Guest Column

Beyond best practices: Knowledge management

By Shelley Burns
Director of Knowledge Management
The Healthcare Management Council

The term knowledge management (KM) has circulated throughout business communities in recent years. Simplistically, it is a term organizations use when they refer to gathering and harnessing the power of employees’ knowledge and processes in order to share experiences and, ultimately, improve operations.

In today’s fast-moving health care industry, administrators often contemplate whether KM is a theoretical construct or a practical tool that, once applied appropriately, can yield substantial improvements in health care operations. Unfortunately, many health care providers do not understand how to apply KM in health care, nor do they realize that leveraging their knowledge assets and those of their communities of practice can result in significant improvements that streamline systems, improve outcomes, and save costs throughout the entire organization.

A good example of KM applied successfully comes from Jean Ann Larson, chief learning officer for William Beaumont Hospital in Royal Oak, MI. When Larson embarked on implementing KM throughout the 10,000-person organization, she realized that the hospital’s professionals were largely unaware of the tremendous untapped resources within.

"We have many levels of highly talented groups of people and some of them even have analogous roles," says Larson. "What I found is that these professionals are constantly seeking to improve practices, and end up meeting their peers and their colleagues at the same professional conferences, seeking the same information."

She continues by explaining how, from a logistical perspective, they can tap into some of that wisdom and at least share the information internally and reflect upon it before applying it.

"It can be as simple as a new clinical practice that the OR (operating room) is trying that can be shared with the endoscopy department, or vice versa," she says. "KM really enables sharing to occur, and that saves costs. It also makes it more synergistic in that you have two different areas of the hospital talking with each other. It’s a prime example of how to expedite the adoption of new clinical practices and expedite knowledge flowing throughout the organization."

Others avoid implementing KM practices in their organizations simply because they are unfamiliar with the processes used to collect, categorize and share knowledge. Further, many are unsure of how this knowledge is put into practice once it’s collected. Fortunately, some health care providers are becoming increasingly aware that instituting KM drives performance improvement and is becoming exceedingly important to their bottom lines.

Create a learning culture

Several factors stymie KM implementation in health care. An issue for most facilities is the rapidly changing industry overall. It’s difficult to contemplate initiating a new learning model like KM in the face of rapidly changing environments. Traditionally, health care organizations have not responded well to new ways of learning. The conservative learning methods practiced by knowledge experts or using traditional hierarchies to access knowledge are becoming obsolete in other industries, but are often favored by health care institutions. On the other hand, many who open the door to change often find they don’t know how to practically apply their collected knowledge once they have it.

How then can that knowledge spread throughout the entire organization? Ideally, health care professionals need to create a culture of learning while deciding on the appropriate KM structure that will benchmark progress, enable knowledge sharing, and record results.

One of the industry’s more dubious opinions about KM systems is the belief that they demand elaborate collection and distribution systems. In some cases, something as simple as a suggestion box can serve the purpose of collecting knowledge. However, the key to benefiting from such a simple system is being able to capitalize on that learning. Any suggestion box may dutifully serve the purpose of collecting ideas, but without a solution-oriented response from management, no one benefits. In addition, although suggestion boxes provide a feedback mechanism, they are not the most comprehensive method of delivering KM.

A more comprehensive method would be one with a built-in resource that benchmarks processes and strategically organizes data. This ensures structure and it’s that structure in benchmarking and knowledge sharing that gives organizations the confidence to use their knowledge to make important decisions and take action.

Strategically gathering and organizing data ensures that benchmark- ing doesn’t become an end unto itself. Only key process measures need to be benchmarked to provide sufficient impetus for action. Many an organization has stumbled by attempting to benchmark nonstrategic and/or immutable factors.

While the hardware to record benchmarks is key, the desire to practice KM throughout the entire organization exceeds its importance.

"It has to start with the passion before you implement the hardware," says Larson. "Some have the misconception that implementing KM practices means implementing a vast, complicated, and expensive computer database that humans may or may not interact with anyway. In most cases KM is as simple as one-on-one conversations. For optimum results, share the skills and share the knowledge throughout the entire organization from department to department."

Start with sharing knowledge

One of the first steps toward creating a successful KM system is getting buy-in across the board. The best outcomes occur when key staff members from every department understand two critical points: 1) Knowledge needs to be shared at all levels, and 2) Shared knowledge needs to be acted upon. Gone are the days when the so-called hierarchy status among physicians, RNs and other health care professionals meant protection of their knowledge and information. Ideally, when health care professionals discover better practices and methods of delivering service to patients, this should be shared throughout an organization, especially when it means conserving costs.

In organizations where there is a wealth of knowledge, all players should be contributing to the new culture, resulting in shared knowledge — a key product of KM.

"The good news is that I am always amazed when I talk to people within our organization at how much due diligence and work they have done, and how they are constantly working to improve their processes," Larson says. "Unfor-tunately, without sharing the knowledge, individuals remain unaware of ways to improve processes."

She explains how, in most cases, their health care professionals are so busy doing what they do best that they don’t take the time to share the knowledge with their colleagues in other departments.

"What has worked recently is our collaborative efforts with an outside source to take a close look at cost data, primarily departmental costs," she says. Larson believes that has value because it causes an organization to challenge its current procedures.

Shared knowledge is the result of collaborative thinking and health care organizations are beginning to realize major gains can be achieved by collaborating externally as well. In some cases, the shared knowledge is coming from other organizations that can provide proven models for KM practices. In other cases, healthcare facilities outsource the process to informed KM providers.

Leverage knowledge: Take strategic action

Collaborative groups, or communities of practice, are groups of people with a vested interest in learning and sharing knowledge. Community members are required to demonstrate their commitment and willingness to contribute to the KM process by gathering information, applying shared knowledge to their organization, and sharing their resultant experiences with the community to yield an ever-growing knowledge base.

Many organizations are still tentatively checking into methods of delivering KM and haven’t yet achieved a streamlined process of collecting knowledge, analyzing it, delivering it, and applying it. While they still don’t know what the fruits of knowledge may bear throughout the organization, the mere effort is a first step toward greater rewards and results.

It’s essential to know that using KM to tackle problems within the health care community is a singular endeavor. No two organizations operate the same, nor collect similar data. Within each organization are unique sets of environments, practices, and methods. Ideas that work well in one organization could be disastrous for another. It’s key to differentiate between mindlessly mimicking best practices and coalescing knowledge from several fronts to develop a customized implementation that works for a particular organization.

While duplicating an effort from a similar organization might have its benefits, organizations do best finding and adapting a set of solutions unique to their respective problems. Knowledge management is not a substitute for leadership or good judgment. If organizations implement KM as a tool, instead of as a panacea, it will make a profound difference in health care delivery and cost savings, as well as reap better rewards overall.

Certainly, embracing KM means embracing a new way of organizational learning. Using the learning models of an expert as the source of up-to-date knowledge or filtering knowledge through tortuous chains of command are the old ways – which lack breadth and speed. Organizations that ascribe to these obsolete learning models will be buried by those embracing the faster, and more effective model of capturing and exploiting peer-to-peer knowledge.

The key is taking the first step toward changing the way health care professionals view the culture within their organizations. Do they know that KM means tapping in on the company’s already knowledgeable resources? Are they willing to listen, learn, adapt, and implement processes that have worked in other departments and organizations? And do they understand that while changing some of the well-worn practices of the past can be fundamentally challenging, it can also be extremely beneficial for their particular departments – as well as the entire organization?

When hospitals begin to get rousing, positive answers to these questions, perhaps then KM practices will begin to improve the business of the health care industry.

Shelley Burns is director of knowledge management at The Healthcare Management Council Inc., a benchmarking and consulting firm in Needham, MA. For further information, call (781) 449-5287 or visit