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Introducing T-shaped managers. Knowledge management's next generation.

Most companies do a poor job of capitalizing on the wealth of expertise scattered across their organizations. That's because they tend to rely on centralized knowledge-management systems and technologies. But such systems are really only good at distributing explicit knowledge, the kind that can be captured and codified for general use. They're not very good at transferring implicit knowledge, the kind needed to generate new insights and creative ways of tackling business problems or opportunities. The authors suggest another approach, something they call T-shaped management, which requires executives to share knowledge freely across their organization (the horizontal part of the "T"), while remaining fiercely committed to their individual business unit's performance (the vertical part). A few companies are starting to use this approach, and one--BP Amoco--has been especially successful. From BP's experience, the authors have gleaned five ways that T-shaped managers help companies capitalize on their inherent knowledge. They increase efficiency by transferring best practices. They improve the quality of decision making companywide. They grow revenues through shared expertise. They develop new business opportunities through the cross-pollination of ideas. And they make bold strategic moves possible by delivering well-coordinated implementation. All that takes time, and BP's managers have had to learn how to balance that time against the attention they must pay to their own units. The authors suggest, however, that it's worth the effort to find such a balance to more fully realize the immense value of the knowledge lying idle within so many companies.

Administrative Personnel↗

What's your strategy for managing knowledge?

The rise of the computer and the increasing importance of intellectual assets have compelled executives to examine the knowledge underlying their businesses and how it is used. Because knowledge management as a conscious practice is so young, however, executives have lacked models to use as guides. To help fill that gap, the authors recently studied knowledge management practices at management consulting firms, health care providers, and computer manufacturers. They found two very different knowledge management strategies in place. In companies that sell relatively standardized products that fill common needs, knowledge is carefully codified and stored in databases, where it can be accessed and used--over and over again--by anyone in the organization. The authors call this the codification strategy. In companies that provide highly customized solutions to unique problems, knowledge is shared mainly through person-to-person contacts; the chief purpose of computers is to help people communicate. They call this the personalization strategy. A company's choice of knowledge management strategy is not arbitrary--it must be driven by the company's competitive strategy. Emphasizing the wrong approach or trying to pursue both can quickly undermine a business. The authors warn that knowledge management should not be isolated in a functional department like HR or IT. They emphasize that the benefits are greatest--to both the company and its customers--when a CEO and other general managers actively choose one of the approaches as a primary strategy.

Commerce↗

Knowledge management is new competitive edge.

Managing knowledge is emerging as the latest business strategy to get ahead of the competition. In the process of developing knowledge management systems, executives are increasing their awareness and understanding of organizational dynamics, collaboration, corporate learning and knowledge management technology. But Donald E.L. Johnson writes that health care executives must buy into and understand collaboration and corporate learning before they tackle knowledge management.

Economic Competition↗

[Knowledge management in health organizations].

BACKGROUND: In 2002 the head of the Israel Defense Forces (IDF) Technology and Logistics Command took a strategic decision to manage knowledge across the organization. The IDF Medical Corps was one of the initiation sites selected. Insights from the process of establishment of a knowledge management (KM) system in the IDF Medical Corps as a health organization (HO) are described. METHODS: IDF's medical services were identified, mapped and their participants interviewed, as were KM personnel in Israeli HOs. Information analysis pointed to the medical rendezvous (MR) as the central process for initiation of KM. The knowledge challenges were identified, and knowledge services and administrative interventions were planned. RESULTS INCLUDING KM CHALLENGES AND RESPONSE: The MR was found to be the process in which most of the clinically and administratively significant decisions in HO's were taken. Practitioners had large clinical and administrative knowledge gaps. Medical and administrative knowledge originated from various sources, in many formats. It could not be retrieved either easily or completely, was usually presented in an inconvenient form for assimilation, and was not always updated. Therefore, the MR was selected as the initial intervention point. Optimally, a comprehensive solution providing access to high quality knowledge can be a knowledge portal, including diagnostic indexing as a key for retrieval of information. Furthermore, indexed clinical, administrative, services list, quality assurance, risk management, and continuing medical education knowledge services, as well as a collegial and administrative feedback, link all entities involved into a knowledge community. This may increase the opportunity for optimal and efficient managed care.

Health Knowledge, Attitudes, Practice↗

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

Decision Support Systems, Clinical↗

Dealing with human factors and managing change in knowledge management: a phased approach.

Ten human factors affect the implementation of knowledge management initiatives, including fear, cultural change, capturing of tacit knowledge, ease of use, stakeholder involvement, and benefits realization. To deal with these factors, a phased change management approach is offered, consisting of an assessment, strategic planning, organization development, systems design, orientation and training, team building, and continuous evaluation and improvement.

Attitude of Health Personnel↗

CardioKnowledge: a knowledge management environment.

Knowledge management supports decision-making by capturing and analyzing key performance indicators, providing visibility into the effectiveness of the business model, and by concentrating collaborative work and employee knowledge reviews on critical business problems. CardioKnowledge is a knowledge management environment based on the business and process requirements of a health care organization in Cardiology. CardioKnowledge supports organizational processes in order to facilitate the communication and exchange of knowledge among the cardiologists, medical students and other employees.

Brazil↗

Managing knowledge and technology to foster innovation at the Ohio State University Medical Center.

Biomedical knowledge is expanding at an unprecedented rate-one that is unlikely to slow anytime in the future. While the volume and scope of this new knowledge poses significant organizational challenges, it creates tremendous opportunities to release and direct its power to the service of significant goals. The authors explain how the Center for Knowledge Management at The Ohio State University Medical Center, created during the academic year 2003-04, is doing just that by integrating numerous resource-intensive, technology-based initiatives-including personnel, services and infrastructure, digital repositories, data sets, mobile computing devices, high-tech patient simulators, computerized testing, and interactive multimedia-in a way that enables the center to provide information tailored to the needs of students, faculty and staff on the medical center campus and its surrounding health sciences colleges. The authors discuss how discovering, applying, and sharing new knowledge, information assets, and technologies in this way is a collaborative process. This process creates open-ended opportunities for innovation and a roadmap for working toward seamless integration, synergy, and substantial enhancement of the academic medical center's research, educational, and clinical mission areas.

Academic Medical Centers↗

Knowledge management in healthcare: towards 'knowledge-driven' decision-support services.

In this paper, we highlight the involvement of Knowledge Management in a healthcare enterprise. We argue that the 'knowledge quotient' of a healthcare enterprise can be enhanced by procuring diverse facets of knowledge from the seemingly placid healthcare data repositories, and subsequently operationalising the procured knowledge to derive a suite of Strategic Healthcare Decision-Support Services that can impact strategic decision-making, planning and management of the healthcare enterprise. In this paper, we firstly present a reference Knowledge Management environment-a Healthcare Enterprise Memory-with the functionality to acquire, share and operationalise the various modalities of healthcare knowledge. Next, we present the functional and architectural specification of a Strategic Healthcare Decision-Support Services Info-structure, which effectuates a synergy between knowledge procurement (vis-à-vis Data Mining) and knowledge operationalisation (vis-à-vis Knowledge Management) techniques to generate a suite of strategic knowledge-driven decision-support services. In conclusion, we argue that the proposed Healthcare Enterprise Memory is an attempt to rethink the possible sources of leverage to improve healthcare delivery, hereby providing a valuable strategic planning and management resource to healthcare policy makers.

Clinical Competence↗

Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma.

AIM: While asthma education increases knowledge, it is less clear whether education influences actual patient behavior. To determine whether there are differences between asthma self-management knowledge and the actual behavior of patients during an acute severe asthma attack and to determine which clinical and psychosocial factors are associated with knowledge and behavior. METHODS: Validated hypothetical scenarios describing the development of life-threatening asthma and patients' reported actual behavior were scored (out of 25) using a system based on Thoracic Society of Australia and New Zealand and British Thoracic Society criteria. RESULTS: In 137 patients admitted to the hospital with severe asthma, the pattern of the index attack was slow onset (> or = 6 h) in 96%. The score for the hypothetical attack (knowledge) was 13.8 +/- 4.6, while that for the timeline (behavior) was 10.2 +/- 3.9 (p < 0.001) with 56% and 84%, respectively, having a score of less than 15 (regarded as inadequate). Certain components showed marked discrepancy (eg, appropriately seeking medical help 82% vs 52% (p < 0.001) and calling ambulance 61% vs 23% (p < 0.001). Factors such as physician-patient relationship, previous asthma morbidity, availability of peak flowmeter, action plan, and oral steroids correlated positively with both measures. Knowledge was negatively associated with being non-European, with anxiety, pessimism, and stigmatization. Behavior (but not knowledge) was negatively associated with lack of knowledge of what to do in the index attack, previous emotional counseling, and business failure. Those factors associated with the difference between knowledge and behavior scores (knowledge-behavior gap) were being non-European, anxiety, pessimism, and stigmatization, concerns about medical costs, and the only income for the household being a Social Security benefit. CONCLUSION: There are marked differences between patients' self-management knowledge and their actual behavior, particularly in terms of potentially life-saving actions. Psychological, health-care, and socioeconomic factors have a powerful and differential influence on knowledge and behavior. Improved understanding of the discrepancies between knowledge and behavior and which factors influence them may lead to more effective asthma educational interventions.

Acute Disease↗

Improving the implementation of evidence-based practice: a knowledge management perspective.

Experience of knowledge management initiatives in non-health care organizations can offer useful insights, and strategies, to implement evidence-based practice in health care. Knowledge management offers a structured process for the generation, storage, distribution and application of knowledge in organizations. This includes both tacit knowledge (personal experience) and explicit knowledge (evidence). Communities of practice are a key component of knowledge management and have been recognized to be essential for the implementation of change in organizations. It is within communities of practice that tacit knowledge is actively integrated with explicit knowledge. Organizational factors that limit the development of knowledge management, including communities of practice, in non-health care organizations need to be overcome if the potential is to be achieved within health care.

Diffusion of Innovation↗

Education and certification influence the nutrition and management knowledge of long-term-care foodservice managers.

OBJECTIVES: To describe nutrition knowledge, attitude toward nutrition, and management knowledge of long-term-care foodservice managers and to determine the relationship between these variables and the foodservice managers' personal and facility characteristics. DESIGN: Nutrition knowledge, management knowledge, and attitudes toward nutrition were measured using survey methodology designed for this study by modifying an instrument developed by the Nutrition Education Training Program for the Texas Department of Human Services. SUBJECTS/SETTING: Surveys were mailed to a random sample of 300 long-term-care foodservice directors from the 1,092 directors listed in the 1996 Ohio Department of Health Directory of Nursing Homes. The participants were 123 of the 300 foodservice directors (41%). STATISTICAL ANALYSES PERFORMED: Descriptive statistics, Spearman rank correlations, 1-way analysis of variance, and post hoc variance were calculated. RESULTS: Mean scores of respondents were 21.2 out of a possible 29 (73%) for the nutrition knowledge assessment, and 18.2 out of 26 (70%) for management knowledge. Dietitians and dietetic technicians scored significantly better than others on these tests. The mean score of attitudes toward nutrition was 4 on a 5-point scale (where 1 = strongly disagree to 5 = strongly agree). All participants requested more training in computers, nutrition terminology, and preparing appealing foods. APPLICATIONS: Dietitians and dietetic technicians are prepared with a wide scope of knowledge in nutrition and management. Thus, they are in an ideal position to take advantage of job opportunities in the area of foodservice management.

Adult↗

Knowledge management in the NHS: positioning the healthcare librarian at the knowledge intersection.

This paper defines what is meant by Knowledge Management, investigates how it interlinks with new ways of delivering health care and gives a synopsis of a study that investigated issues around implementation of Knowledge Management across a sample of healthcare librarians. Areas of investigation that are related to Knowledge Management include: HSG(97)47, evidence-based medicine, clinical governance, information and communication technologies, and the changing role of the healthcare librarian. A diagram is included in this paper which illustrates how the healthcare librarian interacts with resources, staff and practices, so contributing to the knowledge base of health care. The paper concludes that Government policy, new technologies and the push towards the practice of information age medicine are forcing changes throughout the NHS. Recognition of Knowledge Management is still in its infancy in the NHS--it calls for major change in organizational thinking and acceptance by the librarian that their service must also be subject to continuous improvement.

Humans↗

Acts and knowledge management in an open hospital information system.

This communication presents the management of a customizable patient medical dossier as implemented in the NUCLEUS project. After a brief reminder of the NUCLEUS hospital information system features, we discuss the two main innovative concepts underlying the intelligent management of the integrated patient dossier: acts management and knowledge management. The functionalities related to patient dossier are then introduced.

Artificial Intelligence↗

Knowledge management in occupational hygiene: the United States example.

Knowledge management is an emerging field focusing on assessing the creation, transfer, and utilization of knowledge to address specific challenges. Generally, knowledge management has described efforts within and between companies to consider knowledge as a manageable asset. In this paper, we suggest that occupational hygiene knowledge can be considered a manageable asset by businesses and that the entire field of occupational hygiene in the USA can be appraised in terms of knowledge management. The knowledge cycle creates a foundation for knowledge management. Knowledge creation (research, recognition and evaluation), transfer (distribution, dissemination and diffusion), and utilization (risk management and control) make up the key elements of the knowledge cycle. Defining and understanding the roles of knowledge cycle elements facilitate the application of knowledge management to problems, systems, and situations in individual companies and in the field of occupational hygiene in general. Examples of current, effective knowledge management practices within occupational hygiene in the USA are described, and recommendations for further utilization of knowledge management principles are also presented.

Clinical Competence↗

Supporting decisions in medical applications: the knowledge management perspective.

In the medical domain, different knowledge types are typically available. Operative knowledge, collected during every day practice, and reporting expert's skills, is stored in the hospital information system (HIS). On the other hand, well-assessed, formalised medical knowledge is reported in textbooks and clinical guidelines. We claim that all this heterogeneous information should be secured and distributed, and made available to physicians in the right form, at the right time, in order to support decision making: in our view, therefore, a decision support system cannot be conceived as an independent tool, able to substitute the human expert on demand, but should be integrated with the knowledge management (KM) task. From the methodological viewpoint, case based reasoning (CBR) has proved to be a very well suited reasoning paradigm for managing knowledge of the operative type. On the other hand, rule based reasoning (RBR) is historically one of the most successful approaches to deal with formalised knowledge. To take advantage of all the available knowledge types, we propose a multi modal reasoning (MMR) methodology, that integrates CBR and RBR, for supporting context detection, information retrieval and decision support. Our methodology has been successfully tested on an application in the field of diabetic patients management.

Adolescent↗

The effects of knowledge management on surgeon behavior.

Knowledge management is an important process for health care researchers and administrators. The way we manage and transfer knowledge in an organization can have a substantial impact on behavior and performance. In this article, we examine the behavioral effects of transferring performance-efficiency knowledge to a group of hospital-based surgeons. We observe the way the knowledge transfer impacts their sense of professional accountability and practice patterns for a limited set of diagnoses. We defined performance efficiency for a surgeon as the deviation from expected average length of inpatient hospital stay, and from expected average hospital charges (adjusted for risk and outcomes) for three of the most frequently performed and most costly surgical procedures in our subject hospital. We communicated knowledge of their performance efficiency to the group of hospital-based surgeons, along with benchmarked professional best practices, and included an identification of dimensions where performance could be improved. We then measured and compared their performance efficiency one year later. We did observe differences in performance efficiency, but not in consistent directions, and not in statistically significant magnitudes. Also, surgeons who initially had low levels of efficiency continued to have low levels of efficiency one year later. Within a professional accountability system, transfer of performance-efficiency knowledge alone did not provide sufficient motivation to induce consistent, significant change in practice behaviors among the group of surgeons. We conclude that medical opinion leaders and individualized strategies for surgeon motivation may have greater promise for improving performance efficiency if linked to the knowledge transfer system.

Diagnosis-Related Groups↗