A healthy outlook for KM

While developing a new approach to innovation projects in the Dutch healthcare sector, Eric Kalter, Lars Naber and Paul Iske identified three key aspects to their approach. Innovation should be seen as a fair process; it should be owned by all stakeholders and be knowledge enabled. Here they describe how the project has developed into a network-driven, knowledge-conscious approach to innovation.

In 2001, an initiative was taken by the Dutch Board of Medical Specialists to develop a standard for healthcare innovation processes. The project aimed to build a structured, uniform approach to the development of these innovation projects and to facilitate the dissemination and implementation of projects that excelled in content, and organisational or financial aspects. It was known that successful innovation projects were not easily adapted at other locations operating under similar basic conditions.

This was partly because the Dutch healthcare system lacked state-of-the-art communication and information technology, and its reimbursement system did not suit the needs of professionals willing to develop and adopt innovations in healthcare.

The proposed standard also aimed to improve communications about innovation projects to third-party stakeholders: the management at healthcare institutions, the government and the healthcare insurance companies that are, for example, often involved in the approval and financing processes. Within a year, the standard had been developed by a taskforce made up of a multitude of organisations involved in Dutch healthcare, both from theoretical and practical perspectives. The composition of the taskforce was unique, as was the effective way in which it co-operated and created the standard. The team worked together as a community of interest, applying knowledge-management principles and combining the expertise of its members in their respective areas to a new principle, as laid down in the first version of the guidelines, ‘Good Healthcare Innovation Practice’. This article describes how this process was enabled and supported, and how it was effective in such a short period of time.

Start-up phase

The Dutch Board of Medical Specialists carried out a survey of organisations that were confronted with similar problems with their innovation projects, albeit from different perspectives. The responses to the survey showed that a widely accepted method was required for designing, carrying out and documenting an innovation project with transparent results. Such a method was expected to improve the ability to compare projects and their results, as well as their portability to other sites. Between 25 and 30 organisations took part in the working group, which represented a wide spectrum of parties involved in healthcare and its related fields. Often, more than one person was able to carry out tasks or provide intellectual support as a senior member of staff. The first meeting was held on 30 October 2001.

Methods and supportive actions

Typically, community members had a genuine desire to share their knowledge and felt a responsibility to make the project work. Of course, people also wanted to contribute as they were aware that they were participating in a knowledge-management process.

An important aspect was to start the process on a semi-formal basis. People were not officially assigned by their organisations but participated voluntarily as they realised that when GHIP became a success it would be advantageous to belong to the core group and learn from the experience. The group was facilitated by Paul Iske, who is experienced in supporting communities.

Two additional people were brought in by the Board of Medical Specialists to act as a support team, organising meetings and carrying out the administration of the project as a whole. The facilitation efforts were fully aligned with the maturity of the network, and included different stages, such as form, storm, norm and perform.

A virtual team room was developed with the aid of an application especially designed for online collaboration, and physical meetings were organised on a bi-monthly basis. During the group’s first sessions, goals were defined and ideas generated according to standard brainstorming techniques. From these, meetings, general concepts and definitions were adopted and an awareness was generated about the process as a whole. Finally, six working groups were created. Five were devoted to one of the five selected steps (described below) to be included in the new standard and one group was devoted to describing the vision and scope, including the definitions of the concepts to be used. One person from each working group was assigned as the team leader.

The working groups were given tight schedules and deadlines to speed up the process. They were invited to present their results in the virtual team room and at meetings to enable full interaction within the whole group. Between the start of the project on 30 October 2001 and the deadline on 19 April 2002, three plenary meetings were held and two additional meetings were organised between the team leaders.

The group was very productive, and broad support and commitment was generated because all relevant parties were involved. In June 2002 the final version was completed and input was obtained from the organisations involved in the project. After several rounds of editorial comments the first version was finalised and launched on 1 December 2002.

Fundamental to the GHIP approach is the notion that innovation can be seen as a process, with a fixed number of intermediate steps and a variety of stakeholders. The following five process steps are recognised: originate, select, realise, evaluate and disseminate. These steps were chosen based on comparisons made with other innovation approaches in industry. The following stakeholder groups are included: patient, professional, sponsor, management and technique. The final step represents interesting factors that relate to material items for, for example, pharmaceutical companies. The community is also interesting as the groups within it usually represent different perspectives with different interests. It is the aim of the guidelines that the design and description of any healthcare innovation project should pay attention to each of the cells in the GHIP matrix that is composed of the processes, steps and stakeholders mentioned previously.

As already stated, the guidelines aim to ensure that all stakeholders and process steps in a healthcare innovation project are addressed. Providing relevant background information to the cells of the GHIP matrix will create the development of a ‘GHIP dossier’. This dossier will make knowledge easier to find, exchange and interpret for the user.

By the time the first version of the guidelines had been completed, the role of the original community had also changed. Since knowledge (management) is a key asset, a GHIP Knowledge and Co-ordination Centre (GHIP KCC) has been set up to play a key role in putting the guidelines into practice. This also includes generating feedback on how the guidelines were applied, an example of so-called double-loop learning. Furthermore, the GHIP centre acts as a helpdesk for the support of all people interested in the GHIP approach. The Knowledge and Co-ordination Centre also plays a role in communication and education of the GHIP principles via courses, seminars, publications and its website, www.ghip.nl. Included in the site is an expert community based on an online tool, or expert panel, for sharing and capturing knowledge. Via this tool the experiences and personal know-how of people can be shared with the healthcare community, in particular those involved in innovation projects. The integration of this Q&A system in the process, in addition to the explicit knowledge that is captured in the GHIP dossiers, is a good example of knowledge-conscious management.

The welcome screen of the expert panel displays the GHIP process steps and the stakeholder groups, which reflect the GHIP matrix.

The final diagnosis

We have described a unique project and introduced some principles of knowledge management, such as the concept of communities and the introduction of best practices into a knowledge-enabled process for the dissemination of knowledge that has been generated by healthcare innovation projects. A broad group from the Dutch healthcare sector, which originated from a community of interest and evolved into a community of practice, has worked together to develop guidelines with supporting tools. Thanks to its efforts, innovation projects are now fully transparent and ensures that optimal use is made of previous experiences and project results. The project is realising its credo, ‘if they use it, it will build itself’.

Paul Iske is senior vice president and chief knowledge officer at ABN Amro Corporate Finance and freelance consultant on knowledge co-ordination at GHIP. He can be contacted at paul.iske@ghip.nl

Eric Kalter is a staff member at the Dutch healthcare insurance council and is involved in the introduction of new principles into the healthcare insurance system. He can be contacted at ekalter@cvz.nl

Lars Naber is head of the Dutch GHIP Knowledge Co-ordination Centre. He can be contacted at lars.naber@ghip.nl