Untangling the knowledge web

Managing knowledge in the NHS is like trying to knit with thousands of strands of knotted wool: data is held in a number of locations, managed by a variety of people and agencies, and stored in every imaginable format. Judy Aldred describes how nhs.uk is helping the organisation to deliver a more cohesive service to both its customers and its employees as part of a programme of improvements recommended by the recent Kennedy report.

The Kennedy report, published last July following the inquiry into practices at Bristol Royal Infirmary and focused on recommended improvements to clinical performance in the NHS, called for “good quality information for patients, relatives, carers or friends to be widely available, and in a variety of formats and media”. Our aim is to create a new national knowledge service for the NHS, which will provide a framework for identifying and meeting knowledge needs to support patient care.

Some people feel that knowledge management is a modern concept, but Samuel Johnson (1709-1784) is reported to have said, back in the 18th century, “Knowledge is of two kinds: we know a subject ourselves, or we know where we can find information on it.” Knowledge has to be managed like any other commodity and one of the functions of the nhs.uk website is to promote knowledge management as a core activity for the improvement of health and healthcare in the 21st century.

To extract relevant data from the tangled web of information held within the NHS and sort it into a source of knowledge for the public was the challenge presented to the nhs.uk team in the NHS Information Authority. As part of the government’s plan to deliver all public services electronically by 2005, www.nhs.uk was developed as the official internet gateway to NHS services, organisations and websites.

The project’s central aims and objectives were:

To supply patients/citizens with information about NHS services and organisations in a clear and consistent format;
To enable the public to make informed decisions based on quality data;
To help both the public and NHS staff to navigate their way around the existing NHS websites so that all information held on the web can be easily found;
To make best use of resources by reducing duplication of data collection;
To provide all this via a simple, easy-to-remember web address: www.nhs.uk.

One of the first stages for the nhs.uk team was to collate and maintain a core set of information about every dentist, pharmacist, optician, GP and any other NHS organisation in England. This information sits under the Local NHS Services section on the site, and is central to the effectiveness of www.nhs.uk as a whole.

This process has been acclaimed as the largest data-collection exercise ever undertaken in the NHS. Despite doubts in many quarters that the project would succeed, 18 months on we now have all the information in a simple and easy-to-use format that can be quickly searched in a variety of ways. Through a partnership of people and information technology we have delivered a knowledge base that is accessible to the public and NHS staff alike.

Communication is the key

The main lesson we have learnt during this project is that communication is the key to knowledge management: communication with those we rely on to provide us with data, communication within the NHS Information Authority to ensure there is no duplication across projects, and communication with the Department of Health to make certain the work adheres to policy guidelines.

Initial investigations revealed that most of the data we needed was already collected within the NHS. However, some data was held by health authorities, some by NHS trusts and some sat in national databases attached to other programmes. At the start of the project, we identified several sources of data and set up the channels of communications to manage the process of collating and maintaining the data.

First, we set up a network of web editors. A web editor is a designated person in every NHS organisation who is responsible for supplying data to nhs.uk. Some organisations chose to have more than one web editor for different types of data. We currently have over 1,500 web editors throughout England.

The web editors have a choice of methods through which to supply data. Currently, they are able to update data using online templates. In a few months, they will be able to update from their own databases using XML. A password-protected web-services page has also been set up on the website. Web services are already in place to allow the data to be downloaded from the website. This area also allows organisations to export their data so they can make use of all the stored information when they need to. Once the import web services are in place, web editors will be able to choose where they keep their single source of data. They can opt either to keep their own database up to date and use the web services to upload the data to nhs.uk, or to keep nhs.uk up to date and download the data when they need to use it locally. As already mentioned, some of the data for www.nhs.uk had already been collected by other national projects, and the nhs.uk team established a feed from these databases to update the website.

Quick and easy searching

The result of this project is a knowledge service for the public and NHS staff that allows them to find the details they need about NHS organisations, fulfilling one of the essential elements of managing knowledge: the ability to search for and provide required information quickly and easily. Subsequent research into usability with members of the public and the NHS has led to further enhanced search facilities on www.nhs.uk (see figure 1).

Figure 1 - local services search on www.nhs.uk

For each NHS organisation, users can be assured of finding a standard core level of information, including contact details and access to maps showing their location. However, for many NHS services, such as opticians, pharmacies, walk-in centres and hospitals, much more detailed knowledge is now available. For example, users can search for dentists and GPs using various criteria such as:

Location;
Nearest five premises;
Opening times;
Practice name;
Special services;
Specific GP/dentist.

The type of information recorded and the search options created have been developed in accordance with government policy and following consultation with the public and members of the NHS. When the prime minister made a pledge that all members of the public would be able to access dentistry by 28 September 2001, the nhs.uk team was tasked with helping to make this happen. Working with NHS Direct, Department-of-Health dentistry experts and health authorities, the nhs.uk team extended the dataset to include information about which dentists were currently accepting NHS patients. Operators at NHS Direct call centres use this knowledge source when dealing with inquiries (see figure 2).

Figure 2 - searching for a local dentist on www.nhs.uk

Helping patients make informed decisions

Building on the success of the initial project to collate data on local NHS services, which was completed in October 2001, the website has been further developed and extended to provide other information of interest to the public. Since the autumn of 2002, people have also been able to access information about performance of acute hospitals in order to help them make an informed decision about their healthcare. This section includes two new areas.

First, the Star Ratings section gives an overview of how good a hospital’s service to its patients is – how well the hospital is run and whether it is up to scratch on important government targets. The ratings are based on statistics, some of which come from surveys of patients and staff about the service they have received. People can search for a particular hospital if they know the name or by area if preferred. Each acute trust is issued with a rating of zero to three stars – three stars means that a trust has reached the highest levels of performance (see figure three). Full details about how Star Ratings are allocated and what they mean is explained to the user via the web pages, thus creating a fully integrated knowledge service.

Second, a similar project was set up to collate all waiting-times information from NHS Trusts. The Kennedy report spelt out the importance of allowing patients to “compare different waiting times at different hospitals and across different specialties”. The specification given to nhs.uk for this work was to record a waiting time (as per a specific definition) for every consultant, for every speciality and in every acute trust. The nhs.uk team, with the help of consultants from Coba IT Services, designed the web pages and established an updated data-collection system. In line with ministerial expectations, it was important that the system was implemented quickly and that it was simple enough that all NHS Trusts were able to use it straight away, regardless of their status regarding IT knowledge.

A standard-format CSV file was used to receive the data via e-mail and a fully automated process checked each file and uploaded the data to the database. Within two months, data was being received on a regular basis from 96 per cent of trusts. This data provides incredibly useful and detailed information to the public to help them make crucial decisions about their healthcare. They can type in their postcode, select a distance they are prepared to travel and find out what the waiting times are within that distance for the speciality their condition comes under. Users are also able to select a particular consultant or hospital and check those waiting times. They can even cross-reference the consultant with the GMC (General Medical Council) site to get more information.

Positive feedback from public, press and government

Positive feedback is already flooding in about the work the nhs.uk team has done. The prime minister’s health adviser, Simon Stevens, said, “The new nhs.uk waiting-times website is, in my view, an absolutely superb piece of work. It is an example of a can-do approach that has produced a genuinely impressive result in a very short space of time.”

A recent survey of the most visited medical websites of this kind in the UK showed that www.nhs.uk received 164,000 visits in August 2002 alone (source: Nielsen//NetRatings and NetValue). A report by an independent journalist rated the site as an “excellent source of useful information for both patients and practitioners”.

Via a feedback page on www.nhs.uk, users have also provided us with comments:

“Very quick and easy to negotiate.”
“Thanks, I found exactly what I needed in just a few minutes. A great site.”
“Highly informative and very interesting.”

Helping staff in the NHS

Although www.nhs.uk has been developed primarily as a public-facing website, the work of the nhs.uk programme also provides tremendous benefits for the NHS itself. From a knowledge-management perspective, there are clear benefits in NHS staff having a trusted, single source of data. Above all, it helps avoid the problems associated with duplicating information and storing it in various places and formats. For instance, it is vital when people contact NHS Direct for information that call centres have quick access to an easy-to-use, central repository of information. Thanks to the work of the nhs.uk programme, this is now available 24 hours a day, seven days a week.

As mentioned above, information for the website is collated in various ways and, where feasible, web editors can chose which method they use to supply the data to the nhs.uk team. Many of the services available on nhs.uk are made possible by the use of XML web services. XML is a flexible way to create common information formats and share both the format and the data on the web, via an intranet and so on. Whether the local organisation chooses to keep the data updated using online forms and then exports data when required locally, or keeps data updated in a local database and sends us updates, a single source of data is created, which is easily imported/exported using XML.

Figure 3 - an example of a Star Ratings page on www.nhs.uk

The use of XML technology means that the process of providing information to www.nhs.uk is no longer a one-way flow of information. In practice, this has resulted in a considerable reduction in the workload of the individual trusts, as they no longer need to provide certain sets of data to those third parties who request it. Rather, when other organisations request data, they can now be directed to www.nhs.uk for local services information and, depending on what they want to use the data for, they will be able to download the information using web services. Currently, nhs.uk is providing data to UpMyStreet.com and to EDS, suppliers of the new NHS online directory. Both organisations are using nhs.uk data to enhance their already extensive databases on local information.

Making it easier to share information

Not only did the Kennedy report set out guidance about the accessibility of information for the public, it also specified what types of information should be made available. The mechanisms established by nhs.uk are enabling various sources of knowledge to be more easily disseminated. For example, one of the recommendations of the report was, “Trusts and primary care trusts must have systems for publishing periodic reports on patients’ views and suggestions, including information about the action taken in the light of them.”

The report went on to spell out that in order “to demonstrate that the NHS is acting on information gained from patients and responding to patients’ priorities, every NHS Trust and PCT will be required to publish, in a new Patient Prospectus, an annual account of the views received from patients and local standards set specifically to address shortfalls identified through the new patient survey”.

Due to the architecture of www.nhs.uk we have provided a framework that will easily enable trusts to provide this information and display it in an acceptable manner. Our templates allow organisations to submit additional detailed information about their services and also to provide opportunities for links to their own websites, thus negating the need for the public to remember a multitude of web addresses.

The Kennedy report gave us clear messages about the importance of patient choice. It explained that “by helping patients make choices we will ensure that PCTs and hospitals respond more directly to the needs and wishes of patients”. By managing knowledge efficiently and effectively, www.nhs.uk is helping the NHS work towards increasing patient choice. The aim of the nhs.uk programme is to ensure that everyone has open access to the same core information in an easy-to-use, consistent format, rather than a tangled web of threads leading to mixed messages and confusion. For more information about how the NHS Information Authority is providing this service, take a look at www.nhsia.nhs.uk/nhsuk.

Judy Aldred is the nhs.uk programme manager for the NHS Information Authority. She can be contacted at judy.aldred@nhsia.nhs.uk