Feature

posted 16 Apr 2002 in Volume 5 Issue 7

Knowing me – knowing you?

An organic solution to dealing with organisational change

Knowledge management has evolved as a crucial mechanism in helping the UK’s National Health Service cope with the constant level of change the organisation, as Europe’s largest employer, is faced with. Józefa Fawcett describes how a country-wide project using an organic KM infrastructure is leading the way towards improved communication, understanding, and service provision and care for patients.

Allow me to briefly introduce you to the National Health Service (NHS), some of the current changes impacting on healthcare provision, clinical development and training, and to present a case study of how the Knowledge Management Centre (nhs) (KMC) Network in Berkshire is encouraging a new way of learning, collaborative working and sharing knowledge and expertise across professional, organisational and sector boundaries.

Modernising the NHS

The NHS became a reality on 5 July 1948, and over the last 54 years there have been constant changes in health care provision, some of which have caused major organisational headaches and on-going human resource problems. Financial constraints over the years have made it impossible to accurately predict the day-to-day costs of running the NHS, particularly as public expectations grow and more expensive and more frequently used drugs are developed. These tensions continue to challenge senior management and, indeed, successive governments. The current government’s answer to the problems facing the NHS was outlined in its white papers in 1997[1] and 1998[2], making clear its aim of building a modern and dependable health service that provides a fast, responsive and high quality service across all parts of the country. The NHS Plan[3] further outlined a five-stage improvement programme, which included breaking down barriers between different parts of health and social care, and investing in staff, buildings, equipment and information. The restructuring of the NHS began on 1 April 1999 with the creation of 481 Primary Care Groups, each responsible for the co-ordination of healthcare provision. After only five months, two-fifths of these were aiming to become Primary Care Trusts (PCT), with further responsibilities for developing partnerships in commissioning and provision. Berkshire is made up of six Primary Care Trusts, one Mental Health and Learning Disabilities Trust, one Ambulance Trust and two general hospitals.

Changes in the provision of healthcare

The whole of the NHS is working towards an ‘interface’ model of healthcare, a fundamental principle of which is to encourage and enable different relationships between the patient, the clinician and other clinical professionals. These new relationships – based upon consensus teams, integrated practice, blended roles, management integration, mutual acceptance and support for the good of the patient/client – also mean a change in leadership and management styles. Many writers have focused on the strategic issues around consensus building, integration and collaboration. Rosabeth Moss-Kanter argued that to create world-class, 21st century organisations, a range of skills are needed that allow each organisation to operate either with a “collaborative advantage” or as a “collaborative ambassador”[4]. These skills are categorised under three important headings: concepts, competence and connections.

To those in the NHS, this model of collaborative and consensus working between the professions might seem like an impossible dream, but it is from this starting point that the idea for the KMC Network originated.

Various KM approaches in the NHS

One oft-cited definition of knowledge management comes from Karl-Erik Sveiby, who says: “Knowledge management is an organisation’s capacity to influence and create value from its intangible assets.” Others have described KM as the process of managing both explicit and tacit knowledge, and it is clear that few activities depend on knowledge as much as healthcare management, clinical practice and patient choice. To date the NHS has spent more energy on managing buildings and money than on managing its knowledge. This is now changing and there is a major shift towards embracing two strands of knowledge management: the traditional strand, offering a scientific approach where the emphasis is on the management of information and the speed and accuracy of data storage, retrieval and dissemination; and the increasingly popular European strand, concentrating on a more organic approach, and the management and mobilisation of people and their knowledge with a view to encouraging creativity and innovation within an organisation. There is, however, growing confusion as to the difference between information, which is embedded in tools for processing data quickly, and knowledge, which is embedded in the minds of the workforce and depends on a variety of social interactions to encourage knowledge harvesting/creation. The key to any successful KM strategy is to apply a blended KM approach, adopting the best fit for the organisation and its context. No longer does one size fit all. In response to this, the NHS has developed four distinct approaches to KM over recent few years:

· The HR/OD approach (most similar to the organic model) – typified by regular forums, which raise awareness of how to support change initiatives through human resource and organisational development professionals;

· The informatics approach (most similar to the scientific model) – for instance, the NHS Information Authority is working with NHS librarians across the UK on how to adapt and influence the new environment in which the NHS operates. There is also a National Electronic Library for Health;

· The research & development approach (a mix of the scientific and organic models) – as demonstrated by the creation of a national tool designed to identify ways to increase individual and organisational research and development capacity, and promote systematic take-up of research evidence;

· The learning network approach (again, a mix of the scientific and organic models) – for example, Regional Learning Networks offer leadership and management development programmes for non-executive directors and clinical leaders, learning centres, learning partnerships and beacon sites for sharing intelligence.

The Berkshire KM project

The KMC Network was formed in May 2000, its purpose being to encourage knowledge sharing across Berkshire’s professional, organisational and sector boundaries, to build up working partnerships for the future and to provide a wide range of information regarding traditional and e-learning opportunities. The project’s key deliverables, to be realised by March 2003, are:

· Set up KM centres around Berkshire, creating local communities of practice, each with a Learndirect e-learning access point;

· Create an infrastructure that aligns the KMC Network with other development projects going on around the county and establishes working partnerships;

· Market the provision of e-learning facilities for all health and social care staff in Berkshire;

· Support distance learning through the establishment of an e-Learning Advisory Team;

· Act as a ‘signposting’ service that serves to connect people across Berkshire, in order to fully utilise the vast array of explicit and tacit knowledge held within the county;

· Facilitate cross-boundary working relationships so as to underpin the next phase of health and social care changes post-2003.

Berkshire has a number of well established postgraduate libraries that guide users to a variety of existing databases, a corporate intranet and clinically specific websites. This organic KM project, however, seeks to widen access to existing information for healthcare staff who have limited time or have no access to computers in their day-to-day work.

The aim is to allow staff on the ground to access national and other high-level sources of information (guidelines, learning provision, etc), share expertise across joined-up initiatives, and form collaborative partnerships through their own geographically supportive framework. ‘Human portals’ – the KM intermediaries who run the KM centres – can help staff get advice on how to find the information they require and discover what initiatives specific to Berkshire are underway, as well as encourage them to share their local learning (tacit knowledge). The role of these KM co-ordinators is to mobilise this knowledge, rather than simply manage it, and to ensure that those responsible for future decision making and problem solving have access to the wealth of talent already at work across the county.

In July 2000, the KMC Network was invited by the south-east regional office of the NHS to promote the UK-wide NHS e-learning initiative, a partnership between the NHS and the University for Industry. This led to the KM Centres becoming licensed Learndirect sites, allowing enrolment onto any of the 400+ courses available.

Project methodology

The plan is to open six KM centres across Berkshire by 2003. Local implementation teams (made up of partners from health, social, independent and voluntary care sectors and borough councils) have been brought together to oversee the introduction of each KM centre for their own geographical area. The e-Learning Advisory Team addresses the cultural issues associated with the development of the new learning technologies and a Project Advisory Board regularly reports progress to the Department of Health via a National e-Learning Action Group. As one of 16 e-learning pilot NHS sites across the UK, Berkshire is unique in that it is approaching the project with a KM focus that is reflected across numerous sectors on behalf of a whole county. Funding for the project comes from the DoH and the south-east regional office of the NHS, with local on-going support from the project sponsor, Windsor, Ascot & Maidenhead PCT and other stakeholders across the county.

Lifelong learning and KM

Each KM Centre is organised into KM zones:

· The Reflection Zone, with dedicated Learndirect computers;

· The Information Zone, with internet connections, books and journals, and completed assignments, dissertations and other more general information donated by staff members;

· The Networking Zone, providing a neutral venue for meetings;

· The Interprofessional Learning Exchange.

This last KM zone is particularly exciting, because it is introducing ways to further promote and encourage collaboration through a variety of KM initiatives:

· A Postgraduate Advanced Certificate in Change Management (accreditation pending);

· The KM Sharematch scheme – for British readers, this is a cross between ‘Blind Date’ and ‘Jim’ll Fix It’, offering staff an opportunity to work-shadow another profession, cutting across sector boundaries;

· A KM database, capturing information about the talented workforce in each geographical area;

· The Development for Trainers in Berkshire forum, a supportive network through which members can reflect upon the latest learning practices and share professional knowledge;

· The KM Collaborative – aimed at those who are leading KM initiatives, whether from a technological, management or social perspective, this network focuses on how to apply KM principles to other initiatives.

Strategic partnerships

We are constantly seeking out new ways in which we can mobilise local knowledge, from a strategic and an operational perspective, and as such we are keen to identify areas in which we can create local partnerships to drive this work forward. As this is part of an on-going communication and activity plan, the KM co-ordinators regularly work to promote the KMC Network across the county. As interest in knowledge sharing opportunities grows, this work is now paying off. One long-standing partner has been the Health Promotion Service, which uses the KM centres as a shop window for the leaflets and information it produces.

Constraints

Working on a project such as this, which is based on collaboration and networking during a period of large-scale, multi-organisational change, offers both exciting challenges and more practical constraints. A significant challenge is driving the cultural shift from the bottom up, while local resourcing of the project has also been patchy as a result of the changes taking place during 2001/2002. However, as the economy now seems to be entering a period of some stability, the project can resume at the level and pace necessary to meet the intended target dates. Finally, there is a danger that, due to its popularity, access to technology will become the dominant issue, rather than access and utilisation of the knowledge itself.

Project achievements so far

· Two KM centres are already open, and two more will be opening on 16 May 2002, National Learning @ Work Day (part of Adult Learners Week, which runs from 13-17 May);

· A KM database has been built around a generic taxonomy that reflects the clinical governance agenda;

· A mechanism for capturing ‘tacit’ knowledge from local workforce communities has been introduced;

· The project is regarded as a ‘signposting’ service to other providers of information, learning and the like;

· Statistics show a steady increase in people utilising e-learning facilities over the past 12 months;

· There have been a variety of regular users of the KMC network, with local ownership improving further as the health economy stabilises. The network is already proving to be a good framework upon which to develop other countywide initiatives eg, ECDL training and assessment, forthcoming links with a new Centre for Primary Care and Public Health at Reading University and the soon to be developed Public Health Network;

· A KMC website has been launched;

· Links have been fostered with the wider global KM community, including the European KM Forum (a European KM community), Timsoft in Romania and the European Training Village (an interactive vocational education and training facility).

Next steps

In taking this pilot project through to its completion in 2003 (and hopefully to its localised beginnings elsewhere) there is a need to build upon the current communities of practice and encourage greater usage of the expertise stored in local databases to inform future decision making and problem solving. Though e-learning opportunities are well publicised, a learning and development policy needs to be implemented in each organisation incorporating this new and flexible learning solution. More anecdotal evidence also needs to be collected from the Sharematch work-shadowing scheme as to how the initiative underpins improved understanding and future networking. In 2001, a Knowledge Work Contributions tool[5] was designed to assess the effect of this project in the areas of:

· Learning and sharing behaviour changes;

· Recruitment, staff retention and other organisational imperatives;

· E-learning take-up across professions;

· Establishing ‘communities of learning’.

This tool will be applied during 2002, and a further paper produced to report its findings and make further recommendations as to how each organisation in Berkshire can build the mobilisation of knowledge into its strategic planning processes.

Conclusions

This KMC Network project focuses less upon the mechanics of managing knowledge and more on the challenge of how to mobilise and effectively share this knowledge across organisations. Innovations that enable the workforce to learn and share are hard to maintain, and if KM is to be successful then the end result must be a change of culture at all levels. It is not enough to introduce a website or a database; a plan as to how each organisation can build the skills necessary to use the knowledge that is being created also needs to be in place. Berkshire has taken this first important step in crossing the traditional NHS boundaries in relation to learning, knowledge sharing and the utilisation of local intellectual capital. In so doing, we are creating opportunities for the workforce to influence and inform the future provision of health and social care services for our patients.

References

1. ‘Modern and Dependable’ (The Department of Health, 1997)

2. ‘A First-Class Service’ (The Department of Health, 1998)

3. ‘NHS Plan’ (The Department of Health, 2000)

4. Moss-Kanter, R., ‘Change is everyone’s job’ in Organisational Dynamics Journal (Summer 1999)

5. The Knowledge Work Contributions tool was developed specially for the KMC Network by David Simmonds, author of The Evaluation Toolkit (Fenman Publishing, 1998)

Józefa Fawcett is head of workforce development at the Berkshire NHS Shared Services Organisation. She can be contacted at: jozefa.fawcett@berkshire.nhs.uk