Knowledge management a critical component of ongoing excellence

Strong collection process, linkage to strategic mission imperative

The old adage, "knowledge is power," has been used so often it’s become a cliché. In the world of quality and process improvement, the phrase "knowledge is excellence" carries far more weight and truth.

Knowledge management, whether in the form of a learning organization (see Healthcare Benchmarks and Quality Improvement, October 2002, cover story) or some other approach, will hold the key to success for many health care organizations, quality professionals agree.

"For our approach to management, we feel that underlying all of the management processes is a good information system," asserts Mary C. Bostwick, health care specialist with the Malcolm Baldrige National Quality Award in Gaithersburg, MD. "What you choose to collect, how you collect it, how you ensure its accuracy, how you distribute it, and how you use it — all of these are components of knowledge management."

Patrice L. Spath, RHIT, a health care quality consultant based in Forest Grove, OR, agrees. "We have [access to] more information than ever before," she notes. "Just the task of selecting which information is most important to the success of your organization is a huge task. You have to weed through and select [the most important information]."

Effective knowledge management also entails helping leaders, managers, and supervisors become better educators, adds Jean Ann Larson, CHE, FHIMSS, chief learning officer at William Beaumont Hospital in Royal Oak, MI.

"Basically, I am charged with the education effort," Larson explains. "That’s more than just departments. We’ve had managers do wonderful things within their own departments; now, we need to tie it all together."

Supporting the mission

The reason it all needs to be tied together is that for knowledge management to be effective, the knowledge selected for dissemination must support the organization’s strategic objectives.

"The process should be driven by the mission and the vision of the organization," Spath says. "Ideally, they have strategic goals they set and revisit on an annual basis, and they should drive the information that is important to you."

"Information morphs into knowledge," Bostwick explains. "Knowledge is a higher form of information, and we would say that knowledge has to infuse your leadership, your strategic mission, as well as your customer relationships, the management of your human resources, your work processes — all the major components of your management system."

"We want to make sure that what we do in education supports our strategic initiatives — be it safety or career path," Larson adds.

Unfortunately, for some quality managers, this is more easily said than done, Spath notes. "Quality managers tend to work in a vacuum and often aren’t as linked to the strategic goals of the organization as they should be," she says. "This needs to change."

This can happen in one of two ways. Organization leaders can change it on their own, or quality managers can approach leaders and say something, such as: "We have an information overload, and I’m not sure which is the most important information to provide to you and your committees."

"Quality managers need to realize that there are things that need to be done to meet Joint Commission [on Accreditation of Healthcare Organizations (JCAHO)] standards and things that need to be done for the success of the organization; and they may be slightly different pieces of information," Spath says.

"Certainly, the JCAHO standards, especially with their move to these new processes, are important to the success of the organization, but there may be others as well; and quality professionals need to dialogue with administration leaders to find out what they are," she says.

Spath, who currently is teaching a series of seminars to members of the American College of Healthcare Executives, continues to stress the point that knowledge management is critical in and of itself, and not just as part of an accreditation or award process.

"One of the challenges I have in giving my workshop is that once you talk about, [for example] Baldrige, people think about something that leads to getting an award," she adds. "But it’s really a framework for performance excellence and can be applied without even applying for an award."

Once the most important information has been identified, quality managers may have to break some old habits to achieve optimal information flow, Spath says.

"It’s important that quality managers determine which people are the critical nodes in the information exchange process and make sure those people get the information they need — and get it first," she continues. "Quality managers tend to work and think in a structure that includes only the medical staff, but they may be overlooking some people in the organization who are really critical — for example, the pharmacy director."

Making the tacit tangible

According to Bostwick, there are two types of knowledge discussed in the literature: tangible and tacit.

"Tangible knowledge is something you might put in a patent," she explains. "Tacit knowledge is what’s in your employee’s head. That is the place where companies are most vulnerable. For example, organizations with large, older work forces have all that tacit knowledge walking out the door. That information needs to be made tangible. Making the tacit tangible is a foundation of good knowledge management."

Spath agrees. "The biggest education and training issue I see, with the push toward patient safety, is that a lot of learning is going on in root-cause analyses and FMECA [failure mode, effects, and criticality analysis], but that learning is not necessarily being disseminated throughout the organization.

"I would suggest that the lessons learned in those projects, or in any process improvement project, be somehow captured and used as part of job-specific training," she says.

For example, she notes, an intensive care unit (ICU) nurse is trained in equipment and procedures. "Ideally, she should also learn about what could go wrong — what are the common causes of mistakes in the ICU? What are unsafe situations we’ve learned about in the past? What equipment breaks down? This way, you can continue to learn from a root-cause analysis done two years ago. Unfortunately, they often get put on a shelf; nobody pays attention to them; and the same errors keep occurring."

Taking a proactive approach

Bostwick also supports a proactive approach to making the tacit tangible. "What we look for in users of our criteria is how they do it — role model practices — then we try to disseminate that information," she says.

"Take human resources, for example: How do you incorporate it into your education and training? What are you capturing? How are you selecting it? How are you storing it and accessing it? If your processes’ knowledge is used to reduce waste, to avoid duplication or gaps, if you can make that knowledge explicit, we’d expect you to tell us how you transfer that through education and training."

Again, it comes back to the corporate mission. "One of the things we look for in how and what is captured is what it has to do with your key business factors," Bostwick adds. "If you tell us technology is critical to your future success, we would look at how you link your knowledge management to that."

"One of the key strategic issues we have is getting, finding, and keeping the people we need," Larson notes.

"Work force planning is something we’ve talked about for years, and a major area of education we are looking to explore is career development," she says. 

With intelligent use of knowledge management, you even can create strategic initiatives, Bostwick says. "For instance, get in and learn how your customers work so you can gain new knowledge; actually live with them," she suggests. "Then ask yourself, what knowledge have you gotten from the customers — or what feedback can you give to your suppliers? In terms of your customers, you can design better products and services; in terms of your suppliers, you can give them the information they need to better serve you. These could be strategic initiatives."

Another benefit of good knowledge management is innovation, and it should be one of your goals, Bostwick says. "You shouldn’t just look at an employee as someone to be satisfied but also as an investment to generate new knowledge you can use for innovation," she advises. "This will help you create a work force that is flexible and adaptable to change."

The explosion of technology will only serve to support and strengthen knowledge management, she continues.

"Technology is exploding with electronic transfer mechanisms: databases and digital storage that make knowledge accessible to so many people. This all supports knowledge management and makes it easier," she says. "However, as with all new technology, we’re not yet using it to anywhere near its full value."

Need More Information?

For more information on knowledge management, contact:

  • Mary C. Bostwick, Health Care Specialist, Malcolm Baldrige National Quality Award, NIST/NQP, Administration Building 01, Room A635, Gaithersburg, MD 20899. Telephone: (301) 975-4280.
  • Patrice L. Spath, Brown-Spath & Associates, P.O. Box 721, Forest Grove, OR 97116. Telephone: (503) 357-9185. E-mail:
  • Jean Ann Larson, CHE, FHIMSS, Chief Learning Officer, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073. Telephone: (248) 551-0230.