Knowledge Management in Health Services Mallard Valley PCT: a “Factional” Case Study

Setting the Scene  For many of us Knowledge Management is a potentially overpowering concept, largely because of the scale and complexity of our health care organisations.  We have, therefore, chosen to illustrate general principles of knowledge management within the context of a single PCT.  While the organisational backdrop moves on at pace the general principles essentially remain the same.

About Mallard Valley PCT  Approx 1,500 staff. 20 mile radius of Mallard-On-Ooze  25 general practices on 35 sites  2 community hospitals  Specialist clinics and centres  Mallard Manor Hospital site  PCT management offices

The story begins…  Typically knowledge management (KM) initiatives are not created in a vacuum  Usually they are built on a base of existing information/library services  So in Mallard Valley there is a peripatetic librarian, Ms. Litiga Damask-May, who expands her role to take on the portfolio for KM as encapsulated in corporate documents of this time period:

First Steps “A specialist travelling knowledge manager employed to spread evidence of effectiveness and encourage use of on-line databases” “The PCT provides multi-professional workshops, a knowledge manager, and computer skills training” Creation of Mallard Valley PCT, Public consultation document. Summer 2000

Planning a strategy  Litiga Damask-May, the Knowledge Manager, starts by contributing to development of a KM strategy.  This is a valuable way of placing knowledge on the corporate agenda. It acts as a focus for previously “unjoined-up” activities.  The KM strategy embodies both an overarching aim and key principles:

Knowledge Policy Aims:  “Enabling staff to access, understand and use knowledge derived from research as well as from the body of experience of best practice.” Principles:  Commitment from senior management  Developing a learning culture  Facilitating access to information and helping colleagues to share knowledge  Enabling people to develop greater skills in finding and using information  Delivering information electronically

Understanding User Needs  Litiga first conducts a literature review of primary care information needs.  She next conducts qualitative research into the specific needs of her patch.  Then, in Spring 2002, her PCT is included in a County-wide Knowledge Audit.  Knowledge Audit (internal sources) and Knowledge Mapping (external resources) are important early stages in a practical KM approach

What do we know? Information needs and information- seeking behaviour of family doctors  Family doctors seek information for needs arising from professional responsibilities and personal characteristics.  Problem-orientated information, related to the care of individual patients, is the predominant driving factor.  Personal collections are preferred information resource; electronic sources rank second.  The medical library received low use. Both vocational training and the employment of a practice librarian impacted on library use.

Developing an Intranet presence  Successful knowledge sharing requires an underpinning technical infrastructure.  A shared intranet is a good mechanism to facilitate knowledge sharing, particularly where an organisation is spread over several buildings/sites.  In the case of Mallard Valley it was decided to survey staff for their preferences regarding sources to be shared via the intranet….

Knowledge Sharing Networks/ Intranet  Intranet: survey of staff preferences Mallard Valley PCT, Winter 2001

Database of Expertise In sixth place on the list of resources suggested for the staff intranet is a database of experts or staff skills. Such databases of expertise are an excellent way of emphasising the presence of tacit knowledge (non- verbalised implicit knowledge) within an organisation They do carry several challenges (to be explored in more detail elsewhere): Level of detail (balancing conciseness with usefulness) Mechanisms for maintenance (balancing central control with individual responsibility)

Learning Networks/Communities of Practice  With a shared IT infrastructure in place and a mechanism for knowledge sharing underway it becomes possible to look at the development of learning networks or communities of practice. These are built around shared interests of PCT staff – either clinical specialties (e.g. dermatology) or shared functions.  The aim of these is to make implicit knowledge explicit. Communities of shared interest can be fostered through various methods of communication such as person- to- person and through e-communication.

Taking stock  After her promising start Litiga decides to take stock. In 2001 an article appears outlining ten building blocks towards knowledge management within a clinically- focused organisation.  Litiga decides to assess the early progress within Mallard Valley PCT against this published model. She imagines what a hypothetical end of first term report might look like for her emerging organisation……

How does Mallard Valley measure up? Knowledge Audit Knowledge Mapping ? Knowledge Sharing Networks (Intranet) Database of Expertise Environmental Scanning ? Learning Networks (Communities of Practice) Measuring Intellectual Capital X Knowledge organisation and classification ? Chief Knowledge Officer X Entry and Exit debriefings ?

First Term Report  A very promising start with the achievement of some quick wins (e.g. Knowledge Audit and Intranet).  More work required on raising the profile of KM within the Trust  More sophisticated approaches to KM (e.g. Measuring Intellectual Capital) will take time to develop  Issues remain about organisational readiness

The Mallard Valley story continues……

Acknowledgements The Mallard Valley PCT Case Study has been devised using materials in the public domain. However, the FOLIO team would like to acknowledge the contribution of Sue Lacey Bryant (Independent Information Specialist) to realisation of this Case Study. Any resemblance between Mallard Valley PCT and an existing PCT is entirely in the eye of the beholder!

Further Reading Booth, A. (2001) Managing knowledge for clinical excellence: ten building blocks. Journal of Clinical Excellence 3 (4): Bryant, S. L. (1999) Information services for primary care: the organizational culture of general practice and the information needs of partnerships and primary care groups. Health Libraries Review, 16 (3), Bryant, S L (2000) The information needs and information-seeking behaviour of family doctors: a selective literature review. Health Libraries Review 17 (2), 83–90 Bryant, S L (2001) Knowledge management: enabling colleagues to access and share knowledge. Journal of the Learning Workplace 3: 3-6. Bryant, S L (2002) Know-how? Exploring the knowledge dimensions of primary care IFMH Inform 13 (1) 1-3.