Case study: NHS

Chris Collison and Rachel Hinde discuss the creation of 'knewspapers' to support world-class commissioning in the NHS.

At a recent regional knowledge-sharing event, representatives from the 14 Primary Care Trusts (PCTs) across south-west England gathered on a rainy day in Taunton, to share best practice arising from the world-class commissioning assurance programme. They used a sharing technique devised specifically for the event – and which has now been used successfully in other regions.
One of the challenges PCTs face is how to learn from each other. There are 152 PCTs in NHS England. Rather than each of them designing new ways to deliver effective, high quality and affordable health care and ensure the well-being of their local populations, they need to understand what works and then share this knowledge. To do this they need to take time out from their day-to-day activities and spend some time focused on sharing and learning.
In order to counter any resistance to knowledge sharing, to give structure to the discussion, and to retain the focus on learning (rather than critiquing), the event was designed around the idea of newspaper reporting.

Creating a ‘knewspaper’
The group was divided into ten roundtables, at each of which there was someone with a specific story to share. The following briefing was given to the group:

Please be generous to your colleagues, who have had the courage to share – and help them to not just tell their story, but also to discuss it. It’s true that we don’t really know what we know until someone asks us a question that we hadn’t thought of – then we all discover something new.
We’d like you to help us to capture the stories, and discover something new by playing the role of a group of newspaper reporters. Your job is to create a newspaper article which does this. You’ll be working as a group for 30 minutes to do just that…

Each storyteller was allocated a 30 minute slot in which to tell their story. Their brief was to provide a summary of the areas their organisation was trying to address or improve, the actions that were being taken and the resulting outcomes. They were then encouraged to explore how their experience might be helpful for other PCTs, with the people sat at their table.
Rather than acting as passive receivers, the participants at each table were asked to consider themselves as friendly journalists. Their role was to ensure that their storytellers told the story with a newspaper reader in mind. They had to understand what really made the difference and, in many cases, ask the questions that the storytellers wouldn’t have anticipated. While each reporting team listened and interviewed, one participant was asked to capture the story narrative and everyone was responsible for capturing quotes and top tips for other readers, based on a simple template. The ‘knewspaper’ was created using flipcharts, with post-its emphasising the quotes, recommendations and contact information. A photo was taken of the storyteller and added to the flip chart.
After 30 minutes, each group of reporters moved around the room to the next storyteller, so that each one told their story twice. Each different set of reporters drew different insights from the storyteller – in the shape of various quotes and headlines. For example, one story yielded the headlines: ‘Putting the service user at the centre’ and ‘Harnessing our collective strengths’. After an hour of news reporting, the walls were completely covered with stories. These were used to facilitate a knowledge-sharing exhibition and networking session, which gave all of the participants the opportunity to read the outputs from their neighbouring tables.
The storytellers found that they enjoyed the process and gained from the opportunity to reflect on what they had done, using the perspectives and lines of questioning from two groups of their peers.
The outputs from the event – and the other regional ones that followed a similar format – were captured electronically as a set of knowledge assets and then uploaded to the NHS Institute’s website. They can now be accessed by commissioners from across the NHS, enabling them to plan their improvement actions based on the collective experience of other PCTs in their region, and beyond.

Introducing PCTs
PCTs manage the NHS budget for a given area and are accountable to local people and stakeholders for how this money is spent. PCTs work with local authorities and other agencies that provide health and social care to make sure that local community’s needs are being met by the services that are commissioned on their behalf.
In 2008, a national framework was introduced – setting out 11 competencies which, if achieved in full, would deliver world-class commissioning.

A national sharing opportunity
PCTs are assessed annually against the 11 world-class commissioning competencies. The NHS Institute for Innovation and Improvement chose to use the results of this assurance process to illustrate the sharing and learning potential in the NHS. It used the river diagram technique to do this. The technique was originally pioneered by BP’s KM team, and is the subject of the book, No More Consultants – We know more than we think (see ‘Book review’, at www.ikmagazine.com).
The river diagram illustrates the range of scores achieved against each of the competencies, and the position of each PCT relative to that range (the river). The river banks represent areas of high or low performance. The NHS Institute developed the river diagram into a web-based application as part of its PCT Portal. A user can click on a particular competency and find the knewspapers, case studies and contact details of those organisations with something to share. The river diagram was used to identify which organisations should be invited to share their experience at the knewspaper creation session of the regional knowledge-sharing events.

Future plans for the world class commissioning knowledge-sharing
The NHS Institute for Innovation and Improvement continues to support PCTs in sharing and learning as they approach the next round of the assurance process. Examples of good practice are being added to the River Diagram all the time. It will also be updated with next year’s assurance results when they are published.

Rachel Hinde is priority programme associate, Commissioning for Health Improvement, at the NHS Institute for Innovation and Improvement. She can be contacted at rachel.hinde@institute.nhs.uk

Chris Collison is director of Knowledgeable Ltd and a member of the Inside Knowledge editorial board. He can be contacted at chris@collison.com