| Healthcare managers are discovering that a "best | | | | been compared against similar units in terms of |
| practice" imported from another organization is | | | | productivity, cost per unit per discharge and cost |
| not a panacea. First, one size never fits all. | | | | per patient day. If you're the most expensive in |
| Second, managers charged with process | | | | the group, you can call the other hospitals and |
| improvement often think of the search for a best | | | | learn what they are doing to keep costs down. |
| practice as a one-time effort. In truth, | | | | The procedure is simple. The knowledge |
| performance improvement is always ongoing. | | | | community administrator schedules a time for a |
| That's why smart organizations are intensifying | | | | conference; you call in with a password, and |
| the search for best practices with "knowledge | | | | you're on the phone with ten of your peers all |
| communities" - groups of people who share a | | | | discussing your issue." |
| common interest and are committed to exchange | | | | Liston has participated in focused phone |
| information and solve common problems together | | | | conferences concerning staffing mix and |
| on a continuing basis. Here's how knowledge | | | | productivity. "Providing excellent outcomes while |
| communities can make a difference in patient | | | | increasing staff productivity is always a challenge," |
| care and the organization's bottom line. | | | | he says, "but when you share knowledge with ten |
| Why the Search for "Best Practices" Fails | | | | other hospitals, someone always has a creative |
| There are five approaches to best practice | | | | idea." He in turn has shared IHC's |
| "search and implement" missions that strangle | | | | seven-on-seven-off staffing model which works |
| management. They all begin with a vague project | | | | well in a hospital that provides physical therapy |
| to find a best practice without any certainty on | | | | seven days a week. IHC's policy and procedure |
| search parameters or desired outcome. What | | | | were posted on the knowledge community's Web |
| usually happens is one of the following: | | | | site, available for other members to learn from. |
| Scenario 1: | | | | Small Steps to Big Goals |
| The manager cannot find a better performer that | | | | Incremental steps are the best way to improve, |
| is similar to his or her own organization in terms | | | | manage change and make a difference. |
| of size, scope, structure, environment, trauma | | | | Knowledge communities simplify the process of |
| level, profitability, etc. Therefore, there is no one | | | | adapting and evolving a practice to fit the |
| from whom to learn. | | | | organization because managers can learn the |
| Scenario 2: | | | | incremental steps others took to arrive at the |
| Hospitals that are insufficiently diverse swap best | | | | goal. Rather than searching for an elusive best |
| practices, which then become inbred rigidities or | | | | practice or finding one too overwhelming to |
| sacred cows. No innovation occurs because there | | | | implement, managers can obtain practical |
| is no diversity in the learning pool. | | | | information in digestible bite-size pieces. In |
| Scenario 3: | | | | Scenario 5, for example, a member of a |
| The manager searches and searches for the "holy | | | | knowledge community might learn that Pharmacy |
| grail" or elusive best practice. The search | | | | Manager X at Hospital A began by giving the |
| continues with no end in sight, and nothing is | | | | physicians preprinted drug prescription forms. This |
| accomplished. Or, the best practice is found, but | | | | approach worked well and eventually evolved into |
| never implemented. Searching doesn't bring results. | | | | computerized order entry. |
| Doing does. | | | | The healthcare industry has traditionally shied |
| Scenario 4: | | | | away from obtaining and utilizing external |
| The manager at Hospital A succeeds in finding a | | | | information from other healthcare systems and |
| best practice. Hospital B has standardized on a | | | | other industries. A knowledge community makes |
| single vendor for artificial knee implants. The | | | | the process easy and comfortable because the |
| manager copies the practice by standardizing on a | | | | member organizations are not competitors, but |
| single vendor from Hospital A. The result? The | | | | span the country. More importantly, a knowledge |
| physicians revolt because no one was consulted! | | | | community expands the collective knowledge of |
| Or, by signing a two-year exclusive agreement to | | | | the group and raises the bar for everyone. |
| get a lower price, Hospital B misses out on new | | | | "I highly recommend joining a knowledge |
| advances in orthopedic implants and the | | | | community," says Kaufmann. "Busy managers |
| high-volume, well-respected surgeon defects. The | | | | who do not have the time to research topics on |
| moral? Best practices are not commodities. | | | | the Internet or in the medical library can network |
| Mindlessly mimicking a best practice is a recipe for | | | | with hospitals in different parts of the country. |
| disaster. Adapt, evolve, customize! | | | | We learn what financial or clinical issues our peers |
| Scenario 5: | | | | are struggling with or have solved in creative |
| The manager finds that the best practice in | | | | ways. For newcomers, a knowledge community |
| pharmacies is computerized order entry, which is | | | | can seem a bit daunting, but once you get in the |
| extremely costly and challenging to implement. He | | | | habit of sharing information, you realize that it's a |
| or she is overwhelmed by the grand plan, freezes | | | | very valuable educational resource. It's the perfect |
| and does nothing, instead of taking incremental | | | | way to connect with peers on specific business |
| steps to arrive at the goal. Best practice should | | | | and clinical issues. The time spent is well worth it |
| be about motivation, not intimidation. | | | | in the long run." |
| So, what's a manager to do?: Join a Knowledge | | | | "Any organization that is small or lacks a solid peer |
| Community | | | | group needs to belong to a formal or informal |
| No two organizations have the same clientele, | | | | group to bounce ideas off each other, ask |
| physicians or environment. It follows that | | | | questions and get answers," says Liston. |
| knowledge management processes must be as | | | | "Sometimes we need to go beyond our own |
| different as the organizations that practice them. | | | | organization to learn how others are wrestling |
| The process has to meet the specific needs of | | | | with problems that are similar across the industry. |
| the organization and provide managers with | | | | I can't imagine being in a single hospital, or even a |
| experience and knowledge they can use for | | | | small group of hospitals, and not having instant |
| improvement. | | | | access to peers to help deal with questions and |
| Knowledge communities offer a concrete starting | | | | concerns of daily operations. It's not just for the |
| point - a first place for managers to turn when | | | | benefit of hospital leadership. Department |
| they want to customize a successful practice to | | | | managers or senior physical therapists who are |
| the organization and make it an ongoing part of | | | | struggling with certain issues can get help from |
| their management style. In discussions with other | | | | their counterparts in other organizations," he |
| members of the community, they gather ideas, | | | | added. |
| test hypotheses, solve common problems, | | | | Solutions for Better Care |
| compare implementation strategies, and build | | | | Knowledge communities are most successful |
| courage to change and leverage shared | | | | when the sharing of information and experiences |
| knowledge. Available anywhere, anytime through | | | | is accessible to the people (often department |
| the Web and technology such as teleconferencing, | | | | managers) who can effectively create change. |
| knowledge communities are the 21st century | | | | Providing these people with readily accessible peer |
| version of the professional society networking | | | | groups empowers them to learn from others to |
| experience. | | | | create solutions for themselves. This in turn |
| As part of a knowledge community, Baystate | | | | expands the organization's ability to change and |
| Medical Center in Springfield, Massachusetts | | | | improve. Everyone in the organization, not just a |
| participates in telephone conferences with eight to | | | | few executives, are now thinking about the kind |
| ten similar hospitals across the country. Sally | | | | of process improvement that will not only better |
| Kaufmann, Manager of Rehabilitation Services, | | | | the organization, but enhance the patients' |
| explains, "The members of our knowledge | | | | experience, which is what healthcare is all about. |
| community share information on clinical topics that | | | | Sidebar: |
| are of interest to us as rehabilitation managers in | | | | How to Advance or Doom Knowledge |
| an acute care setting. As a benchmarking group, | | | | Management |
| we compare data on the types and volume of | | | | Advance: |
| services we provide and the cost of providing | | | | ·Put knowledge where the action is, the |
| care. And, when clinical questions arise, any | | | | front lines of the organization. |
| member of the community can generate a | | | | ·Leverage internal and external |
| question and email it to the knowledge community | | | | peer-to-peer interactions to grow the collective |
| facilitator, who then generates a survey that | | | | knowledge of the group. |
| helps compare information on the topic. For | | | | ·Make historical knowledge available - easy |
| example, we just completed a series of | | | | to access, readily retrieved. |
| discussions on using whirlpools in the treatment of | | | | ·Encourage a flexible, risk-taking culture to |
| wounds. The therapy has become somewhat | | | | encourage positive change and growth. |
| controversial recently, which raised some | | | | ·Maintain organizational curiosity for new |
| uncertainty about our current whirlpool practice. | | | | ideas to germinate. |
| Hospitals participating in the discussion completed a | | | | Doom: |
| pre-conference call survey to compare our | | | | ·Focus on IT as the answer. IT may |
| programs, followed by a live discussion of specific | | | | provide a shell to contain knowledge, but human |
| issues. I then arranged a follow-up call with a | | | | intervention is necessary to actively manage |
| member of the network who turned out to be | | | | knowledge exchange. |
| particularly expert in this area. She gave me | | | | ·Rely on written documents to transfer |
| some solid advice, which helped me create a | | | | knowledge. Interactive sharing is to effective |
| packet of information for physicians who are | | | | knowledge exchange. |
| referring patients to our whirlpool service. It alerts | | | | ·Breed a culture that inhibits action. |
| them to alternatives and recommends a new | | | | ·Restrict or convolute access to |
| referral process that may or may not include | | | | knowledge. |
| whirlpool." | | | | ·Decline to resource knowledge. |
| Utah Valley Regional Medical Center in Provo, Utah, | | | | Knowledge distribution, archival, use, interactions |
| a division of Intermountain Healthcare, has been a | | | | and access will not be valuable unless they are |
| member of a knowledge community for several | | | | thoughtfully managed and facilitated with |
| years. Ron Liston, Director of Rehabilitation | | | | appropriate manpower. |
| Services, reports, "Periodically, the knowledge | | | | ·Refuse to participate. Asking for |
| community administrator runs a comparison of | | | | information from others without sharing ideas and |
| our hospital with some of our IHC sister hospitals, | | | | information in return creates an unsatisfactory |
| as well as hospitals throughout the U.S. For | | | | relationship. |
| example, our inpatient rehabilitation program has | | | | |