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