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Towards
a Knowledge Management Utopia?
A Knowledge Management
Approach to Unifying Key Operational & Strategic Plans for
North Wales Health Authority, UK
By Clare Robson
Health
Intelligence Officer North Wales Health Authority
Moderator, AOK Healthcare Professionals Community of Practice
 What is Knowledge Management?
"Knowledge
Management is a new focus on information and knowledge:
It is about creating
an environment in which information and knowledge is valued
and an environment
where information and knowledge is shared, managed and used."
Nigel
Oxbrow & Angela Abell, TFPL
Health Management Librarians, London, February 1999
Knowledge Management
is an emerging global discipline which is beginning to become
established within the NHS. The National Electronic Library for
Health is establishing a virtual Knowledge Management floor as
part of the project.
Putting Knowledge
Management into Context
"Knowledge
management is all the rage . . . . As with any new term in widespread
use, there is no single accepted meaning, but most of the books
about knowledge management, even if they are not called that,
emphasise the importance for organisations of producing, distributing,
storing, appraising, making available, and putting into practice
both the knowledge derived from the outside world and that created
by their own employees."
National Electronic Library
for Health Website
Introduction
to Knowledge Management
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NHS Information Management
and Information Technology (IM&T) Services; and Library Information
Services
Traditionally, NHS
data and information has been either of a numerical or textual
nature. Numerical information has been largely the domain of
traditional Information Departments, and textual information
that of Library Services. During recent years it has been recognised
in academic circles that changes to these traditional roles are
required towards a more multi-disciplined approach.
"It is clear
that broad-based skills are required to support the assembling,
analysing and interpreting of numerical and textual data associated
with health needs assessment"
John
Hepworth, "Staffing Intelligence Services: A Survivor's
Guide"
Health Libraries Review. 9. 52-61. 1992
The most recent
edition of the Oxford Text Book of Public Health provides
the following background:
"Information
is a resource no less essential to the survival of an organization
than are personnel, material and natural resources. Information
is a resource that must be conserved, recycled and protected.
As with any other resource it must be managed.
Increasingly, organisations
are coming to accept this premise and hence look for people who
view information management from an 'information science' versus
a 'computer science' perspective. The two perspectives are related
but by no means the same. People with computer science backgrounds
tend to be more concerned with computer hardware and software.
Their formal education had a strong theoretical and mathematical
basis . . . . They usually have had little exposure to information
requirements analysis and organizational considerations. They
have greater expertise in programming, system software and hardware.
People with such a technical background tend to be more machine
and technology focused.
People with an information
science background or orientation tend to be more concerned with
people and the nature of information and information processes
in the organization. They are more likely to assess the value
of information and its effect on the performance of the decision
makers within the organization. In a health care setting, they
are more likely to be aware of how and why information is communicated
between patients, clients, health care providers, epidemiologists,
administrators, evaluators, and planners. The use to which these
people put information is, in the end, the most critical criteria
of success of information systems, be they computer based or
not."
Oxford
Text Book of Public Health. 1997
Development of the
intelligence function
and the significance of the culture of the organisation
Some significant
research, concerning the impact which the culture of the organisation
has upon the development of the intelligence function, was undertaken
in 1995 by Andrew Booth, then Senior Information Officer, Sheffield
Centre for Health and Related Research, and Sue Hey, Librarian,
Northumberland Health Authority.
In "From Intelligence
to Evidence-Based Healthcare: a purchasing odyssey" the
authors refer to a number of related research works including
the following extract from V Peel:
. . . organisational
change is essential for the development of the intelligence function
and . . . the nature of intelligence depends upon an organisation's
characteristics. The priority is not, therefore, the training
of information staff but organisational development.
The authors (who
were involved in two independent though overlapping surveys of
purchasing authorities and the extent of intelligence functions)
also highlight the main components of organisational change as
being structure, strategy, systems, staff, style and shared values.
Listed below are
some key points highlighted in the report, and which are also
very similar to the conclusions and recommendations arising from
the work undertaken on the MSc. dissertation "Beginning
to Make the Connections" (Clare Robson. 1997):
- skills in information
transformation must be acquired by all staff in purchasing authorities
and intelligence must be a concern of all who work within the
purchasing organisation
- purchasing authorities
were unwittingly gravitating towards a "library" rather
than a "business" model of information management.
Useful parallels can be drawn with the use of intelligence in
the business sector
- the biggest challenge
is to move away from collections of books towards a role of knowledge
broker utilising networks and various sources to support the
creation of local intelligence. Suitable activities include abstracting,
summarising, analysing and synthesising leading to the production
of intelligence reports, analytical alerts and intelligence assessments
and estimates.
- the intelligence
co-ordinator should become multi-skilled including e.g.
acquiring and passing on critical appraisal skills
- the potential use
of NHS networks was recognised not only for accessing intelligence
but also for knowledge and resource sharing
- a database of skills
and expertise should be a prime example of an intelligence gathering
activity
An important point
to note, is that to date, the NWHA Finance and Information Department
have implemented the core foundation only of a Health Intelligence
Function via the IRC Cymruweb site. The more sophisticated potential
elements of the service, as noted above have not been achieved.
This is due to the current organisational structural constraints,
which centre around the separation of HA functions into different
Departments/ Local Health Groups (LHGs). These structures result
in the separation between the traditional IM&T Department
and the users of information and knowledge. The work of the IRC
has been an attempt to bridge this gap.
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Knowledge Management (KM)
and Key Operational
andOrganisational Frameworks
All Knowledge Management
Strategies and initiatives must begin by identifying (initially
core) business objectives. As described in the existing literature,
Knowledge Management can easily become intimidating because it's
too overwhelming. This is where the "Knowledge Audit"
can assist in breaking down KM into digestible, manageable projects
without losing sight of the "big picture".
Jerry Ash of the
Association of Knowledgework
offers the following basic questions of the knowledge audit:
- what does your
organization know?
- what doesn't it
know?
- who needs to know
it?
- who knows what?
- are they inside
or outside the organization?
- do your leaders
understand knowledge?
- the value of knowledge?
- are they leading
by example?
- does your organization
systematically organize and transfer knowledge internally?
- is it systematically
acquiring and sharing knowledge outside the organization? Are
you creating new knowledge?
- are you leveraging
knowledge to benefit your members and the organisation? Do you
measure, assign value to the knowledge asset?
- is your work environment
knowledge friendly?
Jerry
Ash, "A Short
Course in Knowledge Management"
Once a Knowledge
Audit has been undertaken, information can be identified which
provides a map of the roads leading to corporate success.
Knowledge Management Forum
The Knowledge Management
Forum, on the Cymruweb intranet, has been established as an informal
mechanism to raise awareness of the potential impact of KM solutions.
One example of this is that; currently preliminary discussions
are underway with the Health Promotion Unit regarding the potential
of web-based developments in relation to Breast Feeding Services
and initiatives.
Potential areas include:
- extranet developments
to encourage and facilitate joint working and information and
knowledge sharing
- establishment of
an internet web site to:
- raise awareness
and understanding of breast feeding issues
- encourage the sharing
of ideas, experiences and knowledge amongst the public via such
mediums as discussion forums
- investigate ways
of increasing public access to and use of internet resources,
e.g. in clinics and GP surgeries
The pilot work undertaken
to date on the Knowledge Management Forum provides many practical
and theoretical examples of using KM approaches to traversing
traditional health and social care organisational boundaries.
The early results of this work are indicating a widespread need
for the following support from central HA services:
- an understanding
of the users' perspective (objectives, skills, difficulties etc.)
- training and awareness
in relation to currently available information and knowledge
sources; and information technology resources and capabilities
- education in, and
awareness of, the movement which is currently taking place within
IM&T services away from a service provider approach towards
a user facilitator and enabler role
- introduction to
basic information management concepts and raising awareness of
the existence of widespread information owned by all users
- encouragement towards
the creation, management and delivery of information by the most
appropriate "data / information owners"
- IM&T training
and awareness programmes
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Organisational Development
Dr. Muir Gray has
written a useful paper entitled "Developing Knowledge Management
in Organisations"
It is the responsibility
of every healthcare organisation to deliver knowledge when and
where it is needed to clinicians, patients and managers. To do
this it needs to:
- develop its library
and support its librarians;
- clarify responsibility
for knowledge management;
- change the culture;
- create systems
for distributing knowledge;
- remove the structural
barriers to good knowledge management.
Knowledge / Information
Sharing Culture
Data, information
and knowledge sharing needs to be actively encouraged and promoted
towards becoming an integral part of health and social care organisations'
cultures. This is already being done via the Information Resource
Centre Health Intelligence website and through the KM Pilots.
It has been easy to "recruit" potential pilot projects
and members of the KM Forum. Through the exploitation of web-based
developments, the traditional tendency to hoard information,
can begin to be turned around.
Currently there
are no clear mechanisms in place to share information. The development
of robust corporate strategies, incorporating clear guidance
and quality standards and utilising web-based approaches, would
progressively develop this vital information and knowledge sharing
culture.
Clinical Governance
The work of Dr.
Muir Gray on the National Electronic Library for Health is
showing the importance of KM in relation to providing health
care professionals and the public (through NHS Direct Online
and the New Library Network) with knowledge and know-how to support
health care related decisions.
In 1999 a Scoping
Study, "Building on Strong Foundations,"
into the existing and potential contribution from libraries and
information units to networked electronic health care information,
was commissioned by the National Electronic Library for Health.
Comprehensive information
was collated about relevant activities in each region, including
Wales. The work of the Information Resource Centre was included
in the study:
North Wales Health
Authority Information Resource Centre (IRC)
The IRC has established
a site on Cymruweb including statistical materials, reports,
other health indicators as well as the more common links. The
Centre has been instrumental in developing the pivotal role of
Gatekeepers within the Authority, liasing closely with the IRC
in relation to training, the management of health intelligence
resources and further extension of the NWHA intranet site. The
IRC also produces "Surfing the internet for health information"
on floppy disc, which is intended for users to take home and
use as a guide when accessing health sites on the internet."
The work of Andrew
Booth and the Sheffield Centre for Health and Related Research
(ScHARR) continues to be cutting-edge and of great value to the
NHS. A newly published book "Managing Knowledge in Health
Services," edited by Andrew Booth and Graham Walton, has
now been acquired by the IRC. The work of ScHARR and Sheffield
University internet websites are most impressive in scope and
value:
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The Role of Chief Knowledge
Officer
In addition to countless
KM consultants and practitioners internationally, Dr Muir Gray
has been actively promoting the need for all health organisations
to appoint Chief Knowledge Officers.
Clarifying responsibility
The Chief Executive
of any organisation is responsible for knowledge management,
as they are for all activities within the organisation, but the
wise Chief Executive recognises the magnitude of the task and
identifies one person at Board level, analogous to the Chief
Knowledge Officer in certain commercial companies. Obviously
this person has to relate to a number of other individuals, notably
the librarian of the organisation, although it must be recognised
that many healthcare organisations do not have a librarian on
the staff, but it is essential to have someone at Board level
who will, in the words of the Director of the UK Cochrane Centre,
"press the What's New button on the Cochrane Library every
quarter" and draw the attention of the Board and Chief Executive
to the new knowledge to make sure that important knowledge of
what should be started and what should be stopped does not whizz
down the knowledge bypass where much good knowledge goes.
Dr Gray's views
on Chief Knowledge Officers were also included in a BMJ article
"Where's
the Chief Knowledge Officer?" .
In response to this
the following eletter was published on the BMJ website: "Why are we still waiting for the Chief
Knowledge Officers? "
Communications Strategy
An effective communications
strategy would play an instrumental role in the development of
a Knowledge Management Strategy. Jerry Ash of the Association
of Knowledgework offers the following
white paper. The creation of the Communications Manager post
is a much needed development. The Operational Plan emphasises
the importance of effective communications systems:
The importance of
good communication is the responsibility of all Board Members
and staff of the Health Authority, and the development of a particular
function to co-ordinate the Authority's approach will redefine
its focus. This is particularly necessary to meet the new spirit
of openness, working in partnership and to take advantage of
the opportunities provided through new technology.
The
Communications Manager
The HR Plan includes
little detail concerning the development of this important new
role and function. The creation of this function would provide
an ideal opportunity to include within the role, responsibility
for the strategic development of the Knowledge Management Function
within the Health Authority, primary care contractors and partner
agencies. The following are the threads which currently exist
on the Discussion Forum set up by the Welsh Assembly for the
NWHA Knowledge Management Forum.
- communications
- communities of
practice
- human resources
- IM, C&T
- involving the public
- KM approaches
- knowledge management
forum
- knowledge sources
- learning organisations
- organisational
culture
- quality issues
- sharing knowledge
- web-based technologies
This list shows
the key subjects of relevance to the development of a KM Strategy.
These issues could all be taken forward through the role of Communications
Manager and their KM Strategy. The role could be responsible
for:
- producing a Communications
Strategy and a Knowledge Management Strategy and
- ensuring that the
other Key HA Strategic Development Plans are aligned with the
KM Strategy
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Key Stages in the Development
of the Information Resource Centre
The development
of the IRC for North Wales Health Authority resulted from work
begun in 1994 (as part of an MSc. in Health Information Management
by Clare Robson).
Date Description
Key Findings / Proposals / Developments
- 1994 Joint Commissioning
Information Study, Clwyd DHA / FHSA Senior Managers required
easier access to, and more guidance on, existing information
sources. The establishment of a central Health Intelligence Library
was proposed (incorporating a computerised directory of information
sources). It was also recommended that the survey results be
used to feed into a review of commissioning information requirements.
- 1995 HIES Project
Clwyd DHA The Health Intelligence Enquiry System Project was
established to investigate ways in which a health intelligence
function could be established for the soon to be created North
Wales Health Authority. Research was collated from the experiences
of other health authorities and various models of intelligence
facilities and systems presented.
- 1996 Creation of
the IRC, North Wales Health Authority On the 14th October 1996,
the IRC was created through the allocation of a large room and
the deposit (by the previous four authorities) of a large amount
of "library" materials. A manual system was established
for the efficient storage and retrieval of resources. A service
was offered to users based on a "How can the IRC help you?"
approach. 527 requests were received during the first year.
- 1997 Snr. Managers'
IM&T User Requirements Survey, NWHA Comprehensive data from
22 senior managers was collected; the main results of which were
incorporated into the NWHA IM&T Strategy, particularly relating
to information required at the point of access and the associated
potential increased use of Information Technology.
- 1997/1998 Consolidation
of the IRC During the second year, a further member of staff
was allocated to the IRC, which responded to 1,401 requests during
the year, covering a wide range of health subjects and from a
variety of users. This second phase of development was based
on a "Are you able to help yourself?" approach, with
users being encouraged to attempt to retrieve more routine information
for themselves.
- 1998/1999 Development
of the IRC Cymruweb Site Commenced in April 1998, the IRC has
now developed a high profile presence on the Cymruweb intranet
system. This has been undertaken within the constraints of the
minimum allocation of IT support resources. Consequently, the
IRC staff have undertaken the highly technical development of
the IRC site using a self-sufficient and proactive approach.
In addition to facilitating easy access to a wide range of health
intelligence resources via the intranet site, the IRC has now
responded to over 3,000 requests to date. In early 1999, the
Gatekeeper Initiative commenced to introduce knowledge management
to the health authority.
- 1999/2000 Knowledge
Management for North Wales HA? A discussion paper to put knowledge
management on the agenda for NWHA and the wider "health
family" in N Wales. A presentation of the opportunities
which now exist for a Knowledge Management Strategy to be devised
and implemented but only with full support from all staff and
the board.
- 2000 Creation of
the Knowledge Management Forum. Knowledge Management Initiatives
for NHS Wales and the wider UK NHS? The "virtual" shrinking
of traditional NHS boundaries through integrated web-development
technologies would suggest that the most efficient and effective
Knowledge Management initiatives should be on a corporate NHS
wide strategic basis. "Knowledge for Health?" - from
the creation of the national Knowledge Management Architecture
(incorporating national standards) through to Local Knowledge
Implementation Strategies incorporating recognised centres of
excellence and specialist expertise.
As can be seen above,
the work of the IRC has effected changes in the corporate culture
moving away from a service provider towards a service enabler
approach. The number of monthly requests increased progressively
to a peak of around 200 per month in mid 1999.
The number of monthly
requests has now been decreasing during 2000. Currently requests
handled by the IRC are 50percent from the North Wales Health
Authority / Local Health Groups (LHGs) and 50 percent from outside
users.
Most external requests
are of a very routine nature where the IRC is in effect acting
as a clearing house to redirect requests to the most appropriate
officer.
Web-based Developments
During the past
two years the IRC has been pioneering various web-based systems:
- general health
intelligence system
- executive news
briefing service
- Welsh Assembly
monitoring service
- NWHA internet site
- knowledge management
forum
User Requirements
The primary focus
for these developments has been based upon an awareness of user
requirements. This has been achieved through:
- daily contact with
users, acting as the "shop front" for the IM&T
department
- user requirements
surveys
- regular user-feedback
surveys and feed back forms
- request monitoring
forms
- requests database
- user profiles and
selective dissemination of information
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Computer Science
versus Information Science Approaches
Please see above
for further explanation from the Oxford Text Book of Public Health
of these two approaches. Prior to undertaking an MSc. in Health
Information Management, the author's background related to largely
handling statistical information projects. The MSc programme
made a significant impact to the author's perception of health
information management issues and on any subsequent research
proposals and implementation.
This particularly
related to the following areas:
- information behaviour
of users (encompassing information needs, information flows and
patterns of information use)
- the advantage of
using "Soft Systems Methodologies" (SSM) compared to
more formal "Structured Systems Analysis and Design Methodologies"
(SSADM). Instead of seeing the design of an information system
as being a solution to a single problem, SSM views the design
of a system as a means of improving a whole range of problems
- of improving a problem situation. It is argued that because
people feature greatly in these problem situations, that SSM
achieves a greater understanding of the situation than a data-oriented
methodology would. Furthermore, SSM views the sum as being greater
than the parts and rejects the more traditional approach to problem
solving and system analysis that relies on functional decomposition.
- the contribution
made by traditional NHS Librarians particularly related to textual
information and their proactive Selective Dissemination of Information
(SDI) techniques.
- developments in
Health Intelligence and Business Intelligence (in the private
sector)
- the importance
of quality initiatives and user feedback in IM&T services
Future Strategic Direction
of the IRC?
As can be deduced
from the comments above, the work of the IRC has now become stretched
too thinly to continue in an effective manner (given current
resources). However some recent developments are helping to shape
a future potential development path:
Current IRC work
areas:
- the necessity to
migrate the IRC website to a new server presents the opportunity
to have a full strategic review
- the web development
templates produced by the Welsh Assembly (which were initially
used for the NWHA internet web site) have now been adopted as
the template for future web developments
Corporate Knowledge
Management Work areas:
- the informal work
on the KM Discussion Paper 1999 and Knowledge Management Forum
2000 has demonstrated the potential for:
- changing the prevailing
corporate culture towards much greater cross discipline and interagency
working as regards sharing information and knowledge and
- utilising web developments
to create a series of intranet, extranet and internet web sites
- piloting a change
in the strategic direction of the management of specialist IM&T
resources towards the Data / Information Owners creating, managing
and delivering their own information
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A Proposal for Implementing
Knowledge Management for NWHA
The most important
point contained within this paper is that whilst the work of
the IRC may have introduced the HA to the new discipline of Knowledge
Management it would be entirely inappropriate and unsuccessful
to try to incorporate KM as a subsection of the work of the IRC.
The all-encompassing and complex nature of KM requires it to
be taken forward at a senior strategic level. As discussed above,
Dr. Muir Gray promotes the concept of a Chief Knowledge Officer
at Board level. Whist such a development may be deemed appropriate
for NWHA in the future, there currently exists an opportunity
to take KM forward as part of the new Communications Manager
post.
Proposal
for the Establishment of an
Inter-Departmental Knowledge Management Unit
The informal work
to date of the Knowledge Management Forum could form the firm
foundation for the development of a KM Unit under the strategic
lead from the Communications Manager but accountable equally
to the Directors of Finance and Information and Corporate Services.
Such a unit could be established and developed as an integral
part of a KM Strategy. Early projects and priorities could be
centred around:
- the Welsh Assembly
Monitoring Project on behalf of all 5 Welsh HAs
- the introduction
of advanced health intelligence services, e.g. executive
news briefing services, sharing intelligence and briefing papers.
Medium / long term
projects could concentrate on:
- further research,
recommendations and implementation of KM approaches and techniques
- incorporate lessons
learned from previous purchasing and business intelligence initiatives
- Strategic development
of corporate web-based developments incorporating quality standards
and editorial controls towards the "Utopian Vision"
and the development of a "Corporate University"
- See also "Eight
Pillars of Knowledge Sharing"
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Click
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Knowledge Management Utopia |
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