CROSS-SECTOR COMMUNICATION
Multi-year research project to ‘uncover barriers’
To address the NHS’s ambition of ‘building knowledge sharing and learning capability [and] supporting communities and networks to share knowledge’,6
a
multi-year research project at the University of Cambridge aims to investigate and improve knowledge flows within and between NHS EFM departments. For this purpose, both the underlying barriers to effective knowledge-sharing, and suitable channels for different knowledge flows, are being investigated.
In the first 12 months of the research project, insights from the academic literature on knowledge management were generated and compared to NHS EFM practitioner views. As part of this, 16 interviews with NHS EFM, energy, and sustainability managers, as well as NHSE/I professionals were conducted. To account for the organisational complexity of the NHS, the study followed a systems approach by interviewing NHS staff at national, regional, and local levels. Interview quotes in the following section were anonymised to maintain the confidentiality of participants. The insights from the interview data were then compared to NHS and government reports from the past decades.
Lack of overarching consistent structure and strategy for knowledge-sharing
There are three broad strategies to share knowledge, depending on whether it is documented or undocumented. Firstly, when no formal knowledge-sharing approach is available, staff can use their social networks to reach out to contacts in other organisational units. The larger the social network of EFM staff, the more likely they can find the solution to the challenge faced in their network. Hence, experienced NHS EFM staff often have large networks and know who can provide assistance, whereas newly appointed EFM staff first need to build their social network, and may struggle with finding the right contact to help them with the challenges they face. To overcome the limited reach of social networks, personalisation strategies can be used. These consist of different networks, such as communities of practice, formal and informal networks, or knowledge brokers. For example, external professional bodies such as IHEEM and HEFMA provide regular meetings, and publish and disseminate newsletters and communications. However, the membership model restricts access to paying members. Since there is a professional body for almost every technical discipline, ‘you can’t possibly keep abreast of all of these different ones’, so that it is not possible to reach all EFM
58 Health Estate Journal November 2021
Healthcare Safety Investigation Branch (2021): Oxygen issues during the COVID-19 pandemic
limits Trusts’ ability to effectively respond to MGPS patient safety concerns
“[…] lack of shared ownership and knowledge […] ”
IHEEM, HEFMA, IFHE & IFHE-EU and Carbon & Energy Fund (2021): A Healthcare Engineering Roadmap for Delivering Net Zero Carbon
“New engineering solutions […] require a strong ”
network […] to collectively work together [and] share best practices [….]
Figure 2: Examples of recent reports, displaying the past and future challenges for NHS Estates and Facilities teams.
staff through a single channel. Knowledge brokers – actors,
technologies, and objects, who enable the knowledge of one community to be shared with and used by those in another7 – can facilitate the flow of knowledge across organisational boundaries. For specialised high-risk-impact services such as medical gas pipeline systems (MGPS), Authorising Engineers (AEs) are well- suited to this process since they are familiar with the relevant jargon and context as a result of their specialised engineering expertise. This enables them to understand and share more complex knowledge across NHS Trusts. However, AEs often look after a large number of Trusts, so they do not have time for involvement in day-to-day problem- solving. Similarly, consulting and
contracting companies can take over the role of knowledge brokers.
Formal and informal networks Formal networks such as Clinical Commissioning Groups (CCGs) or Integrated Care Systems (ICSs) can enable an exchange of ideas among regional NHS Trusts. Informal networks among Trusts with a similar context, e.g. the Shelford Group, or among like-minded staff members, e.g. the Centre for Sustainable Healthcare, are often even more effective in sharing and discussing specific pieces of information. To facilitate the sharing of knowledge, information can also be codified in documents, (documented knowledge) and collected in repositories, which can be systematically searched and accessed
National NHS England & Improvement
Regional
7 Regional NHSE/I teams 106 CCGs/ICSs
Local 217 Trusts
1,263 hospital sites 98,482 EFM
Figure 3: Illustration showing the complexity of the multi-level NHS EFM system (Data and hospital locations from NHS ERIC returns 2019/20).
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