Knowledge management systems and practices

Innovations in healthcare in recent years have resulted in profound improvements in the quality of healthcare services as well as the manner in which they are delivered. One of the more important factors that has been shown to contribute to improved quality of healthcare services is the willingness to share knowledge among healthcare practitioners. To identify what factors serve to improve or detract from effective knowledge management practices, this paper reviews five relevant peer-reviewed studies concerning knowledge management in healthcare settings, followed by an assessment of the significance of the findings that resulted, as well as a summary of the research and potential topics for future research in this area.

Importance of Knowledge Management (KM) in Healthcare

Introduction

Although knowledge management is an important element in almost any organizational setting, effective and efficient knowledge management practices in healthcare settings can spell the difference between life and death as well as the overall quality of care that is provided. A growing body of evidence suggests that people are more willing to share what they know under certain circumstances, but may be reluctant or unwilling to do so in others. To identify the optimal conditions for knowledge sharing practices in healthcare organizational settings, this paper delivers a review of the relevant peer-reviewed literature to provide a background and overview of knowledge management and to identify five studies of knowledge management practices in healthcare settings. An evaluation of the significance of the findings that emerged from this literature review is followed by a summary of the research and potential topics for future research.

Literature Review

Background and Overview

Although most organizations are quick to point out that their human resources are their most valuable capital asset, it is reasonable to suggest that knowledge represents an enormously valuable asset for any type of organization as well. For instance, according to Chatzkel (2003), "The ability to leverage knowledge to create value has grown significantly since the 1980s, with much of this enhanced capability tied to the rise of the disciplines of knowledge management and intellectual capital" (p. 4). It is important to distinguish information from knowledge, though, because although information is readily available in the digital age, raw information lacks context and it may be of limited value until it is converted into relevant knowledge (Zack, 1999). In sum, knowledge is validated and authenticated information that has been transformed into some type of usable form that can be readily applied to the needs of an organization (Alavi & Leidner, 2001).

Studies of Knowledge Management in Healthcare Organizations

A study by Detmer, Shortell, Caldwell and Kizer (2001) used a critical review of the literature approach to provide an overview and background of knowledge-sharing practices in healthcare organizations as well as what steps can be taken to improve these practices. According to Detmer and his associates, "In addition to being able to access patient data when and where it is needed, healthcare professionals need to be able to find and apply evidence (i.e., relevant knowledge) as part of the care process" (2001, p. 3). This fundamental need means that information of any type must be transformed into knowledge that can be readily applied to the needs of the healthcare organization. This need has also assumed new importance and relevance, Detmer et al. note, as the amount of information available to healthcare providers has increased in recent years due in large part to innovations in telecommunications technologies. Many healthcare practitioners, though, may lack the expertise and skills needed to convert raw information into usable knowledge, particularly given the enormous amounts of scientific data that are being circulated in the healthcare literature (Detmer et al., 2001).

For the purpose of their study, Detmer and his colleagues define knowledge management as "Efforts to capture, share, and deploy both tacit and explicit knowledge to meet specified goals" (2001, p. 4). Likening the process of trying to distill the flood of information that healthcare providers are faced with to drinking from a fire hose, Detmer et al. also note that, "Knowledge management is becoming increasingly important to the success of organizations throughout the economy but has particular relevance in healthcare where the volume of knowledge that professionals and even patients must navigate is large and rapidly growing" (2001, p. 4).

Although knowledge management practices share some commonalities across all industries, there are some specific characteristics involved in the healthcare industry that must be taken into account by managers seeking to facilitate the knowledge-sharing process. For instance, according to Detmer and his associates, "From the perspective of the health industry, knowledge management comprises efforts to increase the knowledge base; improve knowledge dissemination mechanisms; implement or strengthen reporting or monitoring capabilities and use; and modify curricula for undergraduate, graduate, and continuing education to provide the workforce with needed skills and knowledge" (2001, p. 4). Moreover, there is a growing need for informed and efficient knowledge management practices among healthcare organizations in order to gain a competitive advantage by delivering enhanced patient-centered and customized services (Detmer et al., 2001). In response to these needs, these researchers advise healthcare managers to inculcate an organizational culture that embraces change and rewards knowledge sharing behaviors (Detmer et al., 2001).

An earlier companion study by Kovner, Elton, Billings and Short (2000) also used a comprehensive literature review to report on the current state of knowledge-sharing practices in healthcare organizations. Based on their review of a wide range of randomized clinical trials and studies of knowledge-sharing practices in healthcare organizations (approaching the level of a meta-analysis), Kovner et al. (2000) report that:

1. Little evidence has been generated about best management practices and such evidence is not widely shared;

2. Historically, healthcare organizations have lacked sufficient size and critical mass to conduct and assess applied research; and,

3. Healthcare managers lack training and experience in collaborating with health services researchers and lack commitment to the values of applied research (p. 4).

Clearly, knowledge-sharing practices in healthcare organizations represent a potential area for management focus in ways that can improve service delivery and clinical outcomes. Based on their analysis, Kovner and his associates suggest that their findings indicate that there are some steps that can be taken to facilitate knowledge-sharing practices in healthcare organizations irrespective of the focus of their services. In this regard, Kovner et al. report that, "Knowledge management will be encouraged to the extent that leaders better manage knowledge and learn from best practice and best experts [and] are able to document better organizational performance, thereby further supporting improved health system processes of decision making" (2000, p. 5).

A study by Wang, Lee, Lin and Zhuo (2007) investigated the extent to which team interaction produced positive or negative effects on team members' willingness to share knowledge levels in a tertiary healthcare setting. Pursuant to this goal, the study also examined the extent to which each of the three categories of personality (i.e., trust, personality, and aspiration type) was related to team members' willingness to share of knowledge and to evaluate these categories among members assigned to quality improvement teams (Wang et al., 2007). With respect to their rationale for the study sample, Wang et al. report, "A healthcare system was chosen to be the sample because it relies heavily upon efficient and accurate knowledge sharing among its staff" (2007, p. 250).

The researchers operationalized their variables as follows:

1. The main dimensions of the study were personality, team process, and willingness to share knowledge;

2. The three sub-dimensions of personality were: trust, personality type, and aspiration type;

3. The sub-dimensions of willingness to share knowledge were sharing of personal knowledge, sharing of learning chance, and stimulation of motivation; and,

4. The three sub-dimensions of team process were team communication, team cooperation, and team coherence (Wang et al., 2007, p. 251).

To accomplish the foregoing research purposes, the researchers used a pretest to evaluate the effectiveness of their custom survey instrument. Following the pretest, Wang and her associates mailed 240 surveys to their targeted population, with 161 being returned in time for inclusion in the data analysis; of these, seven surveys were unusable (the researchers did not indicate the reasons), for a total of 154 usable surveys representing a response rate of 64% (Wang et al., 2007). The researchers used a product-moment analytical method to analyze the results of the usable surveys and present their results in a tabular format (Wang et al., 2007).

Consistent with the findings of comparable studies cited by the authors, the results of the Wang et al. study found that trust among team members is highly correlated to their willingness to share knowledge. This finding indicates that the effectiveness of healthcare organizations can be enhanced by increased levels of trust between team leaders and team members. In this regard, Wang et al. report that, "In order to improve the effectiveness of organizations, leaders should build up trust among their staff, should reduce whatever uncertainty and unease they have to each other" (p. 251).

In addition, Wang and her associates found that team members who rated higher on conscientious and extroversion measures were more willing to share their own knowledge with others, while team members who were rated with higher levels of neuroticism were less willing; the researchers attributed this latter finding to the possibility that these team members were less willing to share knowledge simply because they feared that others would not be interested in what they had to say (Wang et al., 2007). This finding led the researchers to conclude that healthcare managers should assign leadership roles to team members who exhibit high levels of conscientiousness and extroversion (Wang et al., 2007). Finally, the Wang et al. study found that internal, external, and complementing motivation on the part of team members were all positively correlated with their willingness to share knowledge (Wang et al., 2007).

The penultimate study reviewed was by Zuckerman (2006) who cites the relative paucity of timely and relevant research concerning best practices for knowledge sharing in healthcare organizations (an assertion that was supported to some extent by the dearth of relevant studies identified during the research process for this paper). For instance, according to Zuckerman, "Data assembly and analysis in healthcare are still largely done in an ad hoc and unsystematic manner. Rarely does an organization bring much structure to the information-gathering part of the process, and those organizations that do largely confine that structure to internal data assembly" (2006, p. 3).

These healthcare organizational practices are in sharp contrast to the knowledge management practices that are being used by other industries. For example, Zuckerman notes that, "Some of the leading companies have taken all of this effort to another level through the use of knowledge management programs. Such programs sort information into structured databases that allow easy access and use by personnel throughout the organization" (2006, p. 4). While it is reasonable to suggest that many healthcare organizations, particularly tertiary providers, have a patient information database in place, Zuckerman emphasizes that need for a more comprehensive knowledge database for healthcare organizations that will empower clinicians throughout the organization to not only gain access to knowledge, but will encourage their knowledge sharing practices as well.

Further, the strategic planning process can also be facilitated by developing comprehensive knowledge databases in healthcare organizations that can contribute to more effective knowledge management practices. As Zuckerman concludes, "These databases become a readily available asset, not just to 'those in the know' but to all involved in management and planning anywhere in the company. Knowledge management programs facilitate planning throughout the organization" (2006, p. 4). Moreover, expanded knowledge management programs can also contribute to continuous quality management improvements as mandated by the Joint Commission on the Accreditation of Healthcare Organizations. These are important issues for all healthcare organizations, but there are a number of constraints that may prevent the expansion of existing databases for this purpose, including the reluctance of "those in the know" to enhance knowledge management practices because they fear it may detract from their authority and the same types of "turf battles" that characterize all organizations also occur in healthcare settings (Zuckerman, 2006).

To determine the effectiveness of the knowledge management practices in a given healthcare organization in promoting continuous quality improvement, Zuckerman recommends applying the following questions:

1. First and most basic, is the current process comprehensive, objective, timely, and highly participatory throughout the organization;

2. Second, does the process link effectively to operations and to individual and group performance objectives in the organization; and,

3. Third, does the process include continuous learning so that process deficiencies are identified and corrected before the next planning cycle begins? (2006, p. 4).

The final study reviewed was conducted by Droese and Peterson (2006) who review the relevant literature concerning the need for improved knowledge management practices in healthcare organizations as a result of federal programs such as Medicaid that require timely and responsive use of knowledge to improve the efficiency of healthcare service delivery as well as the quality of those services. In this regard, Droese and Peterson emphasize that, "Organizations not only need to acquire knowledge, but also to manage what they know. However, in the fragmented, multidisciplinary world of Medicaid and health policy, an information professional's ability to combine advanced information science training and subject matter expertise provides a unique opportunity for knowledge management" (2006, p. 174).

Following a summary of the historical background of Medicaid and other legislation that has affected healthcare policies in recent years, Droese and Peterson (2006) recommend the use of medical librarians to enhance the knowledge management practices in healthcare organizations. According to these researchers, "Librarians who work behind the scenes may be called on to provide internal reference and consultation to committees to ensure institutional priorities have adequate resources. Librarians can also fill the need to keep a collective history of what information is used for projects, especially in a policy setting, allowing for knowledge transfer even when staff turnover occurs" (Droese & Peterson, 2006, p. 174).