Knowledge Management in Healthcare: Succeeding in Spite of Technology

Technology and healthcare always have had an uneasy relationship. On one hand, there is the promise of technology and the enhancements it offers healthcare. These include improved medical information access, streamlined reporting, automation, reduced errors and more efficient processes. On the other hand, technology has fallen short of its full potential in healthcare, as too many competing systems make integrated data difficult to obtain. Additionally, the burdens of data entry and analysis burdens overwhelm rather than streamline processes.

Healthcare faces these mistakes if it "applies" technology to organizational Knowledge Management (KM) without first identifying KM goals and understanding how a KM system will be used by administrators, physicians, managers, and staff. Technology facilitates knowledge exchange, but it is not the end-all to managing knowledge effectively. Technology designed to enhance the interaction among a community of similar-minded participants, such as healthcare employees, can greatly enhance the exchange of knowledge. But it is the process and culture of an organization rather than the level of applied technology that make a KM system a wealth or void of retrievable information.

An effective KM system is built on communication and education and thrives in organizations encouraging shared learning both within and outside of the hospital walls. These systems store historical knowledge and knowledge created during exchanges of information among people who are interested in learning. Knowledge management systems designed with goals in mind, versus just acquiring the most advanced technology, is what will support healthcare organizations in streamlining processes, reducing costs and improving care.

Why Knowledge Management in Healthcare?

Healthcare industry professionals are realizing that previous efforts, (e.g. searching for the elusive "best practice" and applying it as a commodity), bureaucratic and toothless performance improvement initiatives and poorly thought-out IT implementations, have not led to improved results and reduced costs. As a mindset, KM attaches importance to knowledge and identifies the value of knowledge at different levels. As a framework, KM facilitates knowledge access and transfer, which helps change behaviors and improve decisions. Knowledge management systems support healthcare workers in using available knowledge to develop organizational learning. This learning assists the employees in critiquing a compilation of practice ideas and successfully designing a customized "Best Practice" for the organization. A good KM system can help staff create and exploit new knowledge. It is capable of driving decisions, change and improvements to all levels of the organization. And, in this era of escalating costs and declining reimbursements, an effective KM system is virtually essential to a healthcare organization's process improvement and cost reduction strategies.

Hospitals can be isolated places, which make it tough to gather 'knowledge'. The clinical side has the measurable research and knows the outcomes, but the operational side of the hospital lacks this information. Consider this example. A hospital's operational staff may be well aware of the increased benefit to changing one of its products used for patient care management. Nevertheless, the staff struggles when it comes to demonstrating the cost/benefit to administration and to the physicians. A KM system offers a hospital staff access to strategies and contacts so they can learn how others have successfully carried out similar situations.

Can We Talk?

Hospital staff is willing to share their knowledge with others in the field, although it's often done informally, such as networking at a convention or conversations with internal and external peers. Effective KM systems capitalize on these opportunities.

How does a KM system change behaviors and improve decisions? One hospital department is concerned with retaining staff, especially in light of the current nursing shortage. Typically, the manager struggles with the staffing issues alone or relies on a few peers within the department. Yet, what if the manager could connect with a peer internally and solicit his or her advice, even though this employee works in an unrelated department? The insight and perspective from an "outsider" may be very useful. How about contacting peers at other facilities? An effective KM system would facilitate 'experience sharing' among people struggling with staffing issues. It also archives the solutions brainstormed from the interaction to use as a basis for growing the collective knowledge of the group. This information is then readily accessible the next time a hospital manager (within the hospital or from another facility) faces retention issues.

Another method hospitals typically use to gain knowledge is gathering ideas from a multitude of experts, as is done when attending a conference or a convention. Yet, how is that information disseminated throughout the hospital or healthcare organization if only two employees attended the convention? If it is difficult to share and build ideas within one department or even throughout one hospital, how can anyone expect cross-hospital exchanges to prove fruitful? Obviously, it is more difficult to share information when individuals are not physically together and even more complex when the individuals are employees of different healthcare organizations. The benefits of sharing such a huge reservoir of knowledge are colossal. Technology is a must in these cases.

Knowledge Management ≠ Information Technology

Effective KM cannot be thought of, nor treated, as simply another exercise in information technology. Unfortunately, due to the access and distribution enhancements technology provides, healthcare administrators often have a distorted view of a KM system as an information technology system or as a solution that needs to be applied. While technology enhances sharing and information exchange, even the most technologically advanced KM system will not solve every dilemma. The keys to a successful KM implementation are:

· Identify the knowledge to exchange and distribute

· Determine how knowledge will be managed

· Match technology and resources appropriately to the culture and needs of the organization

Another fallacy about KM is that "knowledge" can be reduced to documents and then warehoused in a computer database for people to access as needed. The improvement resulting from a KM system comes from personal interaction, the sharing of experiences, taking action and recording the results, growing collective knowledge of a group and building new knowledge from the experiences of others. Technology based solely on warehousing knowledge "documents" or best practices are not successful in driving change and improvement in the organization.

It takes resources beyond technology to manage knowledge effectively. Group interactions must be facilitated, results must be archived and reinvested in the knowledge pool and management actions and change must be supported by the organization. Effectively managing and leveraging knowledge in an organization cannot be abdicated to the IT system.

Apply Thoughtful Technology

Organizations have a habit of buying the latest, greatest KM system on the market, if for no other reason than because others have done the same. Yet, elaborate systems that aren't called for tend to breed reluctance. Does the hospital or healthcare organization really need the latest and greatest? When analyzing the implementation of a KM system, first determine what is really necessary to meet the hospital's needs. For instance, take the simple suggestion box. Are the employees making practical suggestions or snide comments? Is the suggestion box readily accessible? Does the hospital culture encourage suggestions and incorporate them into the organization's routines? If so, this is a working and useful KM system. This is when technology can really enhance the system by extending its reach and providing a historical warehouse of implementations. But, when the suggestion box isn't used appropriately, then having the latest, greatest, technologically advanced computer suggestion box won't improve anything. Once again, an organization requires a "learning" culture to value the collaborative learning obtained through KM systems.

Some organizations overcome these obstacles by using technology as a tool instead of as a solution. Technology can enhance knowledge exchange by providing multiple access models (interactive events and data warehouses) and widespread distribution of new and innovative ideas. Thoughtful abstracting and archiving of events and documents enable managers to actively apply lessons learned by others and applies knowledge to their daily work.

Managing Competing Expectations of Users and Administrators

Unless it fills some need and is easily accessible in one's daily routine, a KM system will probably be ignored. Healthcare runs at a hectic pace and staff needs to spend as little time as possible navigating a KM system to obtain useful information. Administrators will not support KM efforts unless they see demonstrated results. Consider the following criteria when weighing the pros and cons of a KM system:

· What is the organization's purpose for the KM system?

· Where is the existing knowledge?

· How is the knowledge transferred?

· Who will have access to the system?

· How will access privileges vary among staff members?

· How will each department use the system?

· How will ideas be exchanged, in-house exclusively or
with other organizations?

· What is the structure of the KM system? Will it just
create directories of experts or will it also create active learning communities (active learning)?

· What amount of support will be required at each level?

· How user-friendly is it?

It never serves an organization to design a system with all the fancy bells and whistles, just for the sake of having slick features. Create a KM system consistent with the way the hospital staff will use it. If the purpose is to inspire employees to think 'outside the box', systems can be designed to facilitate this. The best way to manage competing expectations is to understand it all upfront. The healthcare industry, especially, does not have the bankroll to pay for underutilized features.

Key Components for A Successful KM System:

1. Fulfills organizational goals. A KM system structured around an organization's goals will support the efforts of employees to reach these goals. John Ager, Team Coordinator of the Endoscopy Department for Sentara Healthcare Systems, located in Virginia Beach, Virginia, has participated in monthly teleconference calls with colleagues nationwide. "It is part of my hospital's goal to do benchmarking. This hospital is very strong on sharing information and the previous methods were not effective. Prior to the teleconference calls, we were doing phone communication, which was difficult at best. Now we have set scheduled times on a monthly basis and we just recently picked up using computer-based knowledge."

2. Addresses social networks. If employees feel like they belong to a particular group, then they are more likely to share successes and failures with that group. Sharing failures is especially beneficial to a knowledge management system since people tend to learn more effectively when they're told/shown what not to do. Develop knowledge communities or communities of practice (COP's) around functional and clinical topics. Orchestrate events where staff can share experiences (especially failures) without fear of censure.Collective history of a social network is important. The background information from all participants in a COP builds a shared, historical base, which solidifies commitment to the group process and increases exchanges. "I've really enjoyed the participation," says Ager. "It has really helped me get a better picture of the field I'm in because I'm actually having a one-on-one immediate interaction with somebody as opposed to the old process where you'd have a fixed set of questions you'd e-mail to them. Then, you'd try to call them to get answers or they would fax their answers back to you. It wasn't as clear and concise. This is ongoing and I like the immediate and personal response back," explains Ager.

3. Archives existing knowledge. Create historical records by categorizing and abstracting knowledge gleaned from interactions. Make it easy for users to locate relevant learning. Ager uses his KM system to share documentation prior to the actual teleconference with the other participants. They use spreadsheets and data management for references when talking on the telephone. "I've found this aspect beneficial because as we are talking, I'm able to look at the information firsthand and it spurs questions for me too," says Ager. Additionally, all participants receive e-mail summations of the teleconference (created by the KM system coordinator). Call topics are based on the suggestions and questions introduced in previous teleconferences. If one facility has a specific question, the coordinator will request examples related to this question from all participants, summarize the information and then forward it to all facilities.

4. Facilitates "new" knowledge. Knowledge comes from many sources including knowledge forums, conference calls, research articles, surveys, and opinion polls. Encourage participants to exchange ideas and share experiences, challenges and successes. Most people are not able to develop an action plan simply by reading or analyzing data. Rather, they are more inspired by talking and exchanging ideas. According to Ager, "Participating in the teleconference calls is one of the best ways of sharing information that I've been exposed to in the last nine years since I've been working for this facility. It's given me real time data and real people to talk to. Issues constantly change. At one point, staffing was a priority at several of the facilities and because we shared information, other facilities implemented the shared ideas when it was the right time for them. It's easier than looking at a piece of paper with raw data on it wondering what to do with it."

Moving Forward

The explosion of information technology and its instant accessibility have created powerful solutions for the healthcare business. Healthcare must invest its resources and technology wisely. A carefully considered and well-resourced KM implementation will enable organizations to leverage data, knowledge and experience to improve patient care and lower healthcare costs. Why 'reinvent these conversations' when they've already taken place countless times? KM systems designed to serve an organization's goals, and built to foster social interactions that encourage the exchange of knowledge, will assist organizations in revolutionizing healthcare.

Sidebar: Keys to Generating New Knowledge
Use these ideas when designing a KM system:

· Create Communities of Practice (COP)

· Moderate COP processes to extract learning

· Make continuous learning available

· Determine how successes are shared and how failures are communicated

· Analyze failure for future learning

· Generate, abstract and categorize historical knowledge records

· Provide multiple access paths for participants