By Shelley Burns
Healthcare managers are discovering that a "best practice" imported from another organization is not a panacea. First, one size never fits all. Second, managers charged with process improvement often think of the search for a best practice as a one-time effort. In truth, performance improvement is always ongoing. That's why smart organizations are intensifying the search for best practices with "knowledge communities" - groups of people who share a common interest and are committed to exchange information and solve common problems together on a continuing basis. Here's how knowledge communities can make a difference in patient care and the organization's bottom line.
Why the Search for "Best Practices" Fails
There are five approaches to best practice "search and implement" missions that strangle management. They all begin with a vague project to find a best practice without any certainty on search parameters or desired outcome. What usually happens is one of the following:
The manager cannot find a better performer that is similar to his or her own organization in terms of size, scope, structure, environment, trauma level, profitability, etc. Therefore, there is no one from whom to learn.
Hospitals that are insufficiently diverse swap best practices, which then become inbred rigidities or sacred cows. No innovation occurs because there is no diversity in the learning pool.
The manager searches and searches for the "holy grail" or elusive best practice. The search continues with no end in sight, and nothing is accomplished. Or, the best practice is found, but never implemented. Searching doesn't bring results. Doing does.
The manager at Hospital A succeeds in finding a best practice. Hospital B has standardized on a single vendor for artificial knee implants. The manager copies the practice by standardizing on a single vendor from Hospital A. The result? The physicians revolt because no one was consulted! Or, by signing a two-year exclusive agreement to get a lower price, Hospital B misses out on new advances in orthopedic implants and the high-volume, well-respected surgeon defects. The moral? Best practices are not commodities. Mindlessly mimicking a best practice is a recipe for disaster. Adapt, evolve, customize!
The manager finds that the best practice in pharmacies is computerized order entry, which is extremely costly and challenging to implement. He or she is overwhelmed by the grand plan, freezes and does nothing, instead of taking incremental steps to arrive at the goal. Best practice should be about motivation, not intimidation.
So, what's a manager to do?: Join a Knowledge Community
No two organizations have the same clientele, physicians or environment. It follows that knowledge management processes must be as different as the organizations that practice them. The process has to meet the specific needs of the organization and provide managers with experience and knowledge they can use for improvement.
Knowledge communities offer a concrete starting point - a first place for managers to turn when they want to customize a successful practice to the organization and make it an ongoing part of their management style. In discussions with other members of the community, they gather ideas, test hypotheses, solve common problems, compare implementation strategies, and build courage to change and leverage shared knowledge. Available anywhere, anytime through the Web and technology such as teleconferencing, knowledge communities are the 21st century version of the professional society networking experience.
As part of a knowledge community, Baystate Medical Center in Springfield, Massachusetts participates in telephone conferences with eight to ten similar hospitals across the country. Sally Kaufmann, Manager of Rehabilitation Services, explains, "The members of our knowledge community share information on clinical topics that are of interest to us as rehabilitation managers in an acute care setting. As a benchmarking group, we compare data on the types and volume of services we provide and the cost of providing care. And, when clinical questions arise, any member of the community can generate a question and email it to the knowledge community facilitator, who then generates a survey that helps compare information on the topic. For example, we just completed a series of discussions on using whirlpools in the treatment of wounds. The therapy has become somewhat controversial recently, which raised some uncertainty about our current whirlpool practice. Hospitals participating in the discussion completed a pre-conference call survey to compare our programs, followed by a live discussion of specific issues. I then arranged a follow-up call with a member of the network who turned out to be particularly expert in this area. She gave me some solid advice, which helped me create a packet of information for physicians who are referring patients to our whirlpool service. It alerts them to alternatives and recommends a new referral process that may or may not include whirlpool."
Utah Valley Regional Medical Center in Provo, Utah, a division of Intermountain Healthcare, has been a member of a knowledge community for several years. Ron Liston, Director of Rehabilitation Services, reports, "Periodically, the knowledge community administrator runs a comparison of our hospital with some of our IHC sister hospitals, as well as hospitals throughout the U.S. For example, our inpatient rehabilitation program has been compared against similar units in terms of productivity, cost per unit per discharge and cost per patient day. If you're the most expensive in the group, you can call the other hospitals and learn what they are doing to keep costs down. The procedure is simple. The knowledge community administrator schedules a time for a conference; you call in with a password, and you're on the phone with ten of your peers all discussing your issue."
Liston has participated in focused phone conferences concerning staffing mix and productivity. "Providing excellent outcomes while increasing staff productivity is always a challenge," he says, "but when you share knowledge with ten other hospitals, someone always has a creative idea." He in turn has shared IHC's seven-on-seven-off staffing model which works well in a hospital that provides physical therapy seven days a week. IHC's policy and procedure were posted on the knowledge community's Web site, available for other members to learn from.
Small Steps to Big Goals
Incremental steps are the best way to improve, manage change and make a difference. Knowledge communities simplify the process of adapting and evolving a practice to fit the organization because managers can learn the incremental steps others took to arrive at the goal. Rather than searching for an elusive best practice or finding one too overwhelming to implement, managers can obtain practical information in digestible bite-size pieces. In Scenario 5, for example, a member of a knowledge community might learn that Pharmacy Manager X at Hospital A began by giving the physicians preprinted drug prescription forms. This approach worked well and eventually evolved into computerized order entry.
The healthcare industry has traditionally shied away from obtaining and utilizing external information from other healthcare systems and other industries. A knowledge community makes the process easy and comfortable because the member organizations are not competitors, but span the country. More importantly, a knowledge community expands the collective knowledge of the group and raises the bar for everyone.
"I highly recommend joining a knowledge community," says Kaufmann. "Busy managers who do not have the time to research topics on the Internet or in the medical library can network with hospitals in different parts of the country. We learn what financial or clinical issues our peers are struggling with or have solved in creative ways. For newcomers, a knowledge community can seem a bit daunting, but once you get in the habit of sharing information, you realize that it's a very valuable educational resource. It's the perfect way to connect with peers on specific business and clinical issues. The time spent is well worth it in the long run."
"Any organization that is small or lacks a solid peer group needs to belong to a formal or informal group to bounce ideas off each other, ask questions and get answers," says Liston. "Sometimes we need to go beyond our own organization to learn how others are wrestling with problems that are similar across the industry. I can't imagine being in a single hospital, or even a small group of hospitals, and not having instant access to peers to help deal with questions and concerns of daily operations. It's not just for the benefit of hospital leadership. Department managers or senior physical therapists who are struggling with certain issues can get help from their counterparts in other organizations," he added.
Solutions for Better Care
Knowledge communities are most successful when the sharing of information and experiences is accessible to the people (often department managers) who can effectively create change. Providing these people with readily accessible peer groups empowers them to learn from others to create solutions for themselves. This in turn expands the organization's ability to change and improve. Everyone in the organization, not just a few executives, are now thinking about the kind of process improvement that will not only better the organization, but enhance the patients' experience, which is what healthcare is all about.
How to Advance or Doom Knowledge Management
·Put knowledge where the action is, the front lines of the organization.
·Leverage internal and external peer-to-peer interactions to grow the collective knowledge of the group.
·Make historical knowledge available - easy to access, readily retrieved.
·Encourage a flexible, risk-taking culture to encourage positive change and growth.
·Maintain organizational curiosity for new ideas to germinate.
·Focus on IT as the answer. IT may provide a shell to contain knowledge, but human intervention is necessary to actively manage knowledge exchange.
·Rely on written documents to transfer knowledge. Interactive sharing is to effective knowledge exchange.
·Breed a culture that inhibits action.
·Restrict or convolute access to knowledge.
·Decline to resource knowledge. Knowledge distribution, archival, use, interactions and access will not be valuable unless they are thoughtfully managed and facilitated with appropriate manpower.
·Refuse to participate. Asking for information from others without sharing ideas and information in return creates an unsatisfactory relationship.
Shelley Burns is Director of Knowledge Management and Michelle Gray-Bernhardt is a Healthcare Knowledge Consultant with The Healthcare Management Council, Inc., located in Needham, Massachusetts. HMC is a dynamic benchmarking, knowledge management and consulting company that helps its healthcare clients create goals and execute plans for ongoing performance improvement. For further information, call (781) 449-5287 begin_of_the_skype_highlighting (781) 449-5287 end_of_the_skype_highlighting or visit the company Web site at http://www.HMC-benchmarks.com
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