Implicit Knowledge Assets in Healthcare - Essay Example

Implicit Knowledge Assets in Healthcare The process and issues The industries under the free market forces have quickly sensed the importance of knowledge as an important resource in this knowledge era and taken steps in this direction. Health care systems have largely remained insulated from the free market dynamics due to prevailing policies of reimbursement of insurance amounts and cost of medical services have escalated many folds. This essentially means the productivity of this sector has not kept pace with time. One of the key steps taken to address this issue is an important government legislation i.e. Health Insurance portability and accountability act (HIPPA) signed in 1996 by President Clinton. This legislation aims to create a paradigm shift for medical care industry from a state of providing quality medical care “irrespective of cost” to “cost effective” medical care solutions (Wickremsinghe, Mills). One of the important outcomes of the efforts to initiate change of course of the Health Care industry in USA the concept of Manage Care Organization (MCO) has emerged which provides medical care at fixed cost to its member who have enrolled through payment of monthly fees towards medical services. In their drive towards improving efficiency and cutting cost, Knowledge Management has come as a concept with immense potential. The present case is of a Spine Unit in USA, which is in the environment as described above, and the paramount need is leveraging the potential of its two key assets, technology and knowledge in a manner which is able to enhance its efficiency and reduce costs. The Spine Care unit has rich knowledge assets comprising of surgeons and medical staffs from the disciplines of Neurology, Neuro-surgery, orthopedics, spine surgeons, psychologists, physical therapists and pathologists. It is a technology intensive unit with advanced technologies deployed at clinical side in the form of medical equipments and in the practice management side it has extensive IT facilities like Hospital Management Information System (HMIS). The unit has well developed protocols based on data/information from NCQA, medical journals and its own systems. It is clear from the details that the Spine Unit is not exploiting the potential of its implicit knowledge assets in a structured and strategic manner despite the fact that it has majority of KM technology in place. The issue is to leverage the unit’s existing strength and deploy a full-fledged KM system. It is beyond doubt that knowledge and its management involves only one thing – people, all others are enablers. Larry Prusak says “Knowledge flows along existing pathways in organizations. If we want to understand how to improve the flow of knowledge, we need to understand those pathways.” [citation?] The KM solution for the Spine unit has to exploit the KM concept which creates Communities of Practice, enhances sharing and enriching knowledge, promotes networking and bonding among employees. We see a gap in people focused KM mechanisms, systems and technologies. Proposed solution The objective is to create a KM system comprising of compulsory elements and voluntary elements of KM systems. It is with the approach of leveraging and integrating the exiting assets and existing IT technology Compulsory elements: At every decision point viz. admission of patient, diagnosis, surgery, post operative care, people concerned will be required to refer to the KM system. For example while making a decision to admit the patient one will be required to access the system and system will “Push” relevant information i.e. patient history, probable diagnosis, past experiences, experts list to ensure the best decision in a quick manner. [“relevant” is the key – how do we determine this? If we don’t there is information overload.][It has to be kind of pre-determined and ever evolving based on feedback] Similarly the process has to be designed to identify the compulsory KM points. [what are criteria to do this?][In a process certain activities or steps are to be compulsorily done through KM system, like writing a summary of the operations at each aspect will close the case as far as Km records concern like learnings at each major step diagnosis, operations, recovery etc.] This will address the objective of aligning the employees to KM system through push factor. The key assets which will be used will be information or explicit knowledge captured through various modules and at various points. The push factor is shown below in an exhibit. [can you elaborate on this exhibit – how do I interpet – are there directional arrows?] [ This shows use of repository at decision points shown by arrow and putting information / knowledge to repository, the arrows are directional] Voluntary KM part.: The objective of creating an environment where people get engaged to KM through its sheer elegance and utility. Collaborative tools are to be deployed around KM mechanisms like Communities around practice for sharing and enriching knowledge, Team Rooms [electronic rooms like IM?][ yes] around patients of a particular category depending on the challenge they pose to the Unit. Informal sharing is prevalent in Primary care units and is evident through the concept of “Collectively Constructed Mind lines” (Gabay, May). [does it matter whether physician or nurse – who pays them to do this informal sharing?] [Informal sharing has to be popularized based on the value it offers to people and kind of making people addict to this, payment is by way of gains experienced by people, a voluntary thing] These mechanisms and processes will help in bringing out the most precious part of knowledge, the implicit knowledge creating a favorable environment for innovation. The easy, powerful and value added search is another tool which will be integrated with the system to promote use of knowledge residing with the organization. This will require work flow tools also to create and deploy well defined process for identification, validation, storage and updating of knowledge in the repository. Another tool to be deployed is document management system which will manage various documents in electronic form which include clinical documents and images. Choice of KM processes The proposed solution is addressing both kinds of knowledge, explicit and implicit. As a matter of fact the explicit knowledge is being managed to a large extent. The proposed solution is more to address the implicit knowledge through communities, collaboration, team rooms etc. It is evident that medical professionals have a culture of informal and formal sharing of experiences which shapes up their knowledge base regarding a particular aspect of the profession. The present solution using KM concepts and IT tools is proposing to leverage this culture and harness this cultural attribute for the benefit of one and all. Furthermore there is seemingly a lack of appropriate mechanisms to exploit the implicit knowledge assets. [do these patient rooms begin to create privacy issue? It would seem that everyone on system would have access to team room to be effective – but does everyone on system “need to know” what is happening with a patient? [ A team is as it is assigned for various steps, surgery, post surgery, access can be controlled patient wise identified people can join a particular team] KM systems The KM systems deployed in the solution is Knowledge capture automatically through the process from specified locations like diagnosis centre reports, treatment history, learning,. Other mode of capturing is through the voluntary element, the communities, chat, team rooms and regular capture from external sources, standards, journals etc. Knowledge storage and retrieval will be addressed by repository and search tools. Retrieval & use, collaboration, contacting expert will distribute the knowledge. Impact of KM mechanisms on knowledge The capture from the process locations of clinical and administrative aspects will address the explicit knowledge part, inbuilt in the system. The inputs from external siources also fall under this category. The knowledge captured through the process of sharing, chat, communities will address the implicit kind of knowledge KM technologies Decision support system: It will leverage the existing knowledge of the organization resulting into quick and best decision saving on the cost part. This will also enhance the acceptability of KM in the mind of the individual who gets benefited through this KM technology. It will also avoid reinventing the wheel syndrome prevalent in the organization insulated fro KM concepts. Brainstorming: This will meet the objective of collective pooling in of knowledge and promoting team spirit and collaborative environment [do they brainstorm electronically? These type of systems haven’t been that successful beyond laboratory][ It is catching up in other industries] Repositories: Repositories are basically organizational memory and the bank storing captured knowledge assets. It is accessible to users in a convenient manner. Web based discussion group and Group ware: These are the important KM technologies for enhancing collaboration among employees. A strong use of collaborative tools will lead to progress in KM journey. Changes in KM infrastructure: The key changes are basically addition of repository, search, document management and work flow and most importantly the collaborative tools which will be added in a modular fashion. Avoiding KM pitfalls: The most common pitfall of organizations implementing KM has been the lack of focus. The knowledge resides in the minds of people hence everything in KM is to done around people. The proposed solution includes the KM technology which has a deep focus on people viz. communities, collaboration, push factor of KM and pull factor of KM. Change management It is being widely believed that KM is to be positioned as a cultural aspect rather than technology aspect. Hence the thought leaders, the organizational leaders and most importantly the common employees are to be enthused and the concept is to be marketed to this important stake holder. [but incentivized as well – a big part of CM] [ Reward and recognition for KM contribution a must ]Suitable recognition and reward will facilitate KM journey. Another key is focusing on early results where KM establishes itself as an indispensable tool for employees and communities. Alnowar, You’ve stepped through this very systematically – characterizing what has been done according to the KM Solution figure. That makes it helpful to explain and read. As you can see KM in healthcare is quite challenging. Given that this was individual project, most of comments are for you to think through – you didn’t have group members to work through some of the concepts you proposed. Push is difficult as there is so much data. Selective push would be better but then you’d need to know the needs of the person who is signing on. Prof. K PS Be more careful in citing your sources.. Reference (Nilmini Wickramasinghe, Gail L Mills), e –Knowledge in Health Care- A Strategic Imperative). (Gabay, May) Evidenced Based guidelines or collectively constructed Mind Lines? Complete citations are: Wickramasinghe, N., and Mills, G. "E-knowledge in Health Care: A Strategic Imperative," IEEE Computer Society, 35th Annual Hawaii International Conference on System Sciences (HICSS'02), 2002, pp. 146-. Gabbay, J., and le May, A. "Evidence based guidelines or collectively constructed "mindlines?" Ethnographic study of knowledge management in primary care," BMJ (329:7473), October 30, 2004 2004, pp 1013-. Read More