Knowledge Management Definition

Standards Australia define Knowledge man-agement as “a transdisciplinary approach to improving organisational outcomes through maximising the use of knowledge. It involves the design, implementation & review of social & techno-logical activities & processes to improve the creating, sharing & applying or using of knowl-edge.”

Standards Australia. Knowledge Management - A Guide. AS 5037-2005

What is Knowledge Management?

Knowledge Management (KM) is the system-atic processes by which knowledge needed for an organisation to succeed is identified, acquired, created, captured, shared and leveraged. KM is an evolving discipline which involves people, processes, technology and content. It is also the integration of many disciplines including human resource management, communications, change management, clinical governance, organisational learning and information management and technol-ogy.

Explicit and Tacit Knowledge

While we attribute a high value to explicit knowledge resources, often we do not value the tacit knowledge that is inherent in every organisation. Tacit knowledge is gained through intuition, expertise, experience, judgement and know how. It is hard to ex-press, process, capture or transmit in any logi-cal manner unlike the knowledge resources previously described.

How often have we commiserated on how knowledge walks out the door when experi-enced people leave or retire. Much of what they know is in their heads and not docu-mented anywhere or is only partially docu-mented.

The KM approach recognises the value of tacit knowledge and aims to capture and exploit it. An example is the lessons learnt from imple-menting clinical redesign projects.

KM therefore is about developing a business capability to capture, document and dissemi-nate good ideas, lessons learnt and experi-ences as well as providing access to the ex-plicit knowledge resources currently available .

KM is about promoting a culture of knowledge sharing through connecting people to people, people to content and people to context.

Inside this issue:

The Difference be-tween Data, Informa-tion and Knowledge

2

Addressing the cul-tural barriers to change

2

Organisational barri-ers to Knowledge Sharing

3

Strategies for Knowl-edge Sharing

3

Promoting a Knowl-edge Sharing Culture

4

Organisational Culture & Knowledge Sharing

2

Knowledge Management Demystified

N o v e m b e r 2 0 0 6

Knowledge Management Defined

page 1

Health as a Knowledge Industry

Healthcare is essentially a knowledge based industry. The quality and safety of patient care and the efficiency and effectiveness of work performed in health organisations depends on a health professional’s ability to manage inter-nally created knowledge about patients (e.g. the medical record) and to complement it with knowledge accessed from relevant external sources (e.g. Medline, MIMS).

Knowledge workers (health professionals) must have what they need to do their job effectively within a framework that includes approved processes and structures, good leadership and management, open communications, a support-ing organisational culture and an information technology infrastructure.

Knowledge Sources

There are many sources of internal knowledge including the medical record, either paper or electronic, clinical practice guidelines and clinical protocols. External sources may com-prise peer reviewed literature, citation data-bases, online books, drug and evidence based databases and models of care. These external resources and more are accessible at the clini-cian’s desktop through the Clinical Information Access Program (CIAP) and ARCHI web sites.

Knowledge Manage-ment Standard

AS 5037—2005

“As gold which he cannot spend

will make no man rich, so knowledge

which he cannot apply will make no man wise”.

Samuel Johnston (1709-1784)

Clinical Services Redesign Program http://sesiweb/ppp/

Culture is “the way we do things around here”. You will often hear that phrase when trying to affect change in the organisation. Culture is stable and not easily changed. It is about the values, beliefs and assumptions that are deep rooted in the organisation.

The more established the organisation, the more entrenched the culture. The ability of an organisation to share knowledge and in-formation is predicated on the cultural char-acter and its pace of change.

Organisational Culture and Knowledge Sharing

“Change fatigue” and “change weary” are other terms that are frequently used when staff are faced with a new organisational change. Each organisational culture is differ-ent from the other. Within that culture there is likely to be a number of subcultures found among different groups and/or different departments. These subcultures are fre-quently highly protective of their processes and the more defined their community the harder it often is to initiate change unless they are the initiators and it is done on their terms.

So how does one address the cultural barri-ers when trying to implement a change that requires sharing knowledge when sharing has not traditionally been a value of the organisational culture? What are these barri-ers and how do we address them?

When attempting to change organisational culture, it is wise to take small steps rather than a giant leap and to find champions in the business unit to help you make the changes. The champion needs to have per-sonal and professional credibility and a posi-tion of authority otherwise s/he will not be supported.

The Clinical Redesign projects are an ideal starting point as they are initially focused on a specific business unit(s) and profes-sional groups rather than being enterprise wide. Rewards and recognition are impor-tant in breaking down cultural barriers. A strategy is to create heroes of the early adopters by honouring their willingness to

adopt change. You can do this by giving public recognition to their successes as a reward. If staff do not see that there is “something in it for them” compliance will be more of a challenge.

Identifying benefits and the impact of change is therefore an important first step to get staff on board with a new project. When identifying benefits think about the benefits to the organisation, staff, patients and the wider health system. Benefits need to be realistic, achievable within a reason-able timeframe and measurable. Look at short term benefits to show early wins as well as the medium and longer term bene-fits that may not be realisable for 6 months or longer. Benefits realisation is important because changing the way we do things has to have positive gains if there is to be long term sustainability.

Addressing the Cultural Barriers to Change

Data, information and knowledge are often used in-terchangeably. It is important to recognise however, that while there is a symbiotic relationship between data, information and knowledge, they are different.

Data

are raw facts and in isolation have little mean-ing. For example, a heart rate of 120 could indi-cate a tachycardia, it could be an expected heart rate for someone who is undergoing a stress test or it could be a normal foetal heart rate. Without context it has little meaning.

Information

is data in context. It is structured and has mean-ing. For example, Mr Jones was admitted suffer-ing acute asthma and has a pulse of 120. You can then understand why the heart rate is 120 be-cause you have the context – an asthmatic attack of which one of the symptoms is a tachycardia.

The Difference Between Data, Information and Knowledge

Knowledge

is information that is actionable i.e. what critical capability will this knowledge give you. Knowl-edge is a cognitive process of humans which also uses intuition, experience, values, lessons learnt and expert insight. Knowledge enables you to make a decision about the best course of treat-ment for this patient with asthma. While multiple pieces of data and information are needed, it is knowledge and expertise that makes sense of it all to enable a decision to be made.

Information management is concerned with docu-ments and in particular with information access, tech-nical handling, security, storage and delivery. Knowl-edge management focuses on the human aspect of information utilisation. It is about developing systems and processes that leverage information and knowl-edge in an organisation to promote originality, crea-tivity, intelligence and learning.

The greatest diffi-

culty lies not in

persuading people

to accept new

ideas, but in per-

suading them to

abandon old ones

..John Maynard Keyes

Page 2

Organisational Barriers to Knowledge SharingOrganisational Barriers to Knowledge Sharing

* the notion that knowledge is power when knowledge sharing is more powerful

* historical knowledge that people do not like to have challenged-”this is the way we have always done it”.

* knowledge holders who are hostile, insular and don’t see the “bigger picture” of health care

* limitations related to how knowledge is stored/processed

* the difficulty or inability to articulate tacit knowledge - knowledge is lost when people retire or leave the organisation

* motivational limitations – “what’s in it for me”

* lack of cooperation to share knowledge – people feel they do not need to share knowledge or learn from others

* a need to be acknowledged for knowledge contribution

* competitiveness and rivalry with peers

* lack of technology, infrastructure, budget and resources to create, acquire and dis-seminate knowledge

* information technology silos that don’t inte-grate information e.g. Jonah and the Emer-gency Department Information System (EDIS)

* information technology illiteracy.

* geography - making it difficult to communi-cate effectively.

* credibility of the people who are promoting knowledge sharing

* lack of understanding by external stake-holders of the difficulties in creating an environment that is conducive to knowledge sharing i.e. adequate budget and resources to make it happen.

Most people will be very familiar with some if not all, of the above barriers to knowledge sharing. Barriers are there to be overcome, however, and the rest of this paper talks about knowledge shar-ing and some strategies that you can implement to promote a culture of knowledge sharing.

Knowledge sharing comes intuitively as a social aspect of our professional lives. When we need to know something we ask a colleague we know will have the answers. We gain knowledge because of this informal knowledge network which comprises those willing to impart and share their knowledge. We then pass on

what we have learned to others.

This type of knowledge sharing is generally informal with little permanent record. Often, when staff leave an organi-sation, they take much of their expertise with them. How likely is it that they imparted enough of their knowledge so that the person who assumes their role can continue to carry on this information life cycle?

For any organisation, failure to maximise organisational knowledge can have a major impact on efficiency and ef-fectiveness. The introduction of web technology has had a major influence on the way we share knowledge. The emer-gence of corporate Intranets has had a significant impact on capturing information that was not traditionally docu-mented but remained in people’s heads.

The Intranet has pulled down the walls that confine infor-mation within organisational silos and makes it much more widely available to larger audiences.

Knowledge sharing requires teamwork, trust and respect for one another. It requires an understand-ing of the organisational and personal benefits which can accrue by sharing knowledge. Reducing duplication of ef-fort has a cost benefit as well as facili-tating standards and best practice across the organisation. Knowledge sharing empowers individuals by improving their personal knowledge which in turn bene-fits their patients and the organisation.

While knowledge management encom-passes 4 elements – people, processes, technology and content – people are the most critical element.

On page 4 you will find a number of suggested strategies to promote knowledge sharing.

Diffused

Knowledge

immortalises

itself….

Sir James

MacIntosh

About Knowledge Sharing

Page 3

So why keep knowledge to yourself when it can benefit the organisation as a whole? Is it for job secu-rity? Is it to maintain power? Is it to gain personal advantage over those not in the know?

The following barriers were identified at a SESIAHS workshop on knowledge sharing.

People, processes, technology and content are the four pillars of knowledge management. The term knowledge management simply refers to the creation, identification, capture, acquisition and sharing of knowledge . Whether you are a clinician, an educator or a manager, you will be involved in some way with many of the knowledge activities listed below. Please take the time to consider which of these strategies you could now implement to promote knowledge sharing within your unit, facility or across the Area Health Service.

PEOPLE

♦ Appoint a leader to promote knowledge sharing, build a KM infrastructure and develop a knowledge manage-ment framework.

♦ Establish people networks, for example: • A Reference Group of knowledge advisors • Communities of practice (health pro-

fessionals who share a common knowledge domain and work to-wards improving practice)

• Informal electronic networks (Area Listserver [email]).

♦ Use existing networks of people to communicate

• Committees and Focus groups (e.g. SAP, CSRP, Local Steering Committees

• CIAP Representatives (established to communicate with colleagues about online knowledge resources)

• Regular staff forums. ♦ Hold regular roadshows and seminars to promote clini-

cal redesign goals, benefits and outcomes. ♦ Promote skills and competencies. ♦ Provide recognition and rewards for successes. ♦ Identify network leaders and champions who are will-

ing to contribute and actively participate. ♦ Cultivate senior management as champions and en-

courage them to model knowledge-sharing in visible, meaningful ways.

PROCESSES

♦ Develop a communications and marketing plan and use multimedia to communicate with stakeholders (not eve-ryone has electronic access).

♦ Develop and implement a training and education pro-gram to build the skills and knowledge literacy of health care workers. • Project management • Change management • Understanding patient flow • Process mapping • Patient and carer engagement • Measurement for Improvement • Redesigning roles

♦ Develop project toolkits to assist staff in the change program.

♦ Identify meaningful KPIs. Know what success will look like.

♦ Establish an evaluation program to review the impact of clinical redesign projects on patients, staff and the or-ganisation.

♦ Reward those who show special initiative in sharing knowledge through public recognition at meetings, fo-rums and in newsletters or providing opportunities to take on new roles.

♦ Share lessons learned to avoid duplication and reduce effort and costs.

TECHNOLOGY

♦ Create a repository of information and knowledge us-ing the local Intranet and market it to stakeholders so that they are aware of the content provided.

♦ Establish links to reliable and credible knowledge re-sources such as those provided via CIAP and ARCHI and other Health Knowledge Gateway links.

♦ Promote integration with other key business applica-tions e.g. EMR.

♦ Ascertain whether stakeholders have access to a PC so that they can view the information and knowledge resources that we are encouraging them to use.

♦ Implement electronic tools to assist staff in their change projects and provide training in the use of the tools.

Laying the foundation for a worthwhile KM program takes focused resources and visible commitment by senior management. Start with a few straightforward steps as described above within a program portfolio such as Clinical Redesign, and then ex-pand the program as other parts of the organisation realise the value of Knowledge Management.

CONTENT

♦ Create and acquire knowledge assets and make knowl-edge resources available to stakeholders both elec-tronically and in print medium.

♦ Ascertain what knowledge re-sources are required to meet the needs of staff.

♦ Ensure that content is up to date and accessible to those who need it.

♦ Encourage the sharing of knowledge resources by providing standards and formats for document capture and mandating their storage on a shared site (e.g. Intranet) so that they are available to others.

For further information on knowledge sharing, please contact Dianne Ayres, Knowledge Network Facilitator, Clinical Redesign Unit at SESIAHS. Email: dianne.ayres@sesiahs.health.nsw.gov.au. Telephone 9947 9821 or 0409 604 007

Page 4

Strategies to Promote a Knowledge Sharing Culture