Exploring the Relationship between HTA and Knowledge Management.
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Exploring the Relationship between HTA and Knowledge Management
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Exploring the Relationship between HTA and Knowledge Management.
- 1. Exploring the Relationship between HTA and Knowledge Management Two Sides of the Same Coin Rosmin Esmail MSc, CHE Director, Clinical Epidemiology Health Technology Assessment & Innovation HTAi Conference, June 25, 2012 Bilbao, Spain
- 2. Background • Formation of Alberta Health Services (2009) • 117 000 employees • 7400 physicians • 3.7 million • Formation of HTAI (2009) 2
- 3. HTAI TEAM HTAI TEAM 3
- 4. HTA & Innovation – What We Do HTA & Innovation Team Support an evidence-informed decision model for managing health technologies Identify, prioritize, assess health technology (devices and processes) expected to significantly impact patient safety, clinical/cost effectiveness, health outcomes, clinical practice, human resources, and/or policy Investigate innovative alternatives for current health technology to improve safety, quality, and/or outcomes Promote effective and appropriate uptake of technologies Validate effectiveness of promising health technologies with access through evidence development initiatives (field evaluations, trials and pilot projects) 4
- 5. Key Message To explore and advance the relationship between knowledge management and HTA. 5
- 6. Definition: Knowledge Management A set of principles, tools and practices that enable people to create knowledge, and to share, translate and apply what they know to create value and improve effectiveness. World Health Organization, 2009 6
- 7. Definition: Knowledge Translation An ongoing, iterative and interactive process that focuses on actively translating research evidence into a useable form that will enhance its implementation into practice. (Scott et al, 2007) 7
- 8. Two sides of the same coin… HTA and KM are inter-related HTA is an ally, a knowledge-broker Both are needed for evidence-informed decision making 8
- 9. Alberta Health Services UNIT Health Technology Assessment and Innovation ED e ( A nc ) nt nt ide ai s t pr en me on al me Ev Ap sm ati ss lop ith FUNCTION & ses ov se ve w as Inn De ess As DRAFT Re c Ac PLAN Knowledge Management & Translation AHS PROGRAM health promotion disease prevention public screening diagnosis intervention CDM continuing palliative health rehabilitation care OR SERVICE
- 10. Strategy #1 Connect people to evidence- informed decision making through dissemination Technology briefing notes Operational financial impact analysis Reviews 10
- 11. Strategy #2 Provide skills to use evidence through the application of the knowledge cycle 11
- 12. Strategy #3 Support sharing of HTA knowledge by engaging stakeholders through knowledge transfer activities 12
- 14. Communities of Practice HTAI A process of learning when a group of people with a common interest or problem come together regularly to share ideas, find solutions and build innovation. 14
- 15. Strategy #4 Facilitate, review and implement , evaluate best and innovative practices in HTA 15
- 16. Challenges Ahead… Building a knowledge sharing culture Getting buy in Resistance to change Human & Financial Resources 16
- 17. KM/HTA-heads or tails?… 17
- 18. “A little knowledge that acts is worth infinitely more than much knowledge that is idle.” …Khalil Gibran
Notas del editor
- There once was department called HTAI. We now have 7 team members and it is now 2 and a bit years old (November 2009). It is responsible for: supporting an evidence-informed decision model for managing health technologies that helps to: Build capacity to identify, prioritize, assess health technology Investigate innovative alternatives for current health technology Promote effective and appropriate uptake of technologies Validate effectiveness of promising health technologies with access through evidence development initiatives (field evaluations, trials and pilot projects) Coordinate activities with the Alberta Advisory Committee on Health Technologies
- Innovation-importance to use sound evidence both to be a gatekeeper to ineffective technologies from spreading inappropriately as it is important to stimulate introducing technologies (innovation).
- That process involves managing knowledge. But knowledge alone doesn’t change behaviour, we need knowledge translation as well. Knowledge management is understood to be an umbrella term encompassing the many unique but related facets of knowledge – exchange, transfer and uptake among them. While there is no universally accepted definition of KM, most are extremely similar. There are several definitions of KM, Knowledge Translations, K exchange, knowledge transfer, K mobilization. It is important to have a common understanding. This is the one that AHS and HTAI has adopted. It resonated the most with clinicians. We are going to apply this definition to HTAI.
- As described in the CIHR Act, knowledge translation is a broad concept. It encompasses all steps between the creation of new knowledge and its application to yield beneficial outcomes for society. The concept includes knowledge dissemination, technology transfer, consideration of the ethical context, knowledge management, knowledge utilization, the two-way exchange between researchers and those who apply knowledge, implementation research, technology assessment, synthesis of results within a global context, and the development of consensus guidelines. The overriding principle is that interactions between researchers and stakeholders may vary in intensity, complexity, and level of engagement depending on the nature of the research results and on the needs of the particular stakeholder. KM is about managing knowledge, KT is about putting it into action or closing the ‘know do’ gap from research to practice. a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the healthcare system.
- Definition of HTA The systematic evaluation of properties, effects, and/or impacts of health care technology, i.e., safety, effectiveness, feasibility, cost, cost-effectiveness, and potential social, legal and ethical impact of a technology. It may address the direct, intended consequences of technologies as well as indirect, unintended consequences. (International Network of Agencies for Health Technology Assessment). Chris Henshall (2005) at the WHO meeting provided the only direct ref to this relationship. He stated that bridging the “know-do” gap is much to do with HTA as KM. Close collaboration on WHO’s work on HTA and KM was emphasized in bridging this gap. They both address the fundamental need in healthcare today which is to put the vast amount of knowledge into action and practice. Coupling KM with an analytical tool such as HTA strengthens the application of both in EIDM HTA acts as a knowledge broker, within the health care system by collecting, analyzing and disseminating useful knowledge
- Applying the principles of Knowledge management and Knowledge translation to HTAI-getting the stuff in our heads-the tacit knowledge and evidence-the explicit knowledge into practice. Through the development of a KM/KT plan which will focus on the dissemination of recommendations and results of projects from all 4 programs, provide skills to use evidence through the application of the knowledge cycle and engage stakeholders through knowledge transfer activities. It will do this with the following 4 strategies. Assessment & Appraisal reviews and makes recommendations on health technologies through the systematic evaluation of global literature with respect to the clinical and economic properties, effects and direct and indirect impacts of emerging health technology. Application of this evidence to the AHS context is a key function. This program will also identify and prioritize emerging health technologies and coordinate outcomes monitoring and reporting. Reassessment leads proactive re-assessments of potentially obsolete and/or (cost-) ineffective technologies that may be superseded by safer, more (cost-) effective technologies or those deemed to provide little health gain for the cost. Recommendations include: Disinvest (remove/reduce use of the technology), Substitute (replacement), or Innovate (better use of existing technology). AHS and AHW are collaboratively exploring the operationalization of this program. Access with Evidence Development will design and conduct “field evaluations” (including pilots and trials) that collect AHS-specific data on effectiveness and cost effectiveness of new technologies in early stages of technology development to reduce uncertainty of adoption in the province. AHW and AHS are looking at a common approach for advancing this work. Innovation will support innovations developed within and outside AHS in the areas of clinical testing, validation, data collection and value proposition within the framework of AHS priorities and needs. Knowledge Management and Translation acknowledges that the success of evidence-informed decision-making depends on the understanding and dissemination of the principles of HTA across AHS. This program will oversee strategies to disseminate project recommendations from all four programs, provide skills to use evidence through the application of the knowledge cycle, and engage stakeholders through knowledge transfer activities.
- Recommendations that come from assessment, appraisals, reassessment, innovations, AED need to be shared and disseminated. We do this by: Technology briefing notes: policy, clinical question, technology description, population, intervention, comparator, outcomes, financial information, evidence. For example transient elastrography to measure liver stiffness. The operation financial impact analysis outlines the expected impact to AHS if a technology is implemented or not - specifically focusing on operational and financial implications. It provides a formalized opportunity for AHS to provide system specific information which may serve to influence provincial policy recommendations. For example Islet transplantation. Rapid, scoping, systematic reviews, HTAs (internal or external) We do not conduct assessments: we ask CADTH, IHE, uofC and UofA to do them for us
- Education, skills and tools to build HTA capacity Developing interactive modules, education plan, training in HTA and KM Knowledge Cycle: A knowledge cycle is the process that knowledge passes through an organization as knowledge is identified, created, captured, shared, transferred, and utilized. I Nonaka, R Toyama, and P Byosière. (2001a). ‘A theory of organizational knowledge creation: understanding the dynamic process of creating knowledge’. In Dierkes, M., Antel, A.B., Child, J. and Nonaka, I. (Eds), Handbook of organizational learning and knowledge. Oxford: Oxford University Press, pp 491-517.
- Knowledge Transfer: A deliberate process of information exchange between producers and potential users of research that supports evidence-informed decision making and decision-informed research, ultimately for the betterment of peoples’ lives. (Research Transfer Network of Alberta website: http://www.ahfmr.ab.ca/rtna/rt.php.)
- HTAI Webpage: Launched on April 1 st 2011
- Knowledge Transfer: A deliberate process of information exchange between producers and potential users of research that supports evidence-informed decision making and decision-informed research, ultimately for the betterment of peoples’ lives. (Research Transfer Network of Alberta website: http://www.ahfmr.ab.ca/rtna/rt.php.)One way to do this is through communities of practice that enable use to generate and capture learnings related to HTA.Develop HTA community of practice for HTAI Satellite Units, Clinical Networks, innovation centres, HTAI, Research, Industry, CPSM, COPs capture tacit knowledge Why COPs? It captures the tacit knowledge “ The biggest information repository in most organizations sits in the heads of the people who work there, and the largest communication network is the web of conversations that binds them. Together, people, tools, and conversations—these form the “system.” Coiera, E. Interaction design theory. International Journal of Medical Informatics. 2003;69:205-22
- Support best and innovative practices in HTA implementation. How do we implement HTA? What are the best ways to look for technologies, innovations? Plan for horizon scanning of best practices, upcoming technologies and innovations. Innovative technologies are studies, validated and shared. Results of horizon scanning incorporated into future projects. What are we doing, how can we improve, what can we do in the future. Have an evaluation plan
- Plan has been shared and is being implemented Silos do exist, people want to keep things to themselves, how do we get them to share. Biggest barrier to implementing KM practices or procedures is behaviour modification required of employees. Surgery HTAI Satellite unit was based on a local program, how do we get the other 8 clinical networks to buy in to this concept of a HTAI satellite committee. There are a lot of initiatives and things are constantly changing-is there an appetite for this or is there change fatigue? One payroll system, P2P etc Time and People to understand the application of KM/KT to HTAI
- Heads or tails? HTA and KM are both required in evidence-informed decision making to managing technologies; and both will also be needed in determining future health technologies that will become part of Canada’s health care system.
- Grand Canyon South Rim 7000ft, Colorado river running through it, truly inspirational We all have knowledge and access to knowledge, the key is to put this knowledge into action for the benefit of others.