Knowledge Management and Healthcare

HealthCareCohenSaving Lives

In that moment when you realize that what you are experiencing is real and you have been shaken into the understanding that you are a human being; frail, fragile and living only for a short time this one moment can define or redefine your whole life.

Most of us live our day-to-day lives in a state of ignorance with regard to our health and our lives until we are faced with our mortality or impacted by someone close to us being sick.   People that work in the healthcare industry especially those on the front lines of medicine know all too well about human mortality.  That being said, it is still easy to get into routines and patterns of operation which create a narrow scope of perspective.  In other words,  being in a medical practice can create an intentional numbness.  Some studies show that doctors may suppress their emotions or their brains may automatically inhibit their ability to be empathetic in a short period of time.  The stress of being a person in an environment constantly being reminded that life is short and constantly fighting battles to save lives takes a lot out of people.  It also impacts their decision-making process.

My personal and professional experience has driven me to question why knowledge management is lacking in the healthcare industry.  This industry isn’t short of information but there are indicators that medical practitioners may not have the right information at the right time.

***Frame***

Chip and Dan Health wrote on KevinMD

The following is an exclusive excerpt adapted from #1 New York Times best-selling authors Chip and Dan Heath’s new book Decisive: How to Make Better Choices in Life and WorkHow a smart process helped Kaiser Permanente save lives, which was released on March 26, 2013.

One of the most fundamental problems of decision-making, according to psychologists, is that people get stuck in a “narrow frame”—they view their decision in an unduly limited way, often missing options that are available to them. To break out of a narrow frame, people need new options, and one of the most basic ways to generate those options is to find someone else who’s solved your problem.

For many health care leaders, this search for new options has become second nature. They’ve long since learned to “benchmark” competitors and absorb industry “best practices.” Sometimes, though, the practices that work for one organization may be incompatible with another, like an organ transplant that is rejected. (Imagine if McDonald’s, inspired by movie theaters, started trying to hawk $12 Cokes.)

That’s why we shouldn’t forget, when hunting for new options, to look inside our own organizations. Sometimes the people who have solved our problems are our own colleagues. That’s what was discovered by the leaders of Kaiser Permanente, one of the largest HMOs in the country with almost 9 million members.

In early 2008, Alan Whippy (her first name is pronounced uh-LANN), the medical director of quality and safety at The Permanente Medical Group in  Northern California, was staring at a set of data that astonished her. To continue pushing their hospitals to get better, Whippy and her team had asked the leaders of the 21 Kaiser Permanente Hospitals in Northern California to do detailed case studies of the last 50 patients who had died at each of their hospitals. One problem their hospitals had addressed aggressively—heart attacks—accounted for 3.5% of the deaths. But almost ten times as many deaths came from another cause that was barely on the radar screen at Kaiser Permanente or most of the other hospitals they knew: sepsis.

Dr. Whippy explained sepsis with an analogy: “If you have an infection on your skin, it gets inflamed–red and hot and swollen. The infection itself doesn’t turn the skin red, that’s the body reacting to the infection.” Sepsis is a similar reaction to an infection in the blood stream. The body’s inflammatory reaction spreads to the whole body, even to parts far away from the infection—a case of pneumonia, for instance, can trigger kidney failure or even brain damage.

What Dr. Whippy and her team realized was that physicians were paying careful attention to the infections, like pneumonia, but they weren’t aggressively treating the associated sepsis, which was often the true cause of a patient’s death.

Freeze there. Whippy had a problem on her hands: She needed options for improving Kaiser Permanente’s treatment of sepsis. Where could she find those options?

She located one critical connection within Kaiser: Dr. Diane Craig, a physician at Kaiser Permanente Santa Clara. Craig and her colleagues had spent several years working on sepsis and had already shown some reduction in their sepsis death rate. They were frustrated that progress was not quicker, though—especially since the “recipe” for managing sepsis was known. In 2002, a provocative article had appeared in the New England Journal of Medicine, showing that patients were substantially less likely to die from sepsis if they received quick and intensive treatment shortly after they were diagnosed.

It was easier said than done, though. As Craig knew from personal experience, the quick and intensive treatment was difficult to implement for two reasons. First, sepsis is hard to detect. A patient might look fine in the morning but plunge into crisis by lunchtime, and by then it was often more difficult to correct the cascade of internal damage.  Second, the protocol recommended by the article for treating sepsis—which involves administering large quantities of antibiotics and fluids to the patient—carries its own risks.

As Craig said, “It takes a while for people to get comfortable saying, ‘This patient looks good but I’m going to put a large central IV catheter in their neck and put them in the ICU and pump them full of liters and liters of fluids. And we’ll do all this even though they look perfectly fine at the moment.’” The research supports this early intervention. The risks are worth it. But it was difficult for doctors, with their “Do No Harm” ethos, to move as quickly and forcefully as the research said they should.

Craig and Whippy realized that, to fight sepsis, they had to overcome these two problems by making sepsis easier to detect and by demonstrating to staff the risk ofinaction.

With Whippy’s support, Craig and her team began to incubate new approaches to the problem at Santa Clara. One idea was simple but powerful: Whenever physicians ordered a blood culture—a sign they were worried about a blood-borne infection—a test for lactic acid was automatically added to their orders. (Lactic acid is a critical indicator of sepsis.) This allowed them to detect sepsis well before it began to influence the patient’s vital signs.

Other changes were intended to make the Santa Clara staff more aware of sepsis. Posters and pocket cards were printed up that highlighted the symptoms of sepsis. A grid on the printed materials showed the mortality risk for different patient circumstances. “People could see that this patient, right in front of me, even though they look good—they have a 20% chance of mortality. It was very powerful,” said Craig.

If the doctors and nurses spotted the symptoms of sepsis, they were asked to call a “sepsis alert,” the equivalent in urgency of the “code blue” called when someone is experiencing a cardiac arrest. The sepsis alert summoned a team that could assess the patient and, if appropriate, begin the intensive sepsis protocol.

These innovative solutions began to work. Sepsis deaths began to decline. Whippy, who’d been following the work, knew that the Santa Clara team was assembling a package of cultural interventions that she could spread to other hospitals.  Meanwhile, other hospitals, who’d been pursuing their own solutions, added other critical pieces of the puzzle, like a “pressure bag” that fit around an IV like a balloon, ensuring that sepsis patients would receive fluids quickly enough.

Within a matter of months, under Whippy’s direction, the sepsis protocol was being actively implemented in other hospitals. By summer 2012, Kaiser Permanente Northern California, composed of 21 hospitals serving 3.3 million people, had driven down risk-adjusted mortality from sepsis to 28 percent below the national average.

This solution has astonishing potential. If all hospitals could match Kaiser Permanente’s 28 percent reduction, it would be the annual equivalent, in lives saved, of saving every single man who dies from prostate cancer and every single woman who dies from breast cancer.

* * *

The leaders of Kaiser make it a priority to study their own internal “bright spots”—the most positive points in a distribution of data. For the treatment of sepsis, for instance, Dr. Craig’s team represented a bright spot, because of its lower death rate.

Bright spots can be much more mundane, though. If you’re trying to stick to a new exercise regimen, then your bright spots might be the four times last month that you made it to the gym. If you take the time to study and understand your bright spots—how exactly did you manage to get yourself to the gym on those four days?—then you can often discover unexpected solutions. Maybe you’d notice that three of the four occasions were during lunch, which tends to be the least complicated time for you. So you might make a point to avoid scheduling things at lunch time, keeping that time free for future workouts.

The wonderful thing about bright spots is that they can’t suffer from the rejected-transplant problem, because they’re native to your situation. It’s your own success you’re seeking to reproduce.

Both bright spots and best practices, then, act as sources of inspiration. If you’ve got a dilemma, and you need new options, you can look for new ideas externally, as with benchmarking and best practices, or internally, like Kaiser’s leaders. What’s critical is that we refuse to get caught in a narrow frame, considering only one or two options, and instead widen our perspective so we can see the full spectrum of options that are available to us.

Chip Heath and Dan Heath are the authors of the new book Decisive: How to Make Better Choices in Life and Work, as well as the previous bestsellers Switch and Made to Stick

 ***

The Basics

In the book Decisive, the authors pointed out something that I found compelling but they glossed over.   The time it took from when the article from  New England Journal of Medicine was published until  Dr. Whippy could get the model into best practice was somewhere between 8-10 years.    Authors: Stephen Boone, MD; Christian Coletti, MD; John Powell, MD state in their quick reference guide on sepsis that:

Severe sepsis affects approximately one million patients and claims more than 250,000 lives each year in the U.S. It is the second leading cause of death in non-cardiac ICU patients. Early and aggressive therapy influences outcomes. Utilizing the Surviving Sepsis Campaign Guidelines improves morbidity and can decrease mortality by 25%.

If I am doing my math correctly, in the US alone healthcare professionals had an opportunity to attack 2.5 million cases of sepsis over the past 10 years and the indication is that most haven’t.   Regardless, this is a best practice that should be addressed.

This is about the right information at the right time.   I have written in the past about how in one hospital the leadership turned to a race team to learn how to perform an effective and efficient shift turn over.   I can’t think of any organization that needs to leverage knowledge management more than healthcare.  This is more than just money, this is about saving lives and wellness.onlinelogomaker-102613-2009

When I walk into the doctor’s office today, he is carrying his iPhone or iPad with him, he is managing his personal knowledge but how is his personal knowledge moving from his device to his team or his colleagues?

How many people do you know that have died or have had complications due to sepsis or septic shock?

This is one area of discussion, how many other opportunities are we missing out on?

****

Do you know any healthcare professionals?  If so, forward the sepsis guidelines and best practice guides to them please, you never know you may save a life!

Enterprise KM (Metrics)

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Riding the Bike

As a child learning how to ride a bike I had both my uncle and my grandfather take me out to teach me.

Uncle Mark’s Approach

My uncle took off one training wheel and held the bike from the seat as he walked behind me on the path holding the seat.   He was looking to protect me and make sure that I didn’t fall.  His approach was also very logical.   I am sure that he thought about the process of taking one training wheel off at a time and that one wheel would allow me to learn how to offset the void of the other.   Before we got on the path, he explained to me what I needed to do.  I remember focusing on the pedals and trying to lean on the side that had the training wheel.   I fell and dropped that bike a number of times.   As I recall, it got to the point where he told me to keep practicing and we called it a day.

Grandpa’s Approach

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Now this memory is a killer for me.  Thinking back on this I actually remember how I felt in the moment.  The apartment building I grew up in is on the right.   We walked out the door and he told me to get on the bike. He had already removed both training wheels.  He had his hand on the back of the seat to hold me up and he said “when I push you, just pedal and look at the door in front of you”   In the picture above you see the two buildings almost facing each other.   You can see the entrance door from one building to the other, he was pointing at the door for the building on the left.   

He said “PEDAL”!! and he pushed me.   I looked up at the door, it was where he told me to go and I started to pedal in an instant and I mean an INSTANT, I got it.   I had mastered balance and I was riding.  It was one of those kick pedal bikes where you just push back to brake.  I had hit the brakes and spun the bike around like I knew what I was doing.  I turned the bike around and rode toward him elated.  Both of us were so gleaming and from that point on I knew how to ride.

Outcomes over Activities

Grandpa knew that to get the job done that he had to have me focus on where I was going and that the composition of activities involved were a subtle and covert process.   When I tried to focus on the individual activities of pedaling or taking on training wheels off one at a time, it was more of a distraction than helpful.   The result of having me focus on activities caused me to crash.   When my grandfather relieved me of that burden and helped me focus on the OUTCOME  I was able to learn to ride.    Of course there was room for improvement and there was still a lot for me to learn, but I was able to get where I was going right away.

Measuring the Enterprise

There are activities and business process to measure.   Most organizations aren’t in a position to care or understand the results when it comes to knowledge management.   MOST have yet to deal with the “Eleven Deadliest Sins of Knowledge Management .”

Eleven Deadliest Sins of Knowledge Management:

1. Not developing a working definition of knowledge.
2. Emphasizing knowledge stock to the detriment of knowledge flow.
3. Viewing knowledge as existing predominantly outside the heads of individuals.
4. Not understanding that a fundamental intermediate purpose of managing knowledge is to create shared context.
5. Paying little heed to the role and importance of tacit knowledge.
6. Disentangling knowledge from its uses.
7. Downplaying thinking and reasoning.
8. Focusing on the past and the present and not the future.
9. Failing to recognize the importance of experimentation.
10. Substituting technology contact for human interface.
11. Seeking to develop direct measures of knowledge.

Source: (Fahey & Prusak, 1998).

For some I have realized that no matter what I say, there are two truths.

1)People need to see SHINY OBJECTS —->Tools (i.e. Sharepoint, Wiki, Jive, Confluence etc)

2)People need to measure things GETTING TO THE SPECIFICALLY WRONG ANSWER WITH GREAT PRECISION.

If you are still reading..  and you want to learn more about the measures / metrics and you don’t care about anything else I have said here, you are in luck!

A_Practical_Framework_for_SharePoint_Metrics –Thanks Susan Hanley

KMmetricsguide–Thanks Department of the Navy CIO 2001 !~

Outcome to Measure 

Ok.. now that we have fed that beast..  Really,  you really need to think about a few things for the knowledge ecosystem relative to the business.

How can we Increase Revenue?

How can we Improve Productivity ?

How can we Reduce Costs (overall)?

If you want to break these down to areas like operational resilience and continuity or knowledge transfer or other areas, you can!  The bottom line is how is what you are doing in your knowledge practice going to help your business  / organization.   Even the not for profits have desire their work to be more than naught.

If you find yourself focusing on the tools or the measures / metrics, “results aka (s*&%) happens”

Knowledge Management NOW

KM Future

Starting your knowledge initiative NOW

 

I was working as a Business Analyst, IT specialist, Manager, Process Engineer or even Rocket Scientist and my management turned me into a (KM) Knowledge Management Adviser or Consultant, where do I start?

I have heard of KM but I don’t really understand what it means in terms of my business, why do I need to do this?

KM is bullshit and this is just another management fad, no one around here thinks it makes sense and now I am being forced to do some of this “fluffy” work. What do I need to do to basically meet their needs?

What about SharePoint, isn’t this important in KM for me to get started? How am I going to measure my KM?

These are some real questions I hear on KM from people in many different types of business.   The key is “perspective” and communication.   In many blog posts I have posted there have been two major focus areas (Trust and Communication).

If an organization as a body doesn’t see value or understand the value of trust and communication there will be consistent issues with knowledge management and knowledge transfer. That is it!

Why do we need to identify knowledge management patterns and process?

Information is flowing through your organization regardless of your ability to see it or your feelings about it.  Without data, information, knowledge and wisdom there would be no company, no organization and frankly, no you.    It is pretty simple right?  You are in business to buy, sell, trade, or serve and protect it doesn’t matter you need to know how to do it.   It doesn’t matter that there is a bi-modal distribution issue in that baby boomers or older workers are leaving the work force.   Regardless of whether older workers are leaving or not organizations need information to act on, the knowledge that information composes and the wisdom to know how, when, why to use it.   That is the reason.

It is a Problem

Here is why.   More and more and more and more information is being generated and thrown at everyone faster than we as humans can comprehend.   Unless you have a google worth of memory and more processing power in your brain than Watson, you aren’t smart enough or good enough to manage all the information thrown at you and your organization without some kind of plan.

Business Value

BV= Outcome

How many large organizations can you think of that have failed or have been acquired or destroyed?  What organizations are leading in the world now?   Why?  The largest funeral home service or cemetery service companies in the world will still get business if they don’t do a great job of knowledge management.  They are still vulnerable to knowledge loss and productivity loss.   Energy companies will be productive as long as they produce energy and health care companies will be productive as long as people are sick.    The food industry will be productive because people need to eat and so on and so on.   The question is really around if they will be productive and as effective as they have the potential to be.  How can KM bring undervalued organizations up to par?  How can KM help reduce risk?  How can KM help lower time to market on products or speed up training and knowledge transfer?

This isn’t looking at business from the eyes of a six sigma black belt or through a lens of human resources individually.   This is about a system of people, process, methods and tools.  It is about an ecosystem that is complicated but understandable.   It is about tweaking the system in small bits.    It is about the outcomes vs individual activities per se.

Start NOW

Do you have time to wait?  Will it be something you will get to?   Do you need more of a reason or explanation?  Do you need to be sold?  Do you believe that you don’t know how?  It is time to start looking at your organization in terms of people.  You need to know who your stakeholders are and where they are and what they do.   You need to know the results of their work.  You need to know what drives them.   This needs to be mapped or linked up to the organization mission, vision, scope and objectives.    This is the beginning.   What does your organization do?  Why?  Where are they in the market?  Are they in “a market”?   How do the people feel?  What is the average age of your workers?  When are they leaving? Why are they leaving?  How do they get information?  How do they exchange information?   Where do they find their purpose?  Are they driven by fear or passion?   Start now by asking questions.   Start now by talking to leaders in your organization.  Ask them questions and understand what drives them.    I would never need to sell you on reasons to drink water or eat.   I shouldn’t have to sell you on why understanding what knowledge is important to you, where, why, who, how and when..   Without it..