Five minutes with…Morven Miller

Jacquie Bran, project manager for the Knowledge Management events team, talks to Morven Miller, research assistant with Wisecare (Workflow Information Systems for European Nursing Care), an EC-funded initiative (1997-1999) that aimed to identify the contribution of nursing to patient outcomes through the integration of IT in clinical practice.

When and why did you first consider incorporating knowledge management?

The sharing of information in healthcare is notoriously poor. Dissemination of results is a lengthy process, often hampered by lag times to publication and lack of appropriate dissemination budgets. However, it has been recognised that sharing the clinical information that we have in cancer care would significantly improve patient outcomes in terms of survival. Why should this not be the case for nursing-related patient outcomes?

While vast amounts of health-related knowledge and information are generated, keeping up with this developing knowledge is a full-time job. Consequently, sharing information relevant to clinical practice could give clinicians the opportunity to have a working knowledge of the recent developments necessary to inform their practice.

What have you done to encourage and promote knowledge sharing, and what barriers have you faced as a result?

The Wisecare projects have promoted knowledge sharing using the internet, e-mail and the projects’ data collection tool in a number of key ways:

·· The nurses from the clinical sites have shared their nursing protocols and guidelines for specific patient problems with one another (using the internet and project data collection tool);

· The Wisecare projects provide information about patient outcomes from each clinical site. The nurses from these sites can evaluate these outcomes in relation to local protocols and guidelines, chat with one another about their practices and so identify the most effective interventions;

· A number of literature reviews and best practice guidelines have been developed for the specific problems that the Wisecare projects address. These have been made available to the nursing staff through the projects’ data collection tool and website and so promote best practice;

· The Wisecare website contains links to reputable cancer-related websites that are relevant for cancer nurses, so saving valuable time when searching for information. Nurses visiting these sites are then able to share the information that they found with fellow colleagues.

Wisecare faced few barriers in relation to promoting knowledge sharing, as the clinical sites involved were enthusiastic about the process of knowledge sharing and learning from one another. It could be argued that some clinical sites benefit from the process more than others, depending on their current level of knowledge and how much individuals have to learn. However, this has not been seen to be the case; all clinical sites participate as they have accepted the general ethos of knowledge sharing.

As Wisecare spans Europe, two barriers to knowledge sharing have been culture and language. However, these have not been insurmountable. In the absence of a common European language, English was the language of the project. It should be recognised that this is the second language for many nurses participating in the Wisecare projects. This has necessitated local translation of nursing protocols and this task has fallen to the nurses involved in the projects to ensure that the meaning has been reconstructed appropriately. Culture also has been considered. Within the Wisecare projects, demonstrating mutual respect and value through open discussion and acknowledgement of cultural differences has often helped to ameliorate tensions and anxieties. Discussions with members of the research team from all sites have allowed anxieties to be aired and frustrations to be expressed, and so managed sensitively and appropriately.

How did you implement knowledge management as a business practice and how did colleagues and employees react to it as a concept?

Knowledge sharing was key to the concept of Wisecare and so has been an integral feature in the project since its inception. Those clinical sites participating in the project were committed to the theory of knowledge sharing too, so there were few problems associated with obtaining support from colleagues about the process of knowledge sharing. However, given that knowledge sharing is an alien concept in healthcare, it took some encouragement for the nursing staff to put the theory into practice. As Wisecare is an IT initiative, we primarily used e-mail communication. The clinical nurses preferred this as it allowed them to communicate with each other at a time suitable for them, which was dependent on their clinical commitments, and gave those who were speaking English as a second language the opportunity and time to compose their thoughts. Initially, project support staff had to encourage support nurses to question each other about local clinical practice in relation to patient outcomes. However, this process became much more fluid as clinical staff built relationships with one another and became more confident in the process of knowledge sharing.

Wisecare also provided nurses with a vast amount of information and knowledge about clinical practice through both the Wisecare website and data collection tool. This information has been specifically selected to meet their clinical needs and meant nurses had access to relevant knowledge extremely quickly. The speed of obtaining knowledge as well as the relevance (and reputability) of this knowledge was valued by the nursing staff involved in the project.

As the first Wisecare project drew to a close, the nursing staff highlighted that they would be unable to go back to their pre-Wisecare way of working, demonstrating the impact that knowledge management and sharing had on clinical practice. They were keen that the initiative continued and it is this enthusiasm that has led to the development of Wisecare+.

Has knowledge management been a challenge culturally?

There naturally have been some cultural issues to consider. We are often told that the world is getting smaller, thanks to television, advances in telecommunications and transportation. While it may be true that on the surface we appear to converge, we found that differences in culture exist beneath the surface. However, within the Wisecare projects we understand that if the nature of the collaborative relationship is not supportive of individual group members expressing their fears and uncertainties, both the project and the individual will suffer. It is essential that team members reflect on why they feel the way they do and discuss these feelings with the team. As mentioned above, we were and are extremely conscious of cultural issues within the Wisecare projects. The concepts of mutual respect and acknowledging cultural differences are integral to the project and as such have allowed the sensitive management of any cultural issues that have arisen.

What are the main lessons learnt and are there any new milestones on the horizon?

The main lessons that we have learned through Wisecare and Wisecare+ have been:

· Knowledge management can have, and already has had, a major impact on the knowledge base of clinical nurses across Europe. This increased knowledge has influenced clinical practice and resulted in an improvement in patients’ symptom outcomes, so demonstrating the process and value of nursing. Nurses have also remarked on the ways that Wisecare changed their process of decision making, from isolation to shared decision making;

· Nurses value the opportunity and advantages that participating in a knowledge management project brings them. They report a sense of empowerment and a vision for the future, and, indeed, that they have difficulty contemplating returning to their pre-project state.

New milestones include:

· Extending the specialities involved in Wisecare+. A pilot project is currently being set up to explore the feasibility and acceptability of such knowledge sharing within paediatric oncology nursing;

· Expanding the clinical sites involved in Wiseare+ thereby involving more clinical nurses in knowledge sharing;

· Including more patient problems, which will allow nurses to share increasing amounts of information about key clinical issues with each other.

For more information on the Knowledge Management events programme, visit www.kmmagazine.com/events or call Henry Anson on +44 (0)20 8785 2700.