Knowledge Management (KM) in Healthcare Systems

Introduction

KM is a discipline that promotes an integrated approach to identifying, managing, and sharing all of an enterprise’s information assets, including database, documents, policies and procedures, as well as unarticulated expertise and experience resident in individual workers (Wickramasinghe, 2003). There are many dimensions around which knowledge can be characterized such as storage media, accessibility, typology and hierarchy.

History of KM

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Knowledge Management (KM) is an essential tool in today’s emerging healthcare system. Hospitals that seek to deploy KM systems need to understand the human element in the process. Earlier, success factors were only restricted to a few healthcare variables such as patient care and cost, but over the years, technology (both clinical and administrative) has evolved as a differentiating variable, thus redefining the doctrines of competition and the administration of healthcare treatments. One of the key objectives of a KM system is to insulate a hospital’s intellectual knowledge from degeneration (Elliot, 2000).

The UK public sector now typically spends an estimated ?2 billion per annum on IT, equating to around 1% of the public purse (Holmes & Poulymenakou, 1995), while the NHS spends around ?220 million annually on IT in hospitals (Audit Commission, 1995). Information technology is transforming the healthcare environment in ways that go beyond simple consumer health information Web sites (Hoagland, 1997).

SWOT Analysis

Various Strengths of such organizational structure are:

1. There is a strong control over the employees with clearly defined rules and regulations.
2. The system is highly centralized because of which various decisions can be monitored efficientley..
3. There is standardization in the organization and everyone is following same procedures and thus there is no scope for any confusion.

Weaknesses of bureaucratic form of organizations:

1. The biggest weakness of such form of organization is that there is too much control leading to a lack of innovation initiatives and thus making the jobs dull and boring. Also, this has an adverse impact on the level of morale of employees which is clearly seen in case of Reddix trust hospital.
2. Another weakness is that though decisions can be efficiently monitored it takes a lot of time to take any decision as there are only few people in whose hands such a power rests. In case this group of people is overloaded decision making will become too slow.
3. The chain of communication is too long which generally leads to distortion of the message
4. Bureaucracy itself encourages political behavior in the organization and people try to use wrong means to go up the hierarchy.

KEY ISSUE OF REDDIX HOSPITAL

Reddix Hospital does have an information system in place. It comprises of Radiology Information System, Patient Administration System, Laboratory Information System and Clinical Patient Record System, Pharmacy Systems and Nursing System. But there is a lack of interoperability between these systems and there is no clinical information governance. Further due to an inefficient Hospital Information System patient files are not available to the concerned caregivers when required. These caretakers are not aware of patients’ medical history and if some wrong medicines are given patients suffer from severe reactions. According to NHS performance report 60% of patients were suffering from life-threatening consequences of improper care.

Furthermore nurses and caregivers are not aware of the best practices. Also Reddix is using a centralized computer architecture where softwares being used are 30-40 years old. Such outdated softwares have limited interfaces with other healthcare information systems. Moreover they did not have the ability to interconnect with other desktop applications.

In most of the NHS hospitals a distributed form of computer architecture is followed. Moreover Reddix does not use a secure information security mechanism which is again an important point of consideration.

Due to above reasons and to ensure an efficient and innovative working of Reddix Hospital Trust it was decided to adopt a proper Knowledge Management System at Reddix.

Thus, a combination of all the three systems may be used to address the requirements of various stakeholders to the KM project.

Suggest Change

Reddix can move to divisional form of organization as it will be easy to handle the complexities associated with a complex nature of hospital functions and divisions.

In order to promote learning and development in the organization Reddix can use following methods:

Learning Culture
Reddix need to develop a learning culture in the organization. There should be a free flow of information within the organization. People should be able to share and exchange information and knowledge without any barriers. Senior team should people at all levels to learn regularly and learning should also be rewarded.

Key Management processes
Learning and development can be fostered through proper capability planning, reinforcing teams, developing values and vision for such teams and maintaining an efficient performance reward system.

Tools and Techniques

Open communication, mentoring and supporting colleagues, making people learn to see team and organizational goals as same are some tools to maintain learning in the organization.

Thus, from above mentioned process Reddix can ensure learning and development of its staff so as to implement KM in an efficient manner.

Resourses

These organizations decentralize decision making to the business units, thereby allowing the corporate office to concentrate its focus on corporate strategy, capital allocation, and monitoring of the operational and strategic performance of business units. This creates the advantage of increasing accountability, given that common/comparable measures can be established across different divisions and internal competition for available capital can be stimulated.

Along with its various merits this system may bring about certain disadvantages for Reddix Trust Hospital:

First, there is the problem of duplication of services—that is, redundant marketing, manufacturing, and other functional services that are established within each unit. Costs can escalate when functions are repeated in multiple areas.

Corporate executives in decentralized organizations can too easily distance themselves from their divisional operations and thus find that they lack the needed insights and skills to understand their disparate businesses. Corporate leaders can also focus so much on capital allocation and corporate strategy (e.g., mergers, divestitures, acquisitions) that they lose touch with the operational side of their businesses.

Organizational Fit

SCOPE OF CHANGE AND VISION

Healthcare organizations are facing many challenges in the 21st Century due to changes taking place in global healthcare systems. Spiraling costs, financial constraints, increased emphasis on accountability and transparency, changes in education, growing complexities of biomedical research, new partnerships in healthcare and great advances in IT suggest that a predominant paradigm shift is occurring. This shift is necessitating a focus on interaction, collaboration and increased sharing of information and knowledge which is in turn leading healthcare organizations to embrace the techniques of Knowledge Management (KM) in order to create and sustain optimal healthcare outcomes. This report describes the importance of using Information Technology knowledge management systems for healthcare organizations and provides an overview of knowledge management technologies and tools that may be used by healthcare organizations with a special focus on Reddix Hospital Trust.

RESISTANCE

Reddix hospital is overloaded with work. Doctors are working for double the stipulated time. The information system at Reddix is centralized and nurses and caretakers have no direct and easy access to patient records. Also there is low level of morale, lack of motivation, lack of innovation and high rate of absenteeism and staff turnover and also high rate of sickness among hospital staff.

All these factors prove that Reddix Hospital Trust is following a bureaucratic form of organization.

The bureaucratic hierarchy is by far the most abundant organization form as we start the new millennium. They are everywhere all of the time and it is hard to envision a world without them, or indeed any other kind of organization form that will work as well.

Elliott Jaques (1989, 1990), firmly believed that the bureaucratic hierarchy’s only problem is that it still lacks complete perfection, and Hammer and Champy (1993), asserted that bureaucracy is a glue that holds organizations together.

OPTIONAL APPRAISAL

Reddix can use intranet to make the stakeholders properly understand what is KM and how it can enable them to work efficiently. A dedicated blog can be created where staff can exchange their understanding of the concept and that of project a whole and can learn through shared experiences. Also it will help them in understanding the flow of information within the organization and how to use the new method efficiently. A proper detailed view of the new system along with some relevant examples can be easily provided on the portal which will help in a detailed understanding of the concept.

However in this system people will learn as per their understanding levels. In case there is some misunderstanding on their part it cannot be cleared and people will start working on their individual assumptions about the concept and project. This may lead to conflict and disputes while implementing the concept.

Justify your planned changes?

COMMUNICATION TO STAKEHOLDER

The project of Knowledge Management affects a number of people related with the organization. These are- doctors, nurses, administrative staff, etc. All these people need to be properly aware of the need of KM in their organization and also how they will be benefited from such a change in the organization. The success of any KM program depends upon the clear understanding of concepts by these stakeholders.

FINALIZE CHANGE PLAN

Continuous use of knowledge leads to generation of new ideas which can be recorded in the system and again and again use of such idea further leads to generation of new ideas. Thus, KM will give a scope of innovation to hospital staff.

Proper storage and availability of information about a patient’s health will allow the team of doctors to communicate easily and take decisions on further treatment in an efficient manner. Also the medication prescribed to patient, allergic records, surgery records, etc are readily available which can form the basis of further treatment.

Another important system is to develop a program for providing training with regard to use of new system. Such programs or training workshops should be designed in a manner that each and every person in the organization is properly aware about his/her role in KM and can also help his/her subordinates in achieving efficiency through such a system.

This system is good for imparting knowledge about the concept but lack practical approach. For proper implementation of the concept such workshops should be continued for some time after the introduction of KM in the hospital. It will help the staff to get real time experience of getting trained while working.

Instant flow of information and improved communication leads to quick decision making. Doctors can communicate with each other regarding the treatment of some critical patient, refer to the case history available at a single place and take decision in a short period of time

Reddix can take the groups of staff for some tours to other hospitals using Knowledge management effectively. This will help the staff in getting a real-world idea about use and benefits of KM. This will act as a catalyst to prepare them for them for the next stages of the project. However, this method does not ensure a deep understanding of the concept as methodology of implementing KM varies from organization to organization.

IMPLEMENTING KM AT REDDIX

Various steps involved in implementation of KM program at Reddix Trust Hospital are discussed as follows:

Objectives
Reddix need to implement a KM program so as to improve patient care, reduce accidents, increase the morale level of the hospital staff, efficient decision making and improve the flow of information within the organization.

Strategic model to achieve these objectives

The achievement of an efficient KM program depends upon the designing of an efficient Application Architecture. The key features of such an architecture or model is discussed as follows:

Patient Admission Process

First step in implementing Knowledge Management in Reddix is the automation of Hospital administration and registration systems that are used to “register” patients into the hospital. A powerful first point-of-contact (point-of-sale) approach for the hospital can be used in the form of embedded-chip smart cards. These cards are capable of holding compact patient medical record and biometrics identifiers. This would enable quick, automated registration and admitting, as well as information for health and health insurance purposes such as eligibility, referral, and pharmacy approval.

Communication of Patient Admission Data

Next is to automate the data associated with the admission of a patient which is of a relatively generic nature. Made up of standard patient demographic data, insurance particulars, and the patient’s location (department, room number, and bed), the information associated with the event of admitting a patient is of interest to most if not all of the other information systems used in the hospital. In an e-hospital, this patient information is communicated with all other applications in the hospital. Hospitals organize themselves around specialized diagnostic methods, focused medical interventions, and various therapeutic care strategies.

Supporting Diagnostic and Therapeutic Sciences

According to Becich (2000), it is estimated that 50% to 70% of the major decisions that affect patients are based on information available from clinical pathology (laboratory tests) and anatomical pathology (tissue samples).

Thus it is necessary to computerize laboratories, radiology, cardiovascular laboratories, nuclear medicine, etc. For Example: The classical x-ray film processing has been replaced with “film-less” imaging processes that produce digital images in many hospitals worldwide. Hospital Pharmacy also need to be right from automated drug dispensing devices to robotic workstations used to package and barcode patient medication.

Point-of-Care Data Entry

Further there is a need to automate the point-of-care data. Procedures (e.g., surgeries, laboratory tests, or x-rays) can be scheduled in an enterprise scheduling system to better allocate many types of resources. Integration between the admitting and orders systems makes the process more efficient and accurate. These orders can be communicated to the appropriate clinical system (e.g., radiology or laboratory) electronically if interfaced or integrated with the order management system. Once an order is placed in a clinical system, the process of performing the ordered diagnostic test or delivering the specified medication or service begins. If the physician could consistently digitize these “paper instructions,” the improvements in the accuracy, the timeliness, and the appropriateness of patient care would be staggering. In addition, the patient vital sign data (e.g., blood pressure, fluid input and output, temperatures) are written on the patient’s chart. Technology can be used to convert physician voice dictations to digital text (typically the patient’s admitting history and physical and the discharge plan and diagnosis).

Automated Hospital Information System Architecture

[Adapted from Mon and Nunn (1999)]

Implement a Culture change policy

Next is to develop a proper healthy environment for KM. Staff needs to be made aware and trained about the concept of KM and how that is beneficial for different levels of the organization. People should be able to adapt to such a change being introduced in the organization. Such an acceptance will ensure the efficient implementation of KM program.

Change Models

Here we will discuss two change models which can be applied to Reddix Hospital.

• The Intervention Change Model
• The Strategic Change Process Model

The Intervention Change Model

This model developed by Robbie Paton and Jim MacCalman (2006), is based on the idea of an open system approach which view an organization as a series of interlinked and interdependent elements and components of systems and subsystems.

Reddix Hospital is an organization that consists of several elements like that of consultation, pharmacy, patient care, nursing, specialized treatment, clinical information, etc. As per the intervention model firstly the problem is to be identified, which is the lack of a proper information system in the hospital. Next is to analyze and select the change options available which is determined as the need of KM in Reddix. Finally this KM is to be applied at every level and every department and element of Reddix. These functions or elements are interlinked and a change in one will mean a change in all the elements.

The Strategic Change Model

This model developed by Phil Beaumont complements the implementation stage of the intervention model. This model is also required to be applied at Reddix. It aims at making the staff understand the need for change in the organization. It takes the form of a story-telling which managers often use to promote change.

At the start of this process senior managers at Reddix will initiate communication to engage employees in the change process. Next will be focusing on claims, evidence, theories of cause and effect to help employees understand what the need is and how the change will benefit them.

Further performance conversation will take place to generate action in order to initiate change and finally closure conversations will be there to signify the successful completion of the change process. Such a process will help the staff of Reddix to grasp each and every part of KM program efficiently so as to use it effectively in their future course of action.

Improved Team Communication

Proper storage and availability of information about a patient’s health will allow the team of doctors to communicate easily and take decisions on further treatment in an efficient manner. Also the medication prescribed to patient, allergic records, surgery records, etc are readily available which can form the basis of further treatment.

Reduced Problem Solving Time

Instant flow of information and improved communication leads to quick decision making. Doctors can communicate with each other regarding the treatment of some critical patient, refer to the case history available at a single place and take decision in a short period of time

Improved Patient Care

An efficient KM system will reduce the burden of knowledge on the staff. They can concentrate on their work. Specialists can be consulted easily and decisions can be taken efficiently. This will improve the condition of patient care in Reddix.

REFERENCES

1. Groff, Todd. R. (2003), Introduction to knowledge Management: KM in Business, Butterworth-Heinemann
2. Gay, Paul du (2003), The Values of Bureaucracy, Oxford University Press.
3. Jennex, Murray E (2005), Case Studies in Knowledge Management, IGI Global
4. Miner, John B (2006), Organizational Behavior 2: Essential Theories of Process and Structure,
5. M.E. Sharpe, Inc.
6. Martin, Graeme (2006), Managing People and Organizations in Changing Context, Butterworth-Heinemann.
7. Schwartz, David G.(2006), Encyclopedia of Knowledge Management, IGI publishing.
8. Wickramasinghe(2005), Creating Knowledge-Based Healthcare Organizations, IGI Global.
9. Wickramasinghe, Nilmini( 2007), Knowledge-Based Enterprise: Theories and Fundamentals, IGI Publishing

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