Your Say: KM in the healthcare industry

Healthcare provision is a knowledge-intensive business, and the consequences of an organisation failing to make best use of the knowledge assets at its disposal can be severe. Simon Lelic talks to representatives from the American Heart Association, Cilip, Fujitsu Services, Jenny Stephany Associates and the NHS, and gauges the impact of knowledge management in the healthcare industry so far.

People all over the world rely on a huge array of organisations for the provision of healthcare, from public-sector monoliths and governmental agencies to privately funded associations, consulting and advisory groups, and charities. It is a massive industry, and every organisation it encompasses faces a unique combination of operational hurdles. Any discussion of the healthcare sector as a whole, therefore, can only be in the most general of terms. Yet what every healthcare system has in common is the high price of failure. Faced with the prospect of failing to prevent – or, worse, directly causing – suffering and death, the importance of continuously improving efficiency and effectiveness is high on the agenda for the majority of healthcare organisations. It is consequently not surprising that knowledge management is attracting so much attention from the industry as a whole, but questions remain as to whether the rhetoric is being matched by direct action.

As a formal discipline, the impact of KM has so far been limited. ‘Knowledge’ branding on portals and websites, as Mark Field, information and knowledge management adviser for Cilip, says, is becoming more common, but many tend towards information management and the provision of links to useful resources – admirable in itself, but a long way from knowledge management per se. As Tom Knight, principal consultant for Fujitsu Services, says, “Whether you are talking about the growing emphasis on sharing good practice, or on joining up the health-focused social-care agenda with social-work services, you find solid KM thinking starting to creep in in many corners, even though the language may feel unfamiliar.” But if you probe a little deeper, he continues, and question trust or local authority managers on what ‘knowledge management’ means to them, you are likely to get an answer – if indeed you get one at all – that focuses on data standardisation and the impact of health informatics.

Knight feels that, in the public sector in the UK at least, this is a reflection of the way health authorities and trusts have been managed in the past, as well as the way KM consultancies have engaged (or not) the health industry as a whole. In the private sector, knowledge management is arguably more advanced. As healthcare adviser Jenny Stephany says, this may be because many private-sector healthcare organisations have an insurance base, where KM systems are more developed and from which certain general principles may be transferable. Similarly, she continues, private-sector initiatives tend to segment their markets more effectively, in turn developing more targeted KM programmes. In many cases, higher levels of funding have no doubt also played their part. And yet, as Vickie Peters from the American Heart Association suggests, “The entire galaxy of organisations relating to healthcare are years behind in adopting management and infrastructure models that could improve their performance.”

Thankfully, awareness of the issues that surround knowledge management appears to be improving. Thus far, as Stephany says, the interpretation of the term has been relatively narrow, concentrated on knowledge content and mechanisms for delivery – typically referred to as first-generation knowledge management. “Understanding of key issues relating to the cultural and contextual aspects of KM seems relatively underdeveloped,” she adds. On the other hand, there is a learning curve when it comes to KM implementation. Józefa Fawcett, a consultant and project director of the Knowledge Management Centre (nhs) Network (Berkshire), is confident that healthcare organisations, particularly those within the UK’s NHS, are ready to move to the next level. “The NHS has really grasped the informatics and document-management side of KM,” she says. “Further work is now needed on developing the kind of approach taken in Berkshire, which focuses on the human/social sciences side of KM and how it can support collaborative working and knowledge sharing as a way of informing decision making and problem solving, and promoting change.”

Knowledge management is nevertheless a particularly complex issue for health organisations. The potential benefits knowledge-management implementation could bring are of course enormous: better outcomes for patients, cost reduction, enhanced job flexibility, and improved responsiveness to patients’ needs and changing lifestyles and expectations. “Better collaborative working across boundaries will ensure more effective communication, leading to focused and (hopefully) seamless care interventions and a better patient experience,” says Fawcett. “Using KM to its full potential can support change processes, underpin appraisal systems, provide learning opportunities and a way to really value the wealth of knowledge and expertise carried around in the heads of healthcare workers.” If these goals are to be fulfilled, however, a number of barriers specific to the healthcare industry first have to be overcome.

Chief among these, says Peters, is the problem of how to achieve any degree of integration across such a fragmented sector. “Knowledge management within a single organisation cannot be separated from the larger healthcare system,” she argues. “KM solutions must facilitate the transfer of patient medical information, access to new treatment protocols as they emerge, knowledge exchange among expert consultants on systems-level solutions – and so on.” Add to this the extraordinary levels of bureaucracy (particularly in the public sector) and, as Field says, all the traditional hurdles relating to fiefdom, tribalism, jealousy, ingrained habits, rigid management structures and insufficient time and money, and it is understandable why progress has so far been limited. Healthcare providers also have to balance longer-term targets with short-term operational needs, as Knight points out. “Funds formally allocated for change programmes or new IT systems have been diverted by some trusts in the UK towards alleviating short-term pressures such as waiting-list reduction,” he says. “This is understandable, especially in a world of league tables and institutions being labelled as ‘failing’, but it doesn’t help deliver on the long-term change agenda.”

To overcome the difficulties relating to fragmentation in the healthcare industry, Peters believes some form of standardisation legislation is required, particularly in priority areas such as electronic records. Alternatively, Stephany suggests healthcare organisations consider shifting from a purely internal focus towards one driven by specific programme or disease priorities, thus crossing organisational barriers. More immediately, Knight encourages healthcare providers to start small and work their way up. “Pilot change on a small scale,” he says. “Then, create case studies that tell the story in order to demonstrate potential and bring on board those stakeholders who stand to benefit from wider implementation.” Healthcare providers also need to develop a clear strategy that outlines the role of personally held knowledge and corporate information in delivering on the organisation’s stated goals, he continues. “This should be accompanied by a detailed programme for implementation with clarity on benefits expected from each element in the programme and clear accountability for making sure those benefits are realised.” This is all good practice in any KM programme, of course, but the need for a methodical, structured approach to implementation is all the greater in such a multifarious industry.

It is in this type of environment, too, that the real value of technology becomes evident. Many commercial businesses have already learnt the hard way that expensive ICT systems are not the be-all and end-all of knowledge management, and healthcare organisations need to be careful that they are not seduced by technology’s sirens. The healthcare industry has already demonstrated how valuable technology can be in certain situations, however. In last month’s edition of Knowledge Management, for instance, Tom Davenport described an expert system used by Partners Health Care System in Boston that has succeeded in maintaining the autonomy of physicians at the same time as reducing medication errors by over 50 per cent.[1] A further example of an invaluable technology-based project in the NHS is outlined in ‘Untangling the knowledge web’, which begins on page 13. As Peters says, employed in the right context, technology can help to facilitate integrated decision making, integrated business processes and integrated experiences for patients.

The danger, though, is that healthcare providers miss the opportunity to learn from their peers and neglect those aspects of knowledge management that make the difference between failure and sustained success. “Too much reliance on the informatics and not enough time and energy on the people who are using the system will only create online information junkyards that no-one has time to use properly,” Fawcett says. Indeed, Stephany is wary that this may already be happening in the NHS. “The pressure to invest in IT infrastructure could well divert attention from the wider questions related to ensuring the impact of KM within healthcare organisations is sustained and developed,” she says. “For example, the current emphasis on specific applications as part of the implementation of the national strategic programme could divert attention away from identifying and addressing key knowledge-flow bottlenecks.” This is arguably a symptom of the perennial obsession with short-term results that typifies so many healthcare providers, particularly those in the public sector. “Those responsible for long-term change need to rise above short-term pressures to gain clarity of what the needs will be in the future, and to begin putting things in place to help that come about,” says Knight.

As it is, Peters is sceptical that the number of healthcare providers implementing KM will rise substantially in the near future. “The economy, the continued fragmentation of healthcare, the potential impact of bio-terrorism on resources and political decisions that impact coverage and affordability may be so overwhelming that KM becomes a low priority,” she says. Others are more optimistic; Fawcett, Field, Knight and Stephany included. At a policy level, says Field, there is an absence of reasons not to implement KM, while Stephany is adamant that the growing understanding that healthcare provision is above all a knowledge-intensive business will become the governing factor. Whether healthcare organisations begin to move beyond first-generation interpretation of the principles and practices involved is another matter, for there is clearly still some way to go in this respect. If they do not, however, there is every chance that many projects will ultimately fail, and when organisations are dealing with life and death on an everyday basis, the price of failure – in terms of wasted resources and a missed opportunity to improve working practices – may be unacceptably high.

Reference

1. Davenport, T., ‘Making knowledge work productive and effective’ in Knowledge Management (Ark Group, November 2002)

Contact details

Józefa Fawcett is director of the Pol (Personal and Organisational Learning) Experience and project director of the Knowledge Management Centre (nhs) Network (Berkshire). She can be contacted at thepolexperience@hotmail.com

Mark Field is an information and knowledge management adviser for the Chartered Institute of Library and Information Professionals. He can be contacted at mark.field@cilip.org.uk

Tom Knight is principal consultant at Fujitsu Services. He can be contacted at tom.knight@services.fujitsu.com

Vickie Peters is director, strategic planning, at the American Heart Association, National Centre. She can be contacted at vickiep@heart.org

Jenny Stephany is a healthcare adviser at Jenny Stephany Associates. She can be contacted at jstphany@dircon.co.uk