Knowledge Management in Healthcare: Succeeding in Spite of Technology

Technology and healthcare always have had an				box readily accessible? Does the hospital culture
uneasy relationship. On one hand, there is the promise				encourage suggestions and incorporate them into the
of technology and the enhancements it offers				organization's routines? If so, this is a working and
healthcare. These include improved medical				useful KM system. This is when technology can really
information access, streamlined reporting, automation,				enhance the system by extending its reach and
reduced errors and more efficient processes. On the				providing a historical warehouse of implementations.
other hand, technology has fallen short of its full				But, when the suggestion box isn't used
potential in healthcare, as too many competing				appropriately, then having the latest, greatest,
systems make integrated data difficult to obtain.				technologically advanced computer suggestion box
Additionally, the burdens of data entry and analysis				won't improve anything. Once again, an organization
burdens overwhelm rather than streamline				requires a "learning" culture to value the collaborative
processes.Healthcare faces these mistakes if it				learning obtained through KM systems.Some
"applies" technology to organizational Knowledge				organizations overcome these obstacles by using
Management (KM) without first identifying KM goals				technology as a tool instead of as a solution.
and understanding how a KM system will be used by				Technology can enhance knowledge exchange by
administrators, physicians, managers, and staff.				providing multiple access models (interactive events
Technology facilitates knowledge exchange, but it is				and data warehouses) and widespread distribution of
not the end-all to managing knowledge effectively.				new and innovative ideas. Thoughtful abstracting and
Technology designed to enhance the interaction				archiving of events and documents enable managers
among a community of similar-minded participants,				to actively apply lessons learned by others and
such as healthcare employees, can greatly enhance				applies knowledge to their daily work.Managing
the exchange of knowledge. But it is the process and				Competing Expectations of Users and
culture of an organization rather than the level of				AdministratorsUnless it fills some need and is easily
applied technology that make a KM system a wealth				accessible in one's daily routine, a KM system will
or void of retrievable information.An effective KM				probably be ignored. Healthcare runs at a hectic pace
system is built on communication and education and				and staff needs to spend as little time as possible
thrives in organizations encouraging shared learning				navigating a KM system to obtain useful information.
both within and outside of the hospital walls. These				Administrators will not support KM efforts unless
systems store historical knowledge and knowledge				they see demonstrated results. Consider the following
created during exchanges of information among				criteria when weighing the pros and cons of a KM
people who are interested in learning. Knowledge				system:Â· What is the organization's purpose for
management systems designed with goals in mind,				the KM system?Â· Where is the existing
versus just acquiring the most advanced technology,				knowledge?Â· How is the knowledge
is what will support healthcare organizations in				transferred?Â· Who will have access to the
streamlining processes, reducing costs and improving				system?Â· How will access privileges vary among
care.Why Knowledge Management in				staff members?Â· How will each department use
Healthcare?Healthcare industry professionals are				the system?Â· How will ideas be exchanged,
realizing that previous efforts, (e.g. searching for the				in-house exclusively or
elusive "best practice" and applying it as a				with other organizations?Â· What is the structure
commodity), bureaucratic and toothless performance				of the KM system? Will it just
improvement initiatives and poorly thought-out IT				create directories of experts or will it also create
implementations, have not led to improved results				active learning communities (active learning)?Â·
and reduced costs. As a mindset, KM attaches				What amount of support will be required at each
importance to knowledge and identifies the value of				level?Â· How user-friendly is it?It never serves an
knowledge at different levels. As a framework, KM				organization to design a system with all the fancy
facilitates knowledge access and transfer, which helps				bells and whistles, just for the sake of having slick
change behaviors and improve decisions. Knowledge				features. Create a KM system consistent with the
management systems support healthcare workers in				way the hospital staff will use it. If the purpose is to
using available knowledge to develop organizational				inspire employees to think 'outside the box', systems
learning. This learning assists the employees in				can be designed to facilitate this. The best way to
critiquing a compilation of practice ideas and				manage competing expectations is to understand it all
successfully designing a customized "Best Practice"				upfront. The healthcare industry, especially, does not
for the organization. A good KM system can help				have the bankroll to pay for underutilized
staff create and exploit new knowledge. It is capable				features.Key Components for A Successful KM
of driving decisions, change and improvements to all				System:1. Fulfills organizational goals. A KM system
levels of the organization. And, in this era of				structured around an organization's goals will support
escalating costs and declining reimbursements, an				the efforts of employees to reach these goals. John
effective KM system is virtually essential to a				Ager, Team Coordinator of the Endoscopy
healthcare organization's process improvement and				Department for Sentara Healthcare Systems, located
cost reduction strategies.Hospitals can be isolated				in Virginia Beach, Virginia, has participated in monthly
places, which make it tough to gather 'knowledge'.				teleconference calls with colleagues nationwide. "It is
The clinical side has the measurable research and				part of my hospital's goal to do benchmarking. This
knows the outcomes, but the operational side of the				hospital is very strong on sharing information and the
hospital lacks this information. Consider this example.				previous methods were not effective. Prior to the
A hospital's operational staff may be well aware of				teleconference calls, we were doing phone
the increased benefit to changing one of its products				communication, which was difficult at best. Now we
used for patient care management. Nevertheless, the				have set scheduled times on a monthly basis and we
staff struggles when it comes to demonstrating the				just recently picked up using computer-based
cost/benefit to administration and to the physicians.				knowledge."2. Addresses social networks. If
A KM system offers a hospital staff access to				employees feel like they belong to a particular group,
strategies and contacts so they can learn how others				then they are more likely to share successes and
have successfully carried out similar situations.Can We				failures with that group. Sharing failures is especially
Talk?Hospital staff is willing to share their knowledge				beneficial to a knowledge management system since
with others in the field, although it's often done				people tend to learn more effectively when they're
informally, such as networking at a convention or				told/shown what not to do. Develop knowledge
conversations with internal and external peers.				communities or communities of practice (COP's)
Effective KM systems capitalize on these				around functional and clinical topics. Orchestrate
opportunities.How does a KM system change				events where staff can share experiences (especially
behaviors and improve decisions? One hospital				failures) without fear of censure.Collective history of
department is concerned with retaining staff,				a social network is important. The background
especially in light of the current nursing shortage.				information from all participants in a COP builds a
Typically, the manager struggles with the staffing				shared, historical base, which solidifies commitment to
issues alone or relies on a few peers within the				the group process and increases exchanges. "I've
department. Yet, what if the manager could connect				really enjoyed the participation," says Ager. "It has
with a peer internally and solicit his or her advice,				really helped me get a better picture of the field I'm
even though this employee works in an unrelated				in because I'm actually having a one-on-one
department? The insight and perspective from an				immediate interaction with somebody as opposed to
"outsider" may be very useful. How about contacting				the old process where you'd have a fixed set of
peers at other facilities? An effective KM system				questions you'd e-mail to them. Then, you'd try to call
would facilitate 'experience sharing' among people				them to get answers or they would fax their
struggling with staffing issues. It also archives the				answers back to you. It wasn't as clear and concise.
solutions brainstormed from the interaction to use as				This is ongoing and I like the immediate and personal
a basis for growing the collective knowledge of the				response back," explains Ager.3. Archives existing
group. This information is then readily accessible the				knowledge. Create historical records by categorizing
next time a hospital manager (within the hospital or				and abstracting knowledge gleaned from interactions.
from another facility) faces retention issues.Another				Make it easy for users to locate relevant learning.
method hospitals typically use to gain knowledge is				Ager uses his KM system to share documentation
gathering ideas from a multitude of experts, as is				prior to the actual teleconference with the other
done when attending a conference or a convention.				participants. They use spreadsheets and data
Yet, how is that information disseminated throughout				management for references when talking on the
the hospital or healthcare organization if only two				telephone. "I've found this aspect beneficial because
employees attended the convention? If it is difficult				as we are talking, I'm able to look at the information
to share and build ideas within one department or				firsthand and it spurs questions for me too," says
even throughout one hospital, how can anyone				Ager. Additionally, all participants receive e-mail
expect cross-hospital exchanges to prove fruitful?				summations of the teleconference (created by the
Obviously, it is more difficult to share information				KM system coordinator). Call topics are based on the
when individuals are not physically together and even				suggestions and questions introduced in previous
more complex when the individuals are employees of				teleconferences. If one facility has a specific question,
different healthcare organizations. The benefits of				the coordinator will request examples related to this
sharing such a huge reservoir of knowledge are				question from all participants, summarize the
colossal. Technology is a must in these				information and then forward it to all facilities.4.
cases.Knowledge Management ≠ Information				Facilitates "new" knowledge. Knowledge comes from
TechnologyEffective KM cannot be thought of, nor				many sources including knowledge forums,
treated, as simply another exercise in information				conference calls, research articles, surveys, and
technology. Unfortunately, due to the access and				opinion polls. Encourage participants to exchange ideas
distribution enhancements technology provides,				and share experiences, challenges and successes.
healthcare administrators often have a distorted view				Most people are not able to develop an action plan
of a KM system as an information technology				simply by reading or analyzing data. Rather, they are
system or as a solution that needs to be applied.				more inspired by talking and exchanging ideas.
While technology enhances sharing and information				According to Ager, "Participating in the
exchange, even the most technologically advanced				teleconference calls is one of the best ways of
KM system will not solve every dilemma. The keys				sharing information that I've been exposed to in the
to a successful KM implementation are:Â· Identify				last nine years since I've been working for this facility.
the knowledge to exchange and distributeÂ·				It's given me real time data and real people to talk
Determine how knowledge will be managedÂ·				to. Issues constantly change. At one point, staffing
Match technology and resources appropriately to the				was a priority at several of the facilities and because
culture and needs of the organizationAnother fallacy				we shared information, other facilities implemented
about KM is that "knowledge" can be reduced to				the shared ideas when it was the right time for
documents and then warehoused in a computer				them. It's easier than looking at a piece of paper with
database for people to access as needed. The				raw data on it wondering what to do with it."Moving
improvement resulting from a KM system comes				ForwardThe explosion of information technology and
from personal interaction, the sharing of experiences,				its instant accessibility have created powerful
taking action and recording the results, growing				solutions for the healthcare business. Healthcare must
collective knowledge of a group and building new				invest its resources and technology wisely. A carefully
knowledge from the experiences of others.				considered and well-resourced KM implementation will
Technology based solely on warehousing knowledge				enable organizations to leverage data, knowledge and
"documents" or best practices are not successful in				experience to improve patient care and lower
driving change and improvement in the organization.It				healthcare costs. Why 'reinvent these conversations'
takes resources beyond technology to manage				when they've already taken place countless times?
knowledge effectively. Group interactions must be				KM systems designed to serve an organization's
facilitated, results must be archived and reinvested in				goals, and built to foster social interactions that
the knowledge pool and management actions and				encourage the exchange of knowledge, will assist
change must be supported by the organization.				organizations in revolutionizing healthcare.Sidebar: Keys
Effectively managing and leveraging knowledge in an				to Generating New Knowledge
organization cannot be abdicated to the IT				Use these ideas when designing a KM system:Â·
system.Apply Thoughtful TechnologyOrganizations				Create Communities of Practice (COP)Â·
have a habit of buying the latest, greatest KM				Moderate COP processes to extract learningÂ·
system on the market, if for no other reason than				Make continuous learning availableÂ· Determine
because others have done the same. Yet, elaborate				how successes are shared and how failures are
systems that aren't called for tend to breed				communicatedÂ· Analyze failure for future
reluctance. Does the hospital or healthcare				learningÂ· Generate, abstract and categorize
organization really need the latest and greatest?				historical knowledge recordsÂ· Provide multiple
When analyzing the implementation of a KM system,				access paths for participantsShelley Burns is director
first determine what is really necessary to meet the				of knowledge management at The Healthcare
hospital's needs. For instance, take the simple				Management Council Inc., a benchmarking and
suggestion box. Are the employees making practical				performance improvement firm in Needham, MA.
suggestions or snide comments? Is the suggestion

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Knowledge Management in Healthcare: Succeeding in Spite of Technology

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