How can knowledge be shared better across the NHS?
Building on experience from the COVID-19 response, IfM PhD student Carl-Magnus von Behr explains how new research is looking at knowledge-sharing across NHS trusts.
At the beginning of the COVID-19 pandemic in March 2020, we were invited by the Cambridge University Hospitals NHS Foundation Trust to look at their infrastructure for providing oxygen to patients and how we could help to improve it. We worked closely with their estates department and external advisors, learning about how they understood the system, and identifying if there were things that could be done better.
We soon discovered that knowledge-sharing across NHS trusts was not always effective and, with more than 200 trusts across England all responding to COVID-19, that there was an opportunity to make improvements.
Estates and facilities management departments are unique because they don’t feel like they’re normal estates people in a normal estates organisation. For example, you wouldn’t have oxygen pipelines in a normal building. Most hospital trusts have a unique building context and infrastructure context, so, even with shared challenges, they often feel like they don’t have much knowledge or information they could share with others.
And with the NHS being so large and geographically dispersed it is even more complicated. It’s a complex adaptive system — you have a lot of parts that are working towards one goal but they are all responsible for their own part, and all adapt themselves individually rather than having one strategy that combines them all.
In the NHS, the barriers to knowledge sharing are very broad and there are a lot of them. And many of them relate to the fact that the NHS keeps changing all the time. They are in the process of constant change with reorganisations and new five-year plans which overthrows a lot of infrastructure that enables knowledge-sharing.
What I’m looking at in detail at the moment is the role of organisational trust in knowledge-sharing — not only the interpersonal trust between colleagues based on previous interactions, but also employees’ trust in organisational structures and processes. This aspect is referred to as impersonal or institutional trust and is vastly influenced by how much the organisation changes.
There is a lot of expertise in healthcare in the IfM but less expertise on the estates side. My advisor, Professor John Clarkson (Engineering Design Centre), brings in the expertise in the healthcare systems engineering and looks at all those complex layers of the NHS. We have combined that with the open innovation knowledge that we have here at the IfM to look at this more closely.
Estates managers are very aware of the deficiencies in knowledge-sharing but they don’t have time to participate in any research because they have other urgent issues, such as a roof coming down, for example. And the same applies to the sustainability challenges they are facing. If they are repairing a roof, how are they are meant to focus on net-zero carbon targets?
This was a big issue when we looked at the oxygen infrastructure in Addenbrooke’s Hospital. We had various ideas, which couldn’t be implemented because the system runs 24/7. You can’t just stop the oxygen pipeline to, for example, integrate an invasive flow meter so that you have a better visibility of the oxygen flow in the building. The need for business continuity, or operational continuity, slows everything down. So you need to explore other options that you wouldn’t have to in other sectors. In the end, we went with a non-invasive flowmeter, which is more expensive and, yes, just a bit more complex, but it worked.
I’m now looking at case studies on hospitals in every different region across England to investigate the flow of information about the oxygen systems during COVID-19. We want to understand what pieces of information got to which parts of the country and to which levels of the NHS, and then how they ripple down to the hospital so that we can see what barriers actually stop urgent knowledge reaching the people that it needs to reach.
We are trying to raise awareness that you need to build trust among employees and trust in the organisation. And then you can work on the knowledge-sharing. We are trying to enhance the understanding of that complexity, and hopefully helping to improve the exchange of knowledge.