Holistic KM at the Department of Health

The Department of Health recently embarked on an extensive programme to implement its KM strategy, which will ultimately impact upon every aspect of the agency’s activities. Karen Lewis outlines the programme’s key goals and methods, and reveals the progress the department has made so far.

The Department of Health (DH) has been developing its approach to knowledge management for the past two years. Having a well-developed ICT infrastructure – together with both the advantages and the problems this brings – we could see the potential benefits of adopting a more holistic approach to KM. This understanding was reinforced by the findings of a major departmental review in 2001, which highlighted the recognition that knowledge underpinned the work of the department, although common themes of concern centred on how we could ensure its accessibility, quality, relevance and usability.

Other significant factors in our decision to develop a KM strategy included wider changes within the machinery of government itself. Chief among these was the continued move towards evidence-based policy making, notably in the areas of shared access to documentary information, and better identification and involvement of internal and external experts. The need for greater efficiency relating to the requirements for freedom of information, data protection and electronic records management acted as a further incentive.

One of our earliest initiatives with KM was the development of Klimt, our Knowledge Learning and Information Management Toolkit, which we discuss in greater depth below. While we were piloting Klimt, we embarked on the development of a complete knowledge-management strategy for the department. The first stage of the process was a study, undertaken for us by Fujitsu Services in 2001. We were fortunate in that the study was able to draw on the accumulated knowledge of both the various departmental knowledge-management initiatives already underway and the issues that arose during the development of Klimt.

The study established the direction of the strategy by showing us where we were – in terms of ICT, processes and practices – what we were good at and where we were less successful. This was overlaid with the ‘drivers’ arising from the need to meet departmental goals. The study then identified where and how knowledge management could help us achieve these targets. It used a strategic framework comprising four parts, each relating to strategic activity (see also figure 1):

Department drivers – Identifying the role of knowledge in supporting ministers more effectively, improving the policy-making and policy-implementation processes, facilitating delivery to the NHS, coping with organisational change;
Knowledge-management strategy – Assessing the current situation, setting the vision for knowledge and examining the options available through six knowledge-management ‘levers’ for improving KM performance;
KM-implementation programme – Identifying actions and co-ordinating activity;
Measurement – Determining how successful the activity has been in delivering the knowledge-management vision and supporting the attainment of departmental goals.

The resulting strategy has senior-management support and is now an integral part of the department’s corporate development programme. It has been developed around the need to blend the three classic KM elements of people, processes and tools. As with many large organisations, we recognised that we were strongest in the latter and that future emphasis would have to be put on the first two factors, at the same time as we continued to improve our ICT infrastructure.

While there are many considerations in attempting to implement any major programme of change across a large organisation, we feel there are three crucial aspects needed in the transition towards a fully KM-enabled environment. The first of these is to acknowledge that ‘doing KM’ isn’t just about delivering yet more IT. We also need to make our colleagues see that this is not just another fashionable idea, but a real opportunity to enable us to do what we already do, but better. Finally and equally important, our strategy recognises that KM is not something that can be done to people; rather, it needs to engage them fully. To this end our implementation plan, with its initial two-year programme, touches on virtually every aspect of life in the department and engages with many different communities at all levels.

Figure 1 - the DOH's strategic framework for KM

Organisational background

The aim of the DH is to improve the health and wellbeing of people in England. In brief, we develop policies, set and monitor national standards of public health, provide guidance to health and social-care specialists, and promote healthier lifestyles.

We have over 5,000 staff, of which many are based in our twin headquarters in Leeds and London; others work in a variety of locations around England. In all, we have staff in over 50 locations. We also have staff working from home and a number of mobile workers, who spend little time at their base. As with any other large, geographically dispersed organisation, this presents a number of issues, both physical and behavioural. Add to this our need to maintain close communication links with the NHS, DH agencies, the wider government community and the public at large – all of which impacts on how we manage and share our corporate knowledge.

Over the past 11 years, the department has developed an extensive ICT and information infrastructure to enable staff to communicate and share information. The roll-out of our network started in 1992 and, by 1993, all staff members were connected. Early ‘e’ tools included a staff-location directory, followed by a business directory. The first DH internet site was launched in 1995. Our first intranet, the Noticeboard, was launched in 1996. The following year we began experimenting with remote networking and staff members were also able to access NHSnet and the internet. In 1998 we launched our electronic records-management system (Meds) and the very first online ministerial briefing system (known familiarly as Mint, now Chip), which was the prototype for the award-winning, government-wide system, the Knowledge Network. In 1999 we re-launched our intranet and our fully developed remote networking system. Our key workflow processes, eg, parliamentary questions, policy briefing, correspondence tracking and so on, are now all automated using Lotus Notes. Developments are continuing apace as we introduce new applications, upgrade existing ones and accommodate changing organisational boundaries and relationships.

The effect of all of these developments has been to provide the department with an extensive range of information and knowledge stores, but they are not yet linked sufficiently to create a fully cohesive knowledge base. However, the study undertaken by Fujitsu identified our position in this respect as being fairly advanced; we already had a comprehensive underlying architecture for enabling future KM efforts. We have also undertaken a number of significant knowledge-related pilot projects and local initiatives, which have already demonstrated the potential for changing working practices and behaviours to make better use of knowledge. These have helped us to identify the main areas to be addressed in our ongoing KM strategy.

The strategy and its implementation

A crucial element in both justifying the need for a KM strategy and gaining the support and endorsement of senior management was to identify the strategic business outcomes we envisaged from its implementation. In common with the experiences of many other organisations, the process of having to produce evidence of tangible benefits to the business that KM would generate was particularly difficult. However, we concluded that, for the department, these could be grouped into two main areas:

Developing and motivating our people –
- Improving the job experience through better information-management skills;
- Building the effectiveness of the department to deliver on key targets;
- Improving the induction process;
Improving organisational memory –
- Knowing what we know;
- Learning lessons from the past;
- Building the knowledge base;
- Ensuring public accountability.

The importance of all of the above to the success of the department’s business came through strongly in the departmental review. A further, very practical illustration arose from the significant organisational restructuring that took place earlier this year. Large numbers of key staff moved on to new organisations within a very short space of time, taking with them invaluable knowledge and experience, which, at the time, we had not been able to capture fully. We anticipate that our KM strategy, once fully implemented, will leave us better prepared to deal with future events of this kind.

The framework for the supporting implementation programme is based around four key strands of work:

Leadership and accountability – This strand focuses on identifying the roles, responsibilities and activities required at all levels, from senior-management commitment through to work-group level. We are going for a combined top-down and bottom-up approach. Specific initiatives in this area are aimed at aligning knowledge management in direct support of departmental initiatives, for example the corporate development programme, piloting different approaches to policy making and improving our responsiveness to the public;
People and change management – Projects and initiatives in this strand are concentrated around establishing the behaviours that will help us to improve how we manage knowledge, in addition to how to motivate and enable employees. One example of this is the incorporation of KM principles into the development of our new e-induction package, which we intend to roll out in March 2003. Klimt, our knowledge-management toolkit, is another important element of this strand of the framework;
Content and processes – We are looking at a range of projects in this area, examining our physical management of the knowledge and information lifecycle and the processes surrounding it. We have successfully employed knowledge-harvesting techniques in this area. Two current projects are centred around the use of, and access to, statistics by policy officials;
Information infrastructure – The final strand of our strategy is based around further improving the supporting infrastructure and tools available to improve access to, and the management of, information. Particular challenges will be to support the changing departmental structure and provide an effective information interface with external partners. Two key projects here are the development of our information-management framework and providing a common, easy-to-use thesaurus across all knowledge sources.

By way of further illustration, two of our KM projects are described in more detail below.

Klimt (Knowledge Learning and Information Management Toolkit)

Klimt is a diagnostic tool for work groups. It requires individuals and groups to look at their own behaviours as a means of establishing why, how and where knowledge management could help them. The goal is to make work groups more effective and efficient. Anecdotal evidence shows that it enhances the working environment, too.

The framework was first developed for us by Fujitsu Services in 1999 and has since played a significant role in our thinking about the benefits of KM to the department as a whole. Over time, working with pilot groups and developing the Klimt process, we realised that, as important as a bottom-up approach is, it is not sufficient on its own. It became clear that there were a number of prerequisites to success, central among which are infrastructure tools, appropriate budgetary levels and senior-management commitment. A central role to provide co-ordination and facilitation, to gather and share the lessons learnt, and to provide future direction is also important. Our experience here proved invaluable in developing our strategy, of which Klimt has become an important element.

Klimt is a facilitated set of processes and workshops that can help groups:

Analyse the range of knowledge assets at their disposal;

Ascertain their value, use and accessibility;

Address gaps in knowledge and amend working practices;
Request new tools and implement other changes to make their workplace more effective and efficient.

This is achieved by:

Completing a pre-workshop questionnaire, which helps the group to gauge where they are now;
Taking part in the workshop, which enables the group to identify and understand the knowledge issues they need to address
Creating and implementing an action plan that will address those issues;
Ongoing work to make sure that momentum is maintained and that necessary change is sustained.

Klimt is not an IT solution and most of the work that has to be done as a result of it will be taken forward by the work group itself.

The Klimt process:

Stage 1 – An initial meeting with work-group management to consider whether Klimt might be of value to the particular group;
Stage 2 – At least one workshop and possibly more (depending on the size of the work group) to identify an action plan to address knowledge needs;
Stage 3 – The action plan is put into operation by the work group, with support if appropriate from the department’s KM team;
Stage 4 – The KM team carries out a review process with the work group, capturing lessons learnt and areas for further development. This would normally take place three to six months after an action plan has been agreed.

Figure 2 - the Klimt checklist

Meds (Management of Electronic Documents Strategy)

Meds was developed to help improve the way the department manages electronically created documents and records. It underpins the DH’s strategic approach to delivering the modernising-government target for electronic records that, “By 2004 all newly created public records will be electronically stored and retrieved.” We recognised at the outset that Meds was a crucial development in improving the maintenance of, and access to, the corporate memory. As such, it now plays a significant role within our KM strategy and has informed our thinking in a number of areas, not least regarding the importance of engaging fully with work groups to embed new ways of working.

The resulting Meds system was developed to provide a parallel paper and electronic-document store as, while the department conducts most of its work electronically, it still receives a high proportion of paper documents. It incorporated the awareness and good practice previously established in the DH’s ‘For the record’ initiative and placed existing procedures in an electronic environment.

The system consists of two linked Notes databases – a registry and a document store – for each business unit. The registry holds information about each registered and working file and will replace the traditional file list. The document store holds all of the electronic documents that sit within the registered files. A central file registry supports central co-ordination of major elements of the corporate file-plan and allows records-management specialists to monitor and audit use of the system.

The Meds Basic Module provides the following facilities:

Ability to save many types of electronic document formats (Word, Excel, etc);
Automatic saving of documents to the registered file;
Comprehensive search facilities covering every document and any attachment within the document store;
Sharing with all staff, regardless of location, who need to see the information;
An e-records infrastructure that allows staff to develop new ways of working as their business needs dictate.

An initial pilot, developed in 1998, ran for almost two years in the run up to the DH upgrading its network. Evaluation showed that many pilot users were enthusiastic, and clear business benefits were apparent.

Following the network upgrade, a Lotus Notes prototype was developed and rolled out across a number of work groups. The original pilot groups and their data were also moved to the new prototype. The prototype was further improved in the light of past experience, and the MEDS Basic Module was ready for use. By March 2002, over 1,600 employees were using Basic Module 1 while further refinements, which eventually resulted in Basic Module 2, were made. Basic Module 2 is now being rolled out across the department and we intend that it will be fully available to all staff by December 2003. Work is also well advanced in securing electronic records beyond the basic module, specifically those that are generated from business applications, websites and research databases.

An essential aspect of the roll-out of this new system is that training in the use of the system is not regarded as being sufficient in itself. The implementation process also involves working with each group and looking at local processes and practices to see how these can best be absorbed and/or improved by Meds.

By the end of 2003, all DH staff will be able to store and retrieve electronic records from their desktops, and work is progressing towards making older records accessible to staff across the department. Ephemeral or working documents can be shared for short-term use as part of the same system. New working practices are already being developed, based on the ability to share records and documents with colleagues anywhere on the network. The practical experience in supporting cultural change gained through the Meds programme will provide valuable input as we plan other elements of our KM strategy.

The Fujitsu study recommended that moving knowledge management forward in the department could best be achieved through a gradual approach that builds on current initiatives and focuses on exploitation of existing tools, infrastructure and change management. It further recommended that we should develop an iterative process of continuous improvement, introducing a series of practical, manageable changes. To this end, the two-year implementation plan outlines a range of initiatives, pilots and projects that aim to cover the broad span of our knowledge-management activity. The programme is designed to be flexible and will be tailored and further developed accordingly. We will be building on successes and practical experience of what works well with particular work groups and in a departmental context.

Our vision

Although we have established a two-year implementation programme for the strategy and are looking to achieve a number of short to medium-term gains, we do not expect to have ‘done’ knowledge management at the end of this period. Many of the elements in the programme extend beyond the initial two-year timeframe and will form part of our ongoing commitment to developing DH staff as knowledge workers, ensuring they have the tools, skills and motivation to make best use of the department’s knowledge base.

When our vision is achieved, our ‘knowledge workers’ will be able to draw on the complete range of knowledge available both within and beyond the department in hours instead of days or, potentially, weeks. For the policy adviser, this will have the effect of significantly cutting down the time needed to prepare a brief for the appropriate minister. The analyst will be able to cross-reference comparative data from a range of sources. Staff working offsite will have information available when they need it. Our customer-services centre will be able to field the bulk of inquiries from the public directly, freeing up the policy adviser or specialists from answering routine questions. This vision will be fully realised by the process becoming iterative, whereby the knowledge base is maintained and enriched by those same knowledge workers feeding their knowledge back in.

Karen Lewis is section head, KM and intranet services, at the Department of Health. She can be contacted at karen.lewis@dh.gsi.gov.uk