Technology: Know-It-All
Features
Written by Amy Buttell Crane   
Monday, 31 March 2008
Technology: Know-It-All - Health Executive - Red Coat Publishing
At Frisbie Memorial, a knowledge management system reduced records management staff, improved response time to patient requests, and saved 3,000 hours of employee productivity.
These days, it’s not who you know, it’s what you know. What you and your employees know, and how you act on and share—or don’t share—that knowledge has the potential to transform your health system.

Imagine if the wealth of knowledge stored in your employees’ and your organization’s institutional memory could be seamlessly and easily shared among department members and across departments, and departments could cooperate to define and collaboratively solve problems. That practice, known as knowledge management, is becoming an important tool as health systems across the country strive to cut costs, foster a safer environment, and practice evidence-based medicine.

Implementing a knowledge management system is a challenge because the concept of knowledge and how to manage it is a slippery one. You can’t expect to manage your health system’s entire body of knowledge in one shot. Instead, you need to define a goal and design procedures and systems to meet that goal, sharing best practices between departments along the way.

Breaking down departmental barriers is key to a successful knowledge management initiative, as is commitment on the part of institutional leaders. Too often, hospital departments operate in silos with established practices in one department actually impeding the function of other departments. Without a shared vision and collaborative approach, any individual or system-wide effort at process improvement is almost doomed to fail.

“One of the biggest challenges in healthcare today is getting institutions to share knowledge,” said Dr. Gabriela Cora, managing partner at the Florida Neuroscience Institute in Ft. Lauderdale, Fla., who has studied knowledge management. “When the right hand doesn’t know what the left is doing, care can’t be integrated, and the patient doesn’t get the best healthcare.”
What to do? Because the potential uses of knowledge management are so broad, it’s easiest to understand when implemented in specific ways. Here are two instances of how two health systems implemented knowledge management systems.

True understanding
Wellmont Health System is a 13-hospital health system spread across Northeastern Tennessee, Southwestern Virginia, and Southeastern Kentucky. The system’s goal is to be no less than the “safest health system in the country,” according to Britta Milhorn, director of clinical knowledge management. To achieve this admittedly ambitious goal, Wellmont is defining from the ground up what it means to be a safe hospital and is designing systems with measurable, repeatable goals around that definition.

One goal for Wellmont, and many other hospitals in search of safety improvements, is to decrease the number of patient falls. In a systematic approach to that goal, Milhorn first sought to define exactly what a fall is. “Is a fall when the patient falls flat on the floor, or is it when the patient falls on his hands or knees?” she asked. “We have to operationally define what a fall is and then find out in what nursing units the falls occurred, what the nursing ratio was at that time, and what other data is important around falls.”

Falls are associated with increased length of stay in hospitals as well as increased patient mortality. By examining on a system-wide basis when falls occurred and what caused them, Wellmont can implement solutions, try those out on individual units, and share successes across the system. The key is to understand the problem you have and to examine all the data around that problem, so that the solution you design is actually solving the problem, Milhorn said.

At many hospitals, decisions are made without a true understanding of the problem and don’t solve anything. Adding nursing staff to a unit may reduce the incidence of falls if patients are falling because they can’t get the help they need getting out of bed to go to the bathroom, Milhorn said. But if patients are falling because they are tripping on electrical cords, increasing staffing won’t solve the problem.

ED snafu
At Frisbie Memorial Hospital in Rochester, NH, emergency department medical record creation and retrieval were creating delays, consuming too much staff time, and in some cases compromising effective patient care. Although Frisbie is a medium-sized hospital, it copes with more than 30,000 emergency department visits a year, so medical record snafus were creating a real headache.

“In the old days, a patient might call the day after an ED visit with a question, or we might follow up the visit with a status call to see how the patient is doing,” said Dr. Robert Anthony. “Because we didn’t have the chart on hand in the ED, there were a huge number of steps that had to take place and people who had to be involved to find the chart, get it to the ED, and in some cases get a call to the doctor—then someone would have to call the patient back.”

By implementing software from Digitech Systems that converts paper medical records to searchable electronic records, Frisbie Memorial became much more responsive to patients in terms of answering questions and follow-up, improving patient care and saving money, said Anthony. Under the new system, knowledge about a patient’s medical conditions and past ED treatments is easily accessible by the people who need it the most: the medical staff in the ED.

The project has enabled Frisbie to reduce its records management staff by six, improve response time to patient requests by 15 to 30 minutes per request, and save 3,000 hours of employee productivity.

In the push for cost savings while improving patient care, harnessing knowledge management can make a big difference. Hospitals have learned that throwing money at a problem
doesn’t generally result in long-term, viable solutions. But it seems clear that spending money on a knowledge management system led by committed staff can make a difference, one problem at a time.

Amy Buttell Crane is a freelance writer and editor based in Erie, Pa. She can be reached through her Web site www.amybcrane.com.
 
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