Can the implementation of a knowledge management strategy provide an antidote for information overlo

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Can the implementation of a knowledge management
strategy provide an antidote for information
overload in primary care?

• Simon de Lusignan
• GP Woodbridge Hill Surgery
• Senior Lecturer, Primary Care Informatics
• St Georges Hospital Medical School
• www.gpinformatics.org

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Primary Care Informaticshttp//www.gpinformatics.
org

• Information in the consulting room
• Data Quality
• Telemonitoring
• KSSnet www.kssnet.org

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Presentation of a theoretical model

• Context Information overload
• Definitions
• PCI, Data information knowledge, KM
• A model for KM in primary care
• Conceptual framework for implementation
• Summary

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Information overload

• Expanding volume of clinical information
• Modernisation of managerial and administrative
  structures
• Schemes to capture even more information
• Patients
• Need alternative search strategy
• Want a knowledge prescription

Hibble A et al. Guidelines in general practice
the new Tower of Babel? BMJ 1998 317
862-863 Mimnagh C, Dickens I. Towards capturing
implicit knowledge Current perspectives
2003113-21.
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Is KM a solution

• First, some definitions.

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Meaning context independent
High levels of understanding
Wisdom
Requires brain power
Knowledge



Information
Requires processing power
Data
Meaning totally context dependant
Low level of understanding
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KM sits within the scope of primary care
informatics

• The scientific study of data, information and
  knowledge and how they can be modelled,
  processed or harnessed to promote health and
  develop primary medical care.
• Its methods reflect
• Biopsychosocial model of primary healthcare
• Longitudinal relationships
• Heuristic approach to decision making
• Delivered via the consultation.

Lusignan, Accepted for publication JAMIA 2003.
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Types of knowledge

• Explicit
• Can be written down and recorded
• EBM is highly formalised explicit knowledge
• Tacit
• Technical
• Skills knowhow
• Mental models
• Cognitive models- schemata
• Paradigms
• Perspectives

Takeuchi H, Nonaka I. The knowledge creating
company How Japanese companies create the
dynamics of innovation. Oxford University
Press, New York1995. Polyani The tacit
dimension
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KM Definition

• Knowledge is what you know
• KM is managing what you know
• A KM programme should result in knowing more, OR
  learning new things faster
• KM Accelerating learning
• to promote health and primary medical care.

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Types of KM

• Codification
• Problems/tasks are routine and can be codified
• Personalisation
• Individual problems need individual solutions
• To do both is NOT recommended!
• But is whats needed in primary care

Hansen MT, Nohira N, Tierny T. What's your
strategy for knowledge management? Harvard
Business Review 1999March-April(R99206)61-86.
Wyatt JC. Clinical Knowledge and Practice in
the Information Age. London RSM, 2001.
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Challenges in primary care

• Tension between
• Duty of clinical governance and the need to
  deliver effective (evidence based) healthcare to
  populations
• i.e. Codification
• AND
• Individual patients have health beliefs and
  priorities that may not fit
• i.e. Personalisation

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If KM is about learning.

• Much is known about what does and does not work
• Didactic teaching
• fails to change practice
• Components associated with change
• Participant activity
• Opportunities to practice skills
• Part of CME
• Part of Quality improvement

Davis D. Clinical practice guidelines and the
translation of knowledge the science of
continuing medical education. CMAJ
2000163(10)1278-9.
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Components of a KM model for primary care

• Structural information centred KM
• ICT infrastructure, electronic libraries, e-mail,
  computerised medical records
• Process learner centred KM
• Creating learning opportunities
• Outcomes
• Process outcome
• Surrogate markers of quality of care
• stimulus to learn, not performance management!

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Put together as single model.

• Including
• Need for tacit as well as explicit K
• Information as well as learner centred
  activities

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Model for KM in Primary Care
Explicit
Tacit
Information Centred KM
EBM Domain
Communities of Practice Domain
Clinical Audit Domain
Mentorship Domain
Learner Centred KM
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A more detailed look at the components?
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Explicit knowledge
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KM ThemesExplicit Knowledge
Information Centred KM
Evidence- based medicine
Formalised Explicit K
NeLH-PC
Learner Centred KM
PCDQ
Clinical Audit
Metrics of own Performance (explicit.)
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Tacit knowledge
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KM ThemesTacit Knowledge
Information Centred KM
Heuristic decision- making
Tacit K Know how
Intranet discussion forum
Learner Centred KM
GP Registrar Year
Patient- centred consulting
Mentorship about performance
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Implementing KMin Primary Care

• A balanced portfolio of
• Information centred and
• Learner centred tools
• Containing opportunities for the creation, and
  sharing of both
• Tacit knowledge
• Explicit knowledge
• The simple model combines these elements

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Model for KM in Primary Care
Explicit
Tacit
Information Centred KM
EBM Domain
Communities of Practice Domain
Clinical Audit Domain
Mentorship Domain
Learner Centred KM
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The clinical governance cycle

• a conceptual framework for KM in Primary Care

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Clinical Governance Cycle
On-line Clinicians
Access to EBM
Mentorship Domain
Improved Patient Care
Data recording/Clinical Coding
Data extraction
Feedback on Data Quality Quality of care
Data pooling
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Model implementation

• The model is designed to be implemented at three
  levels
• Individual
• Practice or Clinical Team
• Primary Care Trust
• There needs to be associated metrics some may
  be process measures.

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Summary

• Knowledge Management
• Must incorporate use of brain power
• KM Definition
• Accelerating learning
• Needs to be
• Aligned with strategy
• Part of professional development Quality
  improvement
• Practical model for implementation

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Conclusions

• Model could be used to address to issue of
  overload
• Setting of priorities in organisations and teams
• Alignment of ICT and educational input with these
  goals
• This theoretical model needs field testing!

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The End!

• Thanks for listening
• Contact
• slusigna_at_sghms.ac.uk
• http//www.gpinformatics.org
• Tel [phone]
• Fax [phone]