Collecting Knowledge isn’t Easy

Being Human

Qualia (from the Latin, meaning “what sort” or “what kind”; Latin and English singular “quale”, pronounced KWAHL-ay) are most simply defined as qualities or feelings, like redness, as considered independently of their effects on behavior.

In more philosophical terms, qualia are properties of sensory experiences by virtue of which there is something it is like to have them.  (http://psychology.wikia.com/wiki/Qualia)

Feeling Complexity

I have a memory of being a child living in an apartment.   My mother was out for some reason and it was a cold winter day.   I heard her putting the key into the door and since the door had multiple locks I jumped up and ran to the door to help.   When the door opened up I felt a blast of cold air as she grabbed me and hugged me.  I could smell the scent of rain and snow mixed in with her normal mom smell.   The cool feeling of her outside jacked was cold to the touch but warm to my heart.    This is one of my favorite memories but it is truly hard to describe.

Collecting Knowledge

Everything we can manage is the result of something we can produce.   We can suppress emotions but we can’t really manage them.   We can suppress our reaction to something as long as we can condition our minds to respond to input based on practices of conditioning.   In other words,  if you are boxer,  you may have a condition where you tolerate more pain but we technically can’t manage it.

A collection of knowledge is a “best attempt” to get information about something.    Imagine if we sought to collect all of the knowledge you have, how could this be done?   You don’t even have access to all of your knowledge.    In fact, we rationalize the things we don’t know by addressing them with faith.   I don’t mean religion when I say faith, I mean a rule of expectation.   These rules of expectation allow us to perform tasks.   They are short cuts that our brains use to be effective.

When collecting knowledge, we have to unearth the short cuts. 

When you turn on your computer, you have an expectation that it will perform as you expect.  You may not possess all of the knowledge in the device, all of the knowledge that the device is connected with and/or the knowledge to make the device itself function.

If you wanted to collect knowledge about the device, you would seek out all of these things and more.   In a way, it doesn’t make sense.    What a lot of people say at that point of complication is “it is what it is.”  Why?  Because we can only manage so much and tolerate so much, there are thresholds that we should consider.

We might consider the term Knowledge Management a false harmony.   We can see an explicit list of things in a collection but it would be at best faith to consider that we could attain an understanding and rationalization of this list of things.

Where’s Waldo

Why are we looking for Waldo?

What is the purpose of Waldo?

Even though there is a lot of information here,  the knowledge to find Waldo in fact lives outside of the picture in your head.   I will find Waldo either before or after you find Waldo.  In fact, the only way I could find Waldo faster than you for certain is if I had this picture before you and I know where he is.    One thing is for sure for most of us, we have faith and belief that Waldo is in fact in this image.   What if he isn’t there?  The shortcut of belief that Waldo is in the picture allows us to set the stage to spend more time looking for Waldo.   I could present you with the answer of where Waldo is or you could go on the learning journey of discovery and find Waldo yourself.

It all boils down to the fact that it is all complicated.    We could even consider that depending on our level of tolerance for frustration and patience that you or I may never find Waldo.

Knowledge Management Considerations

We could consider that since we have the technology to collect but we don’t have the capacity to yet understand the wholeness of a collection, that we still need to consider and maintain the value of our subject matter experts.

Knowledge has the most fidelity at the personal level.   We should consider that any overall Knowledge Management practice will always end with something to collect and someone to maintain or interpret the collection. As opposed to gaining the collection as an holistically explicit thing unto itself.

Cluster Transfer Rapid KT Through Maps

Remembering 1 Thing over Many (Communication | Memory | Context)

“Never force anything, you’ll break it.” – Dad Cohen
  • What do we need to know and why? Memory
  • The right information at the right time. Value
  • Clusters in Context. (Maps and Links) Relationships 

MEMORY

STRATEGIES FOR REMEMBERING (http://www.psychologytoday.com/blog/happiness-in-world/200911/how-remember-things)

  1. Become interested in what you’re learning. We’re all better remembering what interests us. Few people, for example, have a difficult time remembering the names of people they find attractive. If you’re not intrinsically interested in what you’re learning or trying to remember, you must find a way to become so. I have to admit I wasn’t so good at this in medical school. The Krebs cycle (I provided the link only to prove how immensely boring it is) just didn’t excite me or relate to anything I found even remotely exciting (though I made myself learn it anyway).
  2. Find a way to leverage your visual memory. You’ll be astounded by how much more this will enable you to remember. For example, imagine you’re at a party and are introduced to five people in quick succession. How can you quickly memorize their names? Pick out a single defining visual characteristic of each person and connect it to a visual representation of their name, preferably through an action of some kind. For example, you can remember Mike who has large ears by creating a mental picture of a microphone (a “mike”) clearing those big ears of wax (gross, I know—sorry—but all the more effective because of it). It requires mental effort to do this, but if you practice you’ll be surprised how quickly you can come up with creative ways to create these images. Here’s another example: how often do you forget where you left your keys, your sunglasses, or your wallet? The next time you put something down somewhere, pause a moment to notice where you’ve placed it, and then in your mind blow it up. If you visualize the explosion in enough detail, you won’t forget where you put it. Remember: memory is predominantly visual (unfortunately, I can’t think of a good image to help you remember this fact right at this moment).
  3. Create a mental memory tree. If you’re trying to memorize a large number of facts, find a way to relate them in your mind visually with a memory tree. Construct big branches first, then leaves. Branches and leaves should carry labels that are personally meaningful to you in some way, and the organization of the facts (“leaves”) should be logical. It’s been well recognized since the 1950’s we remember “bits” of information better if we chunk them. For example, it’s easier to remember 467890 as “467” and “890” than as six individual digits.
  4. Associate what you’re trying to learn with what you already know. It seems the more mental connections we have to a piece of information, the more successful we’ll be in remembering it. This is why using mnemonics actually improves recall.
  5. Write out items to be memorized over and over and over. Among other things, this is how I learned the names of bacteria, what infections they cause, and what antibiotics treat them. Writing out facts in lists improves recall if you make yourself learn the lists actively instead of passively. In other words, don’t just copy the list of facts you’re trying to learn but actively recall each item you wish to learn and then write it down again and again and again. In doing this, you are, in effect, teaching yourself what you’re trying to learn (and as all teachers know, the best way to ensure you know something is to have to teach it). This method has the added benefit of immediately showing you exactly which facts haven’t made it into your long-term memory so you can focus more attention on learning them rather than wasting time reinforcing facts you already know.
  6. When reading for retention, summarize each paragraph in the margin. This requires you to think about what you’re reading, recycle it, and teach it to yourself again. Even take the concepts you’re learning and reason forward with them; apply them to imagined novel situations, which creates more neural connections to reinforce the memory.
  7. Do most of your studying in the afternoon. Though you may identify yourself as a “morning person” or “evening person” at least one study suggests your ability to memorize isn’t influenced as much by what time of day you perceive yourself to be most alert but by the time of day you actually study—afternoon appearing to be the best.
  8. Get adequate sleep to consolidate and retain memories. Not just at night after you’ve studied but the day before you study as well. Far better to do this than stay up cramming all night for an exam.

Mental Tree MindMaps and Remember Once.. And Knowledge Journey

There are differences in transferring long-term and short-term knowledge.   Today people are more likely to know less because of technology.   This means that the requirements to retain information and manage it have changed over time. What a knowledge receiver needs to know is the location of the information and the context of that information as applied once they discover or reference it.  Once they identify what they are looking for they also need the ability to understand and codify the information for it to be useful.

Method of Loci

 The method of loci is a method of memorizing information by placing each item to be remembered at a point along an imaginary journey. The information can then be recalled in a specific order by retracing the same route through the imaginary journey. Loci is the plural for of the Latin word,locus, meaning place or location. The method of loci is also called the Journey Method by Dominic O’Brien, and the imaginary journeys are often referred to as Memory Palaces or Memory Journeys. See also Mind Palace, the term used in the TV show, Sherlock. (http://mnemotechnics.org/wiki/Method_of_Loci)

Rapid KT..  A Mind Map is a ROAD MAP of associations..

The map is a visual representation of the interlinkages of nodes (objects or concepts) and their relationships.   To transfer knowledge rapidly (the secret sauce) is for a—> mentor or SME (Subject Matter Expert) to take the knowledge receiver on a trip through the map.

Example:

It all started..(element of time and location) (HERE at this place) and this turned into the (X), where X = an outcome and (X) is related to (A,B,C) —> It is objects and concepts in story on a map that can account for time and events.   As a result of an event on (this date or timeframe) the object or concept of (x) turned to (X1).  All of this contained in an explicit map.

 

The key is that you don’t have to remember to “Bake” or “Bake In Oven” individually,  you need to remember the map as a whole.   (Even though this map is simple)  The person that is transferring knowledge creates the map or walks the map with the person receiving knowledge.   The story comes with the map.. the story is that TACIT information …  “When I first started here and I was learning how to bake a cake, I didn’t know to pre-heat the oven to 350 degrees for 30 minutes.”  The knowledge receiver can adopt the concept / mind / knowledge map and put their own notes or stories.  It is their investment, it is personal to them.    There are things the receiver may already know and not need.   The image or map is the cluster of relative and relevant knowledge.  In the process of KT, it can be tied to one event.  There are elements of Personal knowledge, Team knowledge and Enterprise knowledge here.    The lower the fidelity of information the higher the knowledge resides.  The map shown above can be linked to in an enterprise repository to team or personal maps.   During the process of knowledge transfer all of the maps and information associated is identified as one clustered object.   The knowledge receiver learns about the process, methods, tools and any links to people who may have existed in the past and exist today.

When I was a young man working on a car with my father, he said “Righty tighty, lefty loosy” and in the same instance “Never force anything, you’ll break it.”   He only told me one time and I have remembered and applied this my whole life.  These two concepts were shared in one event, the relationship of the information is tied to my father, a Dodge Scamp Silver, any given Sunday and working on cars at the top of an open air garage in Coop City.     That is how we remember things..   When looking to transfer knowledge, we have to address the environment, condition, time, sentiment and ability to cluster information and create relationships with the data for purposeful recall.

How do I create a “clustered package” for KT?

Please be clear that I am not inventing something new.   This is a simple outline for steps you would take on a high level.

  1. Identify who, what when, where and why.
  2. How- This will be the process and the methods.
  3. What is important to know today? How much of this information is still relevant?  Can I throw some of this away or do it better?
  4. What is the business case for this information and what historical measures have been used?
  5. What are the stories that are tied to the information?
  6. What can we automate (where it makes sense)?
  7. What changes should be made moving forward?
  8. What is the risk? (From the SME’s perspective)
  9. What is value? (From the SME’s perspective)
  10. How is any of this tied to assessment criteria? (if not, why not?)

These are some of the steps and questions that we may ask.  We must understand (WHY) and we must seek to keep all of the information and content tied through the understanding of relationships.   My good friend and mentor Ron Batdorf will say that this is all tied to Enterprise Architecture.   It is an explicit expression of a moment in time relative to what is important (NOW).  Effectively a best effort to get the right information at the right time.

 

bakemap1

Advanced Map of Context

Alzheimer’s Map <—PDF larger viewAlzheimers_Map-440x264

 

What do you think?

Memory Forum –>http://mnemotechnics.org/

 

 

Practical Knowledge Management in a Strategic World

covercomm

In preparing for battle, I have always found that plans are useless but planning is indispensable.”-Dwight D. Eisenhower

Planning for Knowledge Management

Why do organizations need a structured KM initiative or program?

Most organizations at a very high level seek to do three general activities:

  • Reduce Risk
  • Identify and Execute on Opportunity for Cost Savings
  • Identify and Execute on Revenue Generation Opportunities.

While designing strategic business plans most organizations do not plan for KM activities.    Further, most KM activities are not tied to business strategies.    In 2001, Ronald Maier and Ulrich Remus published an IEEE paper on this subject.   They made a case for a “process-oriented KM Strategy.” This provides an integrated view of resources and market based orientation.

ProcessOriented

 

As a KM practitioner, this view makes a lot of sense, but it is still very strategic.   The key to a successful KM practice is centered in two areas that aren’t often identified as part of the strategy.   These are:

  • Organization Awareness
  • Organization Conflict Management

To plan for Knowledge Management in an organization, the planners must understand the landscape.   Planning to delight clients and customers with goods and services is not enough.    Even if you are planning for an industry of consumers that have few choices, understanding the landscape of the business is key to profitability in margins.     Knowledge Management is essentially about getting the right information at the right time to the right people.   This sounds a lot like logistics.

What is Awareness?

a·ware·ness
əˈwe(ə)rnis
noun knowledge or perception of a situation or fact. “we need to raise public awareness of the issue”

More often than not we are unaware of what is going on in an organization.   When we go to the doctor to get a check up, we are seeking to raise awareness of our health.  Often times we don’t know and we can’t know without some diagnostics what is going on in our organization.  We need a “check up” to find out what is going on.   This check up needs to be performed with a frequency that makes sense and one that it minimally disruptive.

 

 

 

 

process-tree

 


 What activities can we perform to raise awareness?

One of the first practical activities is to start with a communication campaign.   (Internal Communications) <-see the post from  for more details below are Shel’s words.

1. Mobile

Employees are using their personal devices for work simply because they’re better than the devices distributed by the company (if, that is, they were among the employees who actually got company phones) and they’re able to use those meatier features to fuel their own improved efficiency.

Regardless of the motivation, however, there are opportunities to reach employees who were relegated to the have-not class when companies abandoned print for the cheaper (but not necessarily more strategic) intranet.

2. Video

According to one study, 72% of internal communications teams are planning to increase the use of video as a means of communicating with employees. That dovetails nicely with the mobile trend, since YouTube recently revealed that mobile devices account for 40% of the videos consumed on its site.

More and more companies are adopting a YouTube-like approach to video, introducing video libraries that let employees search for videos, comment on them, tag them, embed them and (importantly) upload their own as a means of sharing information and knowledge.

3. Communicating for engagement

Employee engagement has always been the province of Human Resources, but research from the PR Academy supports the notion that good communications contributes to higher levels of engagement.

The focus on engagement is being accelerated by articles in communication publications and sessions at conferences from communicators who have been able to connect the dots. The mandate is clear as alarmingly low engagement levels lead executives to wonder why their communications departments aren’t doing more to correct the problem. Gallup, which more or less invented the whole concept of engagement, found that only 13% of employees worldwide are engaged at work.

There are ample opportunities for communications to bolster engagement. One is to improve the channels through which employees’ collective and individual voices are heard. Another is to recast communications based on the stakeholder groups with which employees self-identify: work groups, project groups and the employee-supervisor relationship. A lot of executives believe employees don’t care about the issues that keep them up at night, but employees do care—deeply—when those issues are articulated in the context of these stakeholder groups.

4. Social software adoption

While social software has been deployed in many organizations, employees generally haven’t adopted it. Adoption is critically important, since businesses that don’t migrate to social software as a conduit for day-to-day business will be mangled by their savvier competitors. The McKinsey Global Institute estimates productivity improves by 20-25% in organizations with connected employees, and the potential for revenue amounts to $1.3 trillion per year.

Yet, according to Prescient Digital Media’s 2013 social intranet study, only 13% of employees participate in the social intranet on a daily basis while 31% rarely or never do.

Given the focus on engagement and some other key internal communications trends, communicators will take a more active role in promoting the adoption of internal social media, which will require a strategic pivot away from the vice-like grip email has on most employees’ communication practices.

5. Activity streams

Nothing succeeds like success. When organizations focus on adoption of social software, the tool that attracts most employees is the activity stream (the equivalent of Facebook’s news feed on your intranet). With employees able to see instantly what their work team peers, project peers, bosses and other employees are doing, they feel more connected and, as a result, get more engaged.

Within organizations that have adopted the activity stream as the dominant homepage feature, communicators are giving up their magazine-style approach to sharing news and simply injecting their articles and other content into the stream. At least three organizations I know have seen this approach result in three or four times the views of their content. That’s right: Getting employees to “follow” or “like” the communications profile leads to more consumption of communications content than the traditional approach of listing headlines on the homepage.

7. Social visual communication

Images are dominating shared content, and with good reason. Engagement levels and interaction with images are significantly higher than narrative text as content consumption shifts from fixed desktops and laptops to mobile smartphones and tablets. While I’m hesitant to call this an internal communications trend—I haven’t seen it manifest yet inside any organization—it is inevitable. Smart communicators will get ahead of the trend and innovate ways to use images to tell stories and deliver messages, along with the channels for delivering them. I wrote a post recently suggesting six ways communicators can use images for internal communications.

8. Digital signage

These devices are activated by touch or motion, incorporate video, and can be tailored to deliver relevant information to employees based on their location, even floor-by-floor. Here’s just one case study from a freight company.

9. Gamification

Gamification, stated simply, makes it fun to do things that usually are mundane and tedious by applying one or more of the elements of game-play. These typically include badging, leveling, leader boards, and completion bars.

Communicators who acquaint themselves with the principles of gamification will be able to apply it to communication challenges.

10. Print

The simple fact is that employees don’t use the intranet the same way they used the company publication. While the periodical all-employee publication isn’t making a comeback, niche uses of print that are based on achieving measurable objectives are making a comeback in many companies. Hospitals, for example, are returning to print to get messages to nurses and other staff who don’t have access to the intranet. Yes, it’s costly. Yes, it has long production lead times. But it also works.

11. Employee influence measurement

As employee-to-employee communication moves into the jurisdiction of internal communications departments, identifying and tapping into those employees with high levels of influence will grow more important. The folks at Microsoft recognize this; it’s why they’ve done a deal with Klout to have an influence score appear on their Yammer profiles based on their internal Yammer activity. I have little doubt that Chatter and other internal networking tools will follow suit, but in the absence of such automated scoring, communicators will find other ways to figure out which employees to tap for advocacy and ambassadorship roles.

 ___

Communicate, Communicate, Communicate.. – Cohen

As your organization gains momentum in communication, feedback and open exchange the ideas around social constructionism – (Social constructionism, or the social construction of reality, is a theory of knowledge in sociology and communication theory that examines the development of jointly constructed understandings of the world.Wikipedia start to emerge.     What this means on a basic level is that WE are smarter than ME.   Strategic communication through a matrix approach facilitated and orchestrated (INFORMS) the organization.   This information … converts in context to KNOWLEDGE and feeds strategy.    Communication is a basic and practical way to turn a KM strategy into an effective KM practice. 

What about organizational conflict management?

Yes.. it is again tied to communication.

 

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Keeping it Practical

1) Position our organization for learning.   We do this by learning about ourselves, our people, our process, our methods, and tools.  What are the best things we never knew we had, including our who, what, when where and why?

2) What level of awareness do we need in our organization to be successful?  What does awareness mean to us?

3) What are our current activities and how do they tie to our current business, mission, vision, scope and objectives?   What questions do we need to come up with to understand OUR landscape.   

4) Does our current Knowledge Management practice align with our business objectives?   Do we work in siloes?  Is that ok for our kind of business?   What information needs to transfer between individual performers and groups? How do we deal with personal, team, and enterprise knowledge?

5) What areas do we need to practice an approach to organizational conflict management?  What are the costs associated with conflict management?  What are the benefits and innovation potential for conflict management?   Inter and intra-department transformational and adjacent innovation?

6) What are we doing well today?  What do we need to reenforce and what do we need to resolve?

Most of the tools are already in our organization.   The key is active communication, facilitation and attention to people our most valuable and precious resource.

 

Leadership has the tools, the process and the methods of communication in hand today.  With a well thought out strategy, leadership can start communication early and often. They can create opportunity for employees to engage and provide feedback.   This communication will inform the strategy for business which includes KM.   The well informed organization lowers risk, increases opportunities for cost savings where it makes sense and increases the opportunities for revenue generation.

Communications

Sometimes Simple is Effective!

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

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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?

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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!