Knowledge Worker 2.0

I continue to fret that the dominant model for understanding healthcare organisations and in defining methods to improve them, comes from an old fashioned industrial process methodology (Lean). I think this continues to hold the stage because it is easy to understand a process and to make charts that count things. It makes us feel better.

But healthcare is not only a service industry it is one based on relationships. The workers are predominantly knowledge workers.  And the role, the use of and the ways in which knowledge workers connect is changing rapidly.

If the whole concept of the knowledge work is an unfamiliar one then have a look at the presentation below. And if you role is one of making improvements in a system then think about how you might go about such changes when you conceive of staff - and patients - as knowledge workers.

Knowledge Worker 2.0 - Power to the people from Stephen Collins

Book Review: Arbesman - The Half Life of Facts: why everything we know has an expiration date

I don't why I never thought of knowledge as decaying over time. Especially when knowledge acquisition and transfer / spread is my specialist topic. Arbesman provides excellent examples and a logical argument to support his hypothesis that facts die out at a predictable rate. This is a fascinating thoguht, especially as in healthcare we believe that we constantly press against "old" facts which are stuck in the system. A reframing to think about what their "half-life" might be, is a useful and inspiring one.

Arbesman has come up with new vignettes rather than trotting out the old favourites. This is not a new take on an old subject, but rather a new subject requiring some disconfirming thinking.

Model 7: data, information, knowledge, wisdom

I thought I would stop at 7 models on the data, information, knowledge and wisdom theme - afterall, the brain is supposed to be able to hold a maximum of seven thoughts at any one time.  I've left my favourite to last. I particularly like the examples given at each stage. You can read more about this model on this blogsite.

Model 6: data, information, knowledge, wisdom

The Liebowitz (1999) model of DIKW is helpful if you are looking for something with details to give you ideas on what you might do in your own work. I can see how this can be used to evaluate large scale programs. The value aspects are useful reminders of the underlying purpose in moving to each stage, and therefore gives an idea of what might need to be planned for in a large scale program to achieve each step.

Model 5: data, information, knowledge, wisdom

So let's start 2011 by continuing the data-information-knowledge-wisdom series of posts with something creative from Topicscape's Mindmap directory:
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I like the zone of potential - zone of possibility continuum as well as half the "effort" being below the surface which can only really be explained by doing a drawing like this.

Model 4: data, information, knowledge, wisdom

The Model from Infovis below shows just what I always struggle in explaining to tohers as to why the results of one project cannot just be pushed onto other, adopting, groups.

The producers, the pilot projects, create the basic data and some information (patterns) about it. The consumers (the adopters) need to retest this in their own environment.  Any pilot project that can be written up in a way that helps the consumer to bridge the gap from information to knowledge will likely be more successful at spread than others. This can include things like: you can adapt this in the following way, we did the following and it didn't work but it may work in xyz circumstances etc.

Model 3: data, information, knowledge, wisdom

One of the QI refrains is "increase the capability and capacity of employees". While this is a great concept, easy to declare and impossible not to support, for me it lacks any concrete applicability. What exactly is meant by this? There is another one of our data-information-knowledge-wisdom models which may help pin down what might be meant. Next time you hear somebody say the capacity/capability thing then whip this model out and ask them to explain their intentions and expectations along the data to wisdom curve.

 The challenge here is to produce learning experiences that enable someone to move up the curve. In my experience, much of healthcare improvement work is focused on developing data based skills - how to measure change. Some people get to the information stage where they learn to look for patterns, say by using SPC charts. Can they port this knowledge to other projects in a predictable way? Can they make intelligent choices? To what extent do the participants on a QI project become "wise"?

The above curve comes from Designing Knowledge Eco-Systems for Communities of Practice.  The web resources are excellent - especially if you are developing CoP's as part of your QI strategy.

Model 1: data, information, knowledge, wisdom

The old adage goes along the lines that knowledge can be defined as knowing a tomato is a fruit, and that wisdom is therefore knowing that you don't add a tomato to a fruit salad...  There are a number of models and frameworks that investigate the data-information-knowledge-wisdom continuum and in the this series of posts I cover a few of these.

For the theorist a good place to start is with an online paper A Primer:, Enterprise Wisdom Management and the Flow of Understanding by ScottCarpenter@CognitiveCybernetics.com

I like the way environment and context have come into play as important factors in understanding that knowledge and wisdom have a contextual perspective.

eLearning 1: 5 Resources for supporting online discussions

Creating and moderating an online discussion group requires more than sending out an email inviting people to join. In some cases it is not the cheap, quick fix you may be after. It's work. Treat it like a project - from strategy, planning, resource allocation through to evaluation.

Here are a few of my favourite resources on the topic:

1. Designing and Managing online discussions from Oxford Brookes University (PDF paper, with references - my favourite)
2. Teaching with online discussion forums - good introduction 
3. Online discussions: Tips for Instructors from the Centre of Teaching Excellence at the University of Waterloo. Web page with bullet hints
4. Using discussion boards to engage students 
5. How to avoid problems with online discussions - student guide. Short web page with more links on it. USeful because it is from the student/user perspective

5 tools for understanding and assessing organisational learning

Organisational learning is a vast discipline full of theories, models and frameworks.  The ability for an individual, team or organisation to learn is a key factor in determining whether the results of a project will be sustainable beyond the duration of the project.

1. The Society for Organisational Learning is the home of the topic and the first port of call for information. There is an excellent overview of OL for beginners and the timeline is interesting for anyone who feels they have heard something similar before but not sure when.
2. SCSI (Social care institute for excellence) has a resource pack that works well for health and social care public sector programs. This pack is designed to allow organisations to assess whether they are a learning organisation, that is, an organisation that uses evidence-based practice and informed decision-making. The resource pack will be beneficial to chief executives, senior managers, frontline staff, service users and carers. The pack has been developed by SCIE Practice Development staff, in collaboration with service users, carers and staff in social care. We would like to thank all those who contributed to the production of this resource pack.
3. Harvard Business Review have an online version of an OL survey for personal use. It links to the article,  "Is Yours a Learning Organization?"
4. The Learning Needs Analysis Toolkit is a useful source not only for the survey but also a variety of links to underpinning theories.
5. European Consortium for Learning Organisations has resources for download with a knowledge management bias.

The above links comprise only a small selection of a vast quantity of resources available.  Feel free to add your favourite link in the comments below.

Mobile learning may be more significant than web learning for healthcare

Educational methods have long been one of the key strategies to encourage the adoption of existing good practice and evidence in healthcare. The predominant method is face-to-face sessions though over the last three or four years this has started to be replaced by virtual sessions. The Web has been the technology used ofr the virtual learning, however, the advent of smart phones suggests learning via the mobile may be overtake the web portion of learning and may dig deeper into the face-to-face session.

The chart above comes from Ambient Insight Research who have an excellent article on this topic.

Are your spread plans including the use of mobile learning and technology?.

Using Twitter in the Classroom or Organisation

Twitter feels like one of those applications that has been searching for its use. Within healthcare, specifically the NHS in England, its use has been limited. Many organisations see it only as another media channel through which they advertise their services. A few, however, have grasped its potential to spread the word  in a personal way and are using Twitter as a means of engaging with patients and staff. A good example is @OBMH (Oxfordshire and Buckinghamshire Mental Health).

While healthcare is prevaricating and the organisations that preach and teach innovation are being slow to catch onto what is now practically a mainstream communication method, education has been stealing a march. An excellent blog post about using Twitter in the classroom includes a framework which made huge sense to me and helped me think through how best to use twitter in a training event as well as for the duration of a healthcare improvement project.

Not only does it help communication for the project it also adds in the "spread" and "Scale up" component that it so often missing.   If you are worried about the word student, then substitute patient or staff member. What I particularly like about this framework is it is a way for organisations using Twitter to self assess their use of it.

(Picture from Prof Hacker http://chronicle.com/blogPost/A-Framework-for-Teaching-with/26223/)

If products, ideas and results are not spreading and being adopted then maybe you need to do an ethics check

The most frequent issue people contact me about is "my project results or project methods are not spreading to other places / are not being adopted by other people". A key reframing here is to ask the question "Why isn't my xxx being spread and adopted?". This is the first step in figuring out the problem - and solution.

I wrote a book a few years ago that faced this issue and provided some ideas to get round it. One topic not covered in detail in the book though one I have since reflected on is that of ethics.

House (1980) provides a list of ethical mistakes which include:

Clientism; this is when we are so focused, as facilitators, project managers and consultants, that we do what the client wants rather than a deeper investigation into what problem needs to be solved. This is prevalent in healthcare where there are multiple clients or where facilitators are unable to take the difficult discussions and fall back on making their clients happy. Any consultant can make their client happy - can they help their client solve identified problems, even if it means walking away or referring on if they are not the best person to help? Projects which have been implemented to serve one specific client are unlikely to be adopted by others as they instinctively feel the solution does not meet their own need.

Methodologicalism; assuming that following a ethnically correct method is the same as being ethical. This is an interesting issue for the spread and adoption of guidelines. Different professionals may have alternative interpretation of the ethics are different parts of the guidelines. This conflict results in the oft heard "this won't work here" or "this won't work for my patient". On solution is to discuss and be transparent about the ethical paradoxes involved.

Elitism; giving the most powerful the strongest voice. This is a concern for the development of solutions and introduction of change methods. The most powerful and loudest voice may not be the most connected to the context in which they are requiring change. Potential adopters may instinctively push back against what they perceive are "loud voices". Or they may try to make the changes to keep the "loud voices" at bay and only partially gain the benefits. This issue is also linked to the concept of "inventoritis" which was the subject of an earlier post.

To what extent are your spread and adoption issues linked to ethical dilemmas?

Airlines & Healthcare; what can we learn

We consider airlines safe so in healthcare we adopt some (and only some) of the techniques they use to be safe - like checklists used by pilots and engineers. I say @some@ because we often forgot some of the more basic and fundamental safety aspects employed by arilines - the often more complex human resources, financial aspects, organisational learning, training etc.

Putting safety aside I read the report by the USA Bureau of Transportation on the statistics for 2009. In 2009 of the 19 airlines who reported they had an average on-time arrival performance of 79.5%. Hmmm. What I like about this figure is it represents the complexity of different airlines, operating in different ways, to different airports - and all affected in some way by the things out of their control, like the weather. This sounds to me like the healthcare system - in public sector systems anyway. So the airline travel system in 2009 was designed for 1 late arrival in every 5 flights. This makes me feel a lot better about the flow of patients around the National Health Service in England. A way higher percentage experiences experiences on time care. I also feel that the NHS is able to work well in a crisis like bad weather.

Ever lost your baggage? Well in the USA in 2009 3.91 bags were mishandled (isn't that a lovely term!) in every 1000 handled. This was an improvement from the 5.26 in 2008 - well done. As rates go these mishandlings are very few. Of course, if it is your bag lost, then the amount of year on year improvement and the overall rate is of no interest. A failure is a failure. This reminds me of the way most healthcare projects adopt goals that are less than perfect. For instance, 95% of patients to be treated xxx. What this tells me is that the improvement project team and the organisation are opting to design for a certain amount of failure. And I am not sure I am happy with this. Mistakes I can forgive. Designed in failure rate, often large ones, are to me a sign of lack of confidence in the people and processes. And as a patient I am less confident being treated there.

We have a great deal to learn about and adopt from other sectors as part of improving healthcare. What have you adopted from another industry and how has it worked for you?

To share or not to share?

I've spotted a proliferation of new initiatives within the NHS in England attempting to encourage staff to share their knowledge online. While this sounds like a useful and pragmatic action to take I wonder what the implications might be.

The main exhortation is about encouraging staff to share what has worked well for them. I expect there will be many who would like to share, though inputting your information into a fairly anonymous database is at the higher end of the perceived risk continuum. Without knowing who (as in a person) will be editing or reading the information, many people will be hesitant to "share" in this way.

The proliferation of different places to share is also confusing. In their own way, each organisation requesting sharing is doing so for the right reasons. However, how do you choose - NHS Networks, NHS Institute, NICE, own organisation's database... random sharing with colleagues using other online networks, professional groups?? Each organisation requesting sharing is doing so for it's own reasons and these reasons may not be easily identifiable by those who are targetted.

For some healthcare staff and their organisations the incentive to share may feel like a perverse one. In a competitive market there may be a disincentive to provide information about how well or how innovative you have been. In my experience the best results are seldom shared because of this restriction. So what we do get shared is often the less innovative and more obvious results of projects and changes.

I think the issue is not "to share or not to share". Sharing is only part of the story. Sharing is only of value if there is someone listening and looking. If the main group looking at what is shared is the group who owns the database then the value of what is shared is quite limited. The real issue is in encouraging staff to look and listen, to be curious and to accept that in just about everything thing they do and every problem they have, someone, somewhere has already addressed it - and this information is already available.

So if you're developing databases to captured shared information then a few pointers to consider:
a) how much of your time, budget and strategy is devoted to encouraging the look and listen?
b) how unique is your database? How will it be found and why should those who are searching use your database?
c) In what way can you build on or link to existing databases so you build a wider knowledge base rather than divide up a crowed space?
d) How can you move from the transactional share and disseminate approach to one which is based on the concept of interaction, dialogue and learning?

Sharing - Seeking; a necessary dynamic of spread

The concept of large corporate databases capturing and storing "good practice" and "knowledge" was discredited by the late 1980's due to the costs involved and limited impact. It seems a standard approach to problem solving is to "start with what I know" and then if really desperate "find someone who can fix the problem". I frequently find that few managers and teams spend a short time seeking out information from those who have gone before them with regards the same problem.

A corporate database tends to be fairly clinical in approach. Woudl you rather get your ideas from the place where all entries have been approved, or from the hundreds of places on the web where forums are filled with people sharing not only technicalities of solving the problem, but also the emotion. Trust and credibility is importnat. How much do we trust the corporate database and how much do we trust what someone has written on a Forum.

Today I had a nightmare with MS Outlook consuming most of my computing CPU. The compiter temperature was rising along with my frustration and a literal metdown was predicted. A quick internet search revealed this was a common problem. The Microsoft database gace some suggestions but I chose not to follow them. INstead I found suggestions from "real" people, who reported on their tests of change and what worked for them, in their circumstance. Problem was eventually fixed (it was an overlarge normal.dot file if you're interested...)

I am hugely grateful for those who are questioning, providing repsonses and generally sharing their knowledge on internet Fora. Search engines are brilliant at organising this morass of wisdom. I really can't see how closed shop databases can be as effective in helping others solve problems.

The bottom lie though is the use of this wisdomw is dependent on some seeking it. So who will be actively seeking infomration from your database? If they use an internet search engine will they find your knowledge?

Knowledge Management on my iPhone/iTouch

A key aim in healthcare is to reduce variation. One of the methods to do this is to encourage the sharing and adopting of good practices.

• Problem 1: where is the good practice and who is doing what?
• Problem 2: how do I get to hear of good practices?
• Problem 3: how do I share what I am doing?

If data is information and knowledge is information we can use to make decisions, then how can data about good practices be shared.

A free application called "Healthmap: Outbreak near me" for the iPhone/iTouch has got me thinking. You can submit data about any disease and the location. This gets added to their database. You can see on a map any number of different diseases from Swine Flu through to African Horse Sickness. You can search by location, keyword or disease. If you allow it, the system can let you know what diseases are currently prevalent in your current location (using the GPS function).

So my please is for someone to develop the application for say, diabetes or cardiac care. I want to be able to find who (locally is great) is doing well on these healthcare processes and has something to share. Maybe even a version for patients where we can see the currently publicly available healthcare data on a map and in a searchable way. Also, we could add comments about services using the system.

The technology to do all this is here and available. As with so much I encounter in healthcare I suspect it may be another decade before we see something like this used.

Can someone prove me wrong please?

Use blogs to develop communities of practice

Use blogs to help knowledge flow and communities of practice to develop One of the great ways to reduce email is to use collaborative systems that enable project teams to work together, to share all their files and choose how they wish to remain in contact.

Dave Snowden has written an article in KMWorld about how blogging can help communities of practice as well as this use of virtual teaming. His perspective is how these methods can help knowledge flow around an organisation and how communities of practice can develop, thus embedding knowledge and helping sharing.He has a number of tips of how blogging can be used http://www.kmworld.com/Articles/News/News-Analysis/%3CI%3EEverything-is-fragmented%3C-I%3E%E2%80%94Building-CoPs-for-knowledge-flow--49849.aspx

Learning is part of knowledge management

There's a good article in Harvard Business Review 08/08 Vol.36 No. 8 P.60 by Amy Edmondson, entitled "The competitive imperative of learning".

This article is about the global trend to move away from a product based organisations to those that are more knowledge based - that is where the value is now. A process called EAL - execution-as-learning is introduced as a means to support the organisational learning and knowledge management process.

I like this framework because it is action orientated (good for healthcare) and shows how competitiveness can be managed, challenged and leveraged, though collaborative tools. This sounds a bit like an oxymoron. My view is that competitiveness might be the overarching strategy but it is delivered, at the action level, by collaborative working, including the use of systems and tools to enable this. There is also an emphasis on evaluation and feedback as essential parts of the learning process.

Sharing knowledge through social networking

There are hundreds of social networking sites around but this new one looks interesting and if it works it could reshape how we share knowledge and learn from, with and among our online friends.

www.ileonardo.com is where social networking meets a social form of knowledge management. You can upload content and create notebooks where you can collaborate with other users. You can see the information that your friends are working on. In this new era of open source knowledge and rapid dissemination, this feature has some significant advantages. It could rewrite the concept and dynamics of what is traditionally known as the opinion leader.

What I like about this site is how it moves on the concept of spreading good practice. It forces us all to think about how much we want to to share and with whom.