ickm-2008-presentation
DESCRIPTION
KM in HealthCare-USATRANSCRIPT
Knowledge Sharing Processes and Tools in U.S.A Primary Health Care: Analysis of Four
Case Studies
BIBI M. ALAJMI, MLIS-Rutgers UniversityCLAIRE R. McINERNEY, PhD-Rutgers University
A. JOHN ORZANO, MD, MPH-Robert Wood Johnson Medical SchoolALFRED F. TALLIA, MD, MPH- Robert Wood Johnson Medical School
ABIGAIL MEESE, MLIS-Rutgers UniversityIULIAN VAMANU, PhD candidate-Central European University, Budapest
ICKM/2008
TALKSDM
Taking Action by Learning and Knowledge Sharing in Diabetes Management
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Overview
Background Where did this all come from ? Who are we ? Where does this research fit within the whole project ?
Research BackgroundTheoretical BaseResearch QuestionsResearch MethodsCase Studies
Research Findings: Knowledge Sharing Processes and ToolsDiscussionConclusion
What is the takeaway “Message”?Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
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Where did this all come from ?
Most Americans seek and receive health care in primary care practices where there are 2 – 12 clinicians.
This health care is personal and friendly, but…
Resources are limited and clinicians are often overworked and stretched to the limit of their energy.
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
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Where did this all come from ?
The main purpose of the study is to improve health care delivery;
HOWEVER, interventions designed to translate scientific advances into effective action in practice have met with mixed results or limited sustainability.
A physician attending social sciences courses was looking for solutions.
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Where did all this come from?
A Knowledge Management course opened a discussion on how KM could benefit health care services.
A socio-technical model of KM was developed.
The impact of knowledge “process” management on performance and work relationship in ways that enhance learning and decision-making was examined.
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
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Who are we ?
Research Project-----> “TALKSDM" (Taking Action by Learning and Knowledge Sharing in Diabetes Management)
Research Team-----> * Doctors/physicians in Robert Wood Johnson Medical School* Academics in Rutgers University*The University of Texas at Austin (Department of Management Science and Information Systems)*Colombia University (Division of General Medicine)* PhD students in Rutgers University* MLIS students in Rutgers University
Research Purpose---->1) To examine how health care practices employ knowledge sharing tools and
processes to the benefit of their daily work processes. 2) To understand how knowledge sharing could contribute to practices'
performance.Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
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Where does this research fit within the whole “TALKSDM" Project
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
Phase (2): Case Studies &
Hypothesis Formulation
Phase (1): Modeling and
Taxonomy
Phase (3):Piloting & Full
Study
Our Research
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Research Background: Theoretical Base
Theory of Reasoned Action – What factors predict a physician’s intention to perform a behavior (e.g. to share knowledge)?
Theory of Planned Behavior – How would physicians perceive their ability to perform a certain behavior (e.g. the ease or difficulty of sharing knowledge)?
There is little context specific research about knowledge sharing in health care practices, but these two theories have been used to explain physicians’ attitudes and willingness to share knowledge with other clinical staff.
( Ryu et al., 2003)
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
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Research Background: Research Questions
1) How do certain health-care practices exhibit knowledge sharing tools and processes?
2) What hypotheses can be developed from this
study to guide additional research?
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Research Background: Research Methods
Research Sample---->Four health care practices located in NJ were selected based on a prevention study evaluation criteria.
Research Methods ------> Principal investigator (a physician) conducted INTERVIEWS with all clinical staff in four health care practices in NJ. In addition to OBSERVING interactions among staff and patients while on site. FIELDNOTES were recorded, and the recordings were later converted to written transcripts.
Case Study--->This study is an explanatory one, aiming to develop pertinent hypotheses and propositions for the third phase.
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
CriteriaHP#17
HP#21
LP#22
LP#3
Clinical (1=Upper Quartile/2=Lower Quartile)
Diabetes (meeting targets: HgbA1c 8, LDL 100, BP 130/85) 1 1 2 2
Hypertension (meeting target: BP 140/90) 1 1 2 2
Cholesterol (screening for cholesterol within 5 years) 1 1 2 2
Productivity (1= reported losing money within the past three yrs/2=stay same or gained)
2 2 1 1
Learning (assessment from facilitators of the practice’s uptake of the quality improvement process scale 1-5, 1=greatest).
1 1 5 5
Size (N=number of approximate full time equivalent clinicians) 4 4 2 3
Type of Medical Record (EMR=1/paper=2) 2 1 2 1
Affiliation with Health System (Yes=1/No=2) 1 2 1 2
Case Studies: Measurement for Selection
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Research Background: Research Methods
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
Research Sample---->Four health care practices located in NJ were selected based on a prevention study evaluation criteria.
Research Methods ------> Principal investigator (a physician) conducted INTERVIEWS with all clinical staff in four health care practices in NJ. In addition to OBSERVING interactions among staff and patients while on site. FIELDNOTES were recorded, and the recordings were later converted to written transcripts.
Case Study--->This study is an explanatory one, aiming to develop pertinent hypotheses and propositions for the third phase.
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Medical Practice #3Low-Performing
In this case, a note was attached to paychecks explaining the purpose of the project.
Medical Practice #22Low-Performing
Members were introduced to the research during a meeting. The principal researcher explained the purpose of the research to all members of the practice and to the two doctors.
Medical Practice #17High-Performing
Researcher’s recognition applied to the receptionist as well as other staff members. They had been told beforehand about the researcher visit and the general purpose of his visit.
Medical Practice #21High-Performing
Practice’s leader indicate that he’s going to introduce the research team for the practice staff and assign a contact point to facilitate their job.
Case Studies
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
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Knowledge Sharing Tools
Knowledge Artifacts----->Educational materials, bulletin boards, manuals and procedures and patients' medical records
Meetings------>Face-to-face conversation producing minutes and reports
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
Communication Channels-->Including face-to-face, written communication, or mediated communication technologies such as databases and decision support systems
Images imported from http://www.fotosearch.com/
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Knowledge Sharing Processes
Communities of Practice--->Group of named individuals who interact both in face-to-face and virtual environment to exchange experience and knowledge; share learning and build knowledge and expertise (Wenger et al., 2002).
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
Training and Apprenticeship-->Incidents in which staff is exposed to training or teaching opportunities provided by the practice or other organizations, and also the learning opportunities provided to non-staff members, including medical students.
Images imported from http://www.fotosearch.com/
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Research Results
Knowledge Sharing Tools
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
High-Performing Practices Low-Performing Practices
Depend heavily on manuals and procedures; however there are problems of accuracy and currency.
Lack of manuals and procedures resulted in incomplete learning. Members work based on their own experience and personal notes.
Less formal meetings and more ongoing and ad hoc meetings. Once needed, all staff get together.
Meetings are for critical and urgent issues. In one practice there was a no-meeting policy.
Face-to-face communication is the preferred tool; less emphasis on using the technologies (e.g. Electronic Medical Record (EMR), intranets, website, e-mail). Postal mail or in-person documents are preferred for patients.
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Research Results
Knowledge Sharing Processes
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
High-Performing Practices Low-Performing Practices
Engage in Communities of Practice; however, issues of cost and timing might hinder their participation.
Staff find conference attendance has no benefits since they don’t focus on their own problems. Use consultation to improve work.
Training is done through external sources, training manuals, and on-the-job-training.
Training is done through observation and watching others due to budgeting issues.
Discussion
How do health care practices in the U.S exhibit knowledge sharing tools and processes ?
All four health-care practices displayed patterns of sharing knowledge among their members as well as with other communities of practice.
A comparison of the high-performing and low-performing practices showed that all have limited knowledge sharing practices.
Knowledge sharing processes and tools were not completely integrated throughout the entire practice.
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Discussion
Knowledge Sharing cannot be forced or mandated. What is required to enhance knowledge sharing practices in health care? An integrative approach
Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008
Takeaway “Message”
KM has great potential for health care and illness management.
Clinicians and information scientist need to work together to understand how KM tools and processes can be applied in a health care setting.
We will test the efficacy of KM in a diabetes care context in the coming months.
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Contact Information
Ms. Bibi AlajmiDoctoral StudentSchool of Communication, Information and Library Studies – Rutgers Universitybmalajmi “at” eden.rutgers.edu
Prof. Claire McInerneyAssociate ProfessorSchool of Communication, Information and Library Studies – Rutgers University http://www.scils.rutgers.edu/~clairemcKnowledge Institute http://knowledgeinstitute.rutgers.edu/ clairemc “at” scils.rutgers.edu+1 732-932-7500 ext. 8218
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References
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Cheuk, B. (2004) "Sense-making methodology and communities of practice within the British Council", In: Trezzini, B., Lambe, P., Hawamdeh, S. (Eds.), People, knowledge, and technology: What have we learnt so far: 55-65, Proceedings of the first IKMS
International Conference on Knowledge Management Singapore 13-15 December 2004. New Jersey: World Scientific. Connelly, C. and Kelloway, K. (2003) "Predictors of employees’ perceptions of knowledge sharing cultures", Leadership and Organization Development Journal, 4(5): 294 – 301.Davenport, T. H. and Prusak, L. (1998) "Working knowledge: How organizations manage what
they know", Boston: Harvard Business School Press.Dyer, J. H. and Nobeoka, K. (2000) "Creating and managing a high-performance knowledge
sharing network: The Toyota case", Strategic Management Journal, 21: 345-367. Feagin, J., Orum, A., and Sjoberg, G. (Eds.) (1991) "A case for case study", Chapel Hill, NC:
University of North Carolina Press.Hislop, D. (2007) "Knowledge processes and communication dynamics", In: McInerney, C. R.
and Day, R. E. (Eds.), Rethinking knowledge management: From knowledge objectives to knowledge processes: 187-208, Heidelberg, Germany: Springer. Holsapple. C. W. and Joshi, K. D. (2001) "Organizational knowledge resources", Decision Support Systems, 31(1): 39-54.Lee, C. K., and Al-Hawamdeh, S. (2002) “Factors impacting knowledge sharing”, Journal of
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References
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Orzano, J., McInerney, C. R., McDaniel, R., Meese, A., Alajmi, B. and Tallia, A (in review) "Knowledge Management in primary care practices and implications for improving practice performance" Orzano, A.J., McInerney, C. R., Tallia, A.F., Scharf, D., and Crabtree, B.F. (2008) "Practice performance and knowledge management", Health Care Management Review, 33(1): 21-28. Polanyi, M. (1966) "The tacit dimension", London: Routledge.Ruggles, R. (1998) "The state of notion: Knowledge management in practice", California Management Review, 49(3): 80–89.Ryu, S, Ho, S. H. and Han, I. (2003) "Knowledge sharing behavior of physicians in hospitals", Expert Systems with Applications, 25: 113-122.Stake, R. E. (1995) "The art of case study research", Thousand Oaks, CA: Sage Publications.Stefanelli, M. (2004) "Knowledge and process management in health care organizations",
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Publications. Walz, D., Elam, J. J., Curtis, B. (1993) "Inside a software design team: Knowledge acquisition, sharing and integration", Communications of the ACM, 36(10): 63-77Wenger, E., McDermott, R., and Snyder, W. (2002) “Cultivating communities of practice”, Boston, Massachusetts: Harvard Business School Press.