
  Um, years ago I remember trying to do some work on clinical pathways, uh, in a, in a group of general practices.
• 1:05:39
  And I remember speaking to somebody at the RCN that it was, and he said to me, but you've gotta realize that it's not the output that matters, it's the process.
• 1:05:48
  Uh, and so what he was saying to me is, you can't import this.
• 1:05:51
  So there's something about distinguishing between what actionable knowledge we need to get patients who have had a stroke.
• 1:06:00
  To this piece of therapy within one hour or three hour, four hours, whatever it is.
• 1:06:04
  Okay? That's actionable knowledge that we need to embed right into the half of our clinical practice.
• 1:06:10
  And then there is stuff around how do we get people to engage with theology and improve processes and the relational parts and the human aspect of become very important in that work.
• 1:06:25
  So it's never a simple piece, um, around and straight lift and shift, but you definitely want your systems to make it really easy for people to be asked the right thing.
• 1:06:37
  It's very easy to think you're an expert in your field and uh, and lose sight of the other expert, other experts working around you.
• 1:06:48
  You know, health is, health is a knowledge.
• 1:06:52
  Intensive industry and it's a team game.
• 1:06:56
  And those two things need to come together so that you draw on the knowledge base and indeed the language and vocabulary that people use to talk about knowledge and evidence and what they know in each of those things.
• 1:07:08
  So I think that's a lifelong piece.
• 1:07:11
  You know, be curious, look further back, but, but think about your whole thing, uh, and what they know.
• 1:07:18
  And that team great.
• 1:07:20
  In my ideal, it's the patient, the public.
• 1:07:22
  And think about how you can make it really easy for someone to understand what your child, they and how to embed it.
• 1:07:31
  Question to yourself is always, I believe this needs to be done.
• 1:07:35
  My research tells me that we need to change practice to do this.
• 1:07:40
  How do I embed it into practice? And it is likely to be a mix of sort of human behavior or nudge techniques, um, through Taylor.
• 1:07:50
  Put solutions that say and do this bit next what, what the data for this bit at the spectrum.
• 1:07:59
  Thank you.
• 1:08:00
  So, and there's a huge number of skills behind all of that that we haven't even touched on.
• 1:08:05
  Um, you've mentioned leadership a few times, but there's so much there.
• 1:08:08
  But I think what you've given people is a real sort of understanding, um, and you've taken, and some ideas and some practical tips.
• 1:08:15
  And as I say, we've put the resources in there and you've taken us all the way from that.
• 1:08:19
  You know, I'm gonna go back to that term that you said, the penalty of ignorance and what that means and actually why it's so important.
• 1:08:25
  That'll we do these things and embed that and really thinking about.
• 1:08:29
  Linking in with our teams, but that wider community.
• 1:08:32
  You know, since I've left the NHS as a a direct NHS employee, I always talk about beyond the NHS because there's so many other people out there who are assets to us and are important to us.
• 1:08:44
  So thank you so much, Sue, for joining us and joining me today.
• 1:08:47
  I've really enjoyed it.
• 1:08:48
  It's been an amazing conversation.
• 1:08:50
  Um, I've learned so much, which I will be using all of these things as well in my own project.
• 1:08:55
  So thank you very much.
• 1:08:56
  You're very welcome.
• 1:08:58
  I hope you found this episode interesting and inspiring.
• 1:09:02
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• 1:09:07
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• 1:09:15
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• 1:09:28
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• 1:09:29
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• 1:09:33
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