ICKM-2008-Presentation

364 views
320 views

Published on

KM in HealthCare-USA

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
364
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Title in small letterStrategies for driven culture.
  • Over two decades of interventions designed to translate scientific advances into effective action in practice have met with mixed results or limited sustainabilityJust putting thoughts, nothing fancy yet.Relate it to our background –he found KM to be a key solution for improving KM
  • But there are problems and limitations
  • Over two decades of interventions designed to translate scientific advances into effective action in practice have met with mixed results or limited sustainabilityJust putting thoughts, nothing fancy yet.Relate it to our background –he found KM to be a key solution for improving KM
  • Over two decades of interventions designed to translate scientific advances into effective action in practice have met with mixed results or limited sustainabilityJust putting thoughts, nothing fancy yet.Relate it to our background –he found KM to be a key solution for improving KM
  • The project aims to aims to develop a socio-technical model of knowledge management for primary health careLynnClemow (facilitator) psychology (dept of psychology) Research teamJohn Orzano (Principal investigator), and Alfred Tallia, Benjamin CrabtreeClaire McInerney, DavidaScharf, Stewart MohrReuben R. McDaniel JrBibiAlajmi, IulianVamanuAbigeel MeeseP. S I inlcuded the financial support to indicate how important is this research for U.S health care
  • Where does this fit in the whole projectSuper scripts. For the small
  • Some examples: Smoking and exercisingAdd some words to distinguish the two theories so people don’t get confused. The TRA suggests that a person’s behavior is determined by his or her intention to perform the behavior and that this intention is, in turn, a function of the person’s attitude and subjective norm toward the behavior (Fishbein & Ajzen, 1975). The TRA model is based on the premise that humans are rational and that the behaviors being explored are under volitional control (Fishbein & Middlestadt, 1997). Accordingto the theory, a specific behavior defined by a combination of four components: target, action, context, and time (TACT) (Ajzen, 2001a). Attitudes and subjective norms shape a person’s intention to perform a behavior. Finally, a person’s intention determines the actually desired behavior. The TRA provides a framework for linking each of the above variables together.E. GThe theory of reasoned action was used to identify the culturally appropriate beliefs of Hispanic smokers that might be targeted in an anti-smoking campaign. In-depth interviews were conducted with 263 Hispanics and 150 non-Hispanic whites. Intentions to quit smoking were predicted most strongly by the attitudinal rather than the normative component of the model. A pattern of cultural differences between the two ethnic groups was identified. Family-related consequences and concerns about bad smell contributed more to Hispanic attitudes toward quitting than to those of non-Hispanic whites, while the effects of withdrawal from cigarettes contributed more to non-Hispanic whites'attitudes than to Hispanics'. The bad smell of cigarettes, improving relationships with the family, weight gain, breathing more easily, and having a better taste in the mouth were the consequences of smoking and quitting that most strongly discriminated between those Hispanics intending and not intending to quit.Respondents consisted of 225 high school students who were questioned in 1994 about their attitudes, subjective norms, perceived behavioral control, past behavior, intentions, and actual behavior relating to the use of cigarettes. Results indicated that the modification of the TRA incorporating past behavior provided a marginally better fit than the other models. For this group of high school students, attitudes toward smoking, past behavior in relation to smoking, and perceptions of what significant others think they should do were significant predictors of their intentions to smoke. Intentions, together with past behavior, predicted their actual behavior.
  • The primary analysis utilizes data from the Using Learning Teams for Reflective Adaptation (ULTRA) study, an ongoing practice improvement trial targeted at prevention and management of multiple conditions, to select two higher and two lower performing primary care practices from the 21 initial intervention practices based on a variety of measures including clinical and productivity ones. ULTRA ---prevention study
  • Introduction of this Hemoglobin, Blood Pressure, LDL-bad—low density lipo protein See some clinical measure, and organizational measure, technology measure,
  • There are situations where very little is known about a particular phenomenon, or research is particularly difficult to undertake in a certain area. Under such circumstances, case studies play a path-breaking or a so-called “exploratory” role, serving to open up the way to a previously unfamiliar or inaccessible area of research
  • The four health-care practices selected for the purpose of this research share several characteristics. They are all located in New Jersey, USA, and were selected based on a variety of criteria including clinical and productivity measures (Table 1). Two are considered high performing (HP #17 and #21) and two are low performing (LP #22 and #3) practices.SnapshotCommunication is really the big issue
  • Images from http://www.fotosearch.com/
  • These type of knowledge sharing processes is really imprtant for knowledge that are more complex, noncodified, tacit knowledge. BriefGive example of communities of practice. PHOs
  • Conclusion or the message , Huddles=ad hoc meetings –five minutes confer, informal meetings, get people together more foten
  • Even though there are problems with attending these communities of practice, However, there are emphasis on the role they play to learn and make better decision. In the low performing practices there was less emphasis on engaging in these communities of practice.
  • Horizon biggest insurance company: like financial rewards for best management styles.
  • Primary care service delivery no longer exists solely as the province of the clinician, but rather with the practice as an organization. To excel at delivering primary care, the creation and sharing of knowledge must occur not only between the clinician and patient, but also throughout the practice, and between the practice and other health system participantsKM informs our understanding of this process, and its enhancement can improve communication and understanding of health conditions and facilitate effective treatments. Quality does not simply reside in an individual, but in the quality of the group and with the PCP’s organizational attributes such as the quality of relationships
  • ICKM-2008-Presentation

    1. 1. TALKSDM<br />Taking Action by Learning and Knowledge Sharing<br />in Diabetes Management<br />Knowledge Sharing Processes and Tools in U.S.A Primary Health Care: Analysis of Four Case Studies <br />BIBI M. ALAJMI, MLIS-Rutgers University<br />CLAIRE R. McINERNEY, PhD-Rutgers University<br />A. JOHN ORZANO, MD, MPH-Robert Wood Johnson Medical School<br />ALFRED F. TALLIA, MD, MPH- Robert Wood Johnson Medical School<br />ABIGAIL MEESE, MLIS-Rutgers University<br />IULIAN VAMANU, PhD candidate-Central European University, Budapest<br />ICKM/2008<br />
    2. 2. Overview<br />Background<br /> Where did this all come from ?<br /> Who are we ?<br /> Where does this research fit within the whole project ?<br />Research Background<br /> Theoretical Base<br /> Research Questions<br /> Research Methods<br /> Case Studies<br />Research Findings: Knowledge Sharing Processes and Tools<br />Discussion<br />Conclusion<br /> What is the takeaway “Message”?<br />2<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    3. 3. Where did this all come from ?<br />Most Americans seek and receive health care in primary care practices where there are 2 – 12 clinicians.<br />This health care is personal and friendly, but…<br />Resources are limited and clinicians are often overworked and stretched to the limit of their energy.<br />3<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    4. 4. Where did this all come from ?<br />The main purpose of the study is to improve health care delivery; <br />HOWEVER, interventions designed to translate scientific advances into effective action in practice have met with mixed results or limited sustainability. <br />A physician attending social sciences courses was looking for solutions. <br />4<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    5. 5. Where did all this come from?<br />A Knowledge Management course opened a discussion on how KM could benefit health care services. <br />A socio-technical model of KM was developed.<br />The impact of knowledge “process” management on performance and work relationship in ways that enhance learning and decision-making was examined.<br />5<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    6. 6. Who are we ?<br />Research Project-----> “TALKSDM" (Taking Action by Learning and Knowledge Sharing in Diabetes Management)<br />Research Team-----> <br />* Doctors/physicians in Robert Wood Johnson Medical School<br />* Academics in Rutgers University<br />*The University of Texas at Austin (Department of Management Science and Information Systems)<br />*Colombia University (Division of General Medicine)<br />* PhD students in Rutgers University<br />* MLIS students in Rutgers University<br />Research Purpose----><br />To examine how health care practices employ knowledge sharing tools and processes to the benefit of their daily work processes. <br />To understand how knowledge sharing could contribute to practices' performance.<br />6<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    7. 7. Where does this research fit within the whole “TALKSDM" Project<br />7<br />Phase (2): Case Studies & Hypothesis Formulation<br />Phase (1): Modeling and Taxonomy<br />Phase (3):<br />Piloting & Full Study<br />Our Research<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    8. 8. Research Background: Theoretical Base<br />Theory of Reasoned Action – What factors predict a physician’s intention to perform a behavior (e.g. to share knowledge)?<br />Theory of Planned Behavior – How would physicians perceive their ability to perform a certain behavior (e.g. the ease or difficulty of sharing knowledge)?<br />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.<br /> ( Ryu et al., 2003)<br />8<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    9. 9. Research Background: Research Questions<br />1) How do certain health-care practices exhibit knowledge sharing tools and processes?<br />2) What hypotheses can be developed from this study to guide additional research?<br />9<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    10. 10. Research Background: Research Methods<br />Research Sample---->Four health care practices located in NJ were selected based on a prevention study evaluation criteria. <br />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.<br />Case Study--->This study is an explanatory one, aiming to develop pertinent hypotheses and propositions for the third phase. <br />10<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    11. 11. Case Studies: Measurement for Selection<br />
    12. 12. Research Background: Research Methods<br />12<br />Research Sample---->Four health care practices located in NJ were selected based on a prevention study evaluation criteria. <br />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.<br />Case Study--->This study is an explanatory one, aiming to develop pertinent hypotheses and propositions for the third phase. <br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    13. 13. Case Studies<br />Medical Practice #22<br />Low-Performing<br />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.<br />Medical Practice #17<br />High-Performing <br />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.<br />Medical Practice #3<br />Low-Performing<br />In this case, a note was attached to paychecks explaining the purpose of the project.<br />Medical Practice #21<br />High-Performing<br />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. <br />13<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    14. 14. Knowledge Sharing Tools<br />Knowledge Artifacts----->Educational materials, bulletin boards, manuals and procedures and patients' medical records <br />Meetings------>Face-to-face conversation producing minutes and reports<br />14<br />Communication Channels--><br />Including face-to-face, written communication, or mediated communication technologies such as databases and decision support systems<br />Images imported from http://www.fotosearch.com/<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    15. 15. Knowledge Sharing Processes<br />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).<br />15<br />Training and Apprenticeship--><br />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. <br />Images imported from http://www.fotosearch.com/<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    16. 16. Research Results<br />Knowledge Sharing Tools<br />16<br />High-Performing Practices<br />Low-Performing Practices<br />Depend heavily on manuals and procedures; however there are problems of accuracy and currency.<br />Lack of manuals and procedures resulted in incomplete learning. Members work based on their own experience and personal notes.<br />Less formal meetings and more ongoing and ad hoc meetings. Once needed, all staff get together.<br />Meetings are for critical and urgent issues. In one practice there was a no-meeting policy.<br />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. <br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    17. 17. Research Results<br />Knowledge Sharing Processes<br />17<br />High-Performing Practices<br />Low-Performing Practices<br />Engage in Communities of Practice; however, issues of cost and timing might hinder their participation.<br />Staff find conference attendance has no benefits since they don’t focus on their own problems. Use consultation to improve work.<br />Training is done through external sources, training manuals, and on-the-job-training.<br />Training is done through observation and watching others due to budgeting issues.<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    18. 18. Discussion<br />How do health care practices in the U.S exhibit knowledge sharing tools and processes ?<br />All four health-care practices displayed patterns of sharing knowledge among their members as well as with other communities of practice.<br /><ul><li>A comparison of the high-performing and low-performing practices showed that all have limited knowledge sharing practices.
    19. 19. Knowledge sharing processes and tools were not completely integrated throughout the entire practice.</li></ul>Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />18<br />
    20. 20. Discussion<br />Knowledge Sharing cannot be forced or mandated. What is required to enhance knowledge sharing practices in health care? An integrative approach<br />19<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />
    21. 21. Takeaway “Message”<br />KM has great potential for health care and illness management. <br />Clinicians and information scientist need to work together to understand how KM tools and processes can be applied in a health care setting.<br />We will test the efficacy of KM in a diabetes care context in the coming months. <br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />20<br />
    22. 22. Contact Information<br />Ms. BibiAlajmi<br /> Doctoral Student<br /> School of Communication, Information and Library Studies – Rutgers University<br />bmalajmi “at” eden.rutgers.edu<br />Prof. Claire McInerney<br /> Associate Professor<br /> School of Communication, Information and Library Studies – Rutgers University http://www.scils.rutgers.edu/~clairemc<br /> Knowledge Institute http://knowledgeinstitute.rutgers.edu/<br />clairemc “at” scils.rutgers.edu<br /> +1 732-932-7500 ext. 8218<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />21<br />
    23. 23. References<br />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. <br />Connelly, C. and Kelloway, K. (2003) "Predictors of employees’ perceptions of knowledge sharing cultures", Leadership and Organization Development Journal, 4(5): 294 – 301.<br />Davenport, T. H. and Prusak, L. (1998) "Working knowledge: How organizations manage what they know", Boston: Harvard Business School Press.<br />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. <br />Feagin, J., Orum, A., and Sjoberg, G. (Eds.) (1991) "A case for case study", Chapel Hill, NC: University of North Carolina Press.<br />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. <br />Holsapple. C. W. and Joshi, K. D. (2001) "Organizational knowledge resources", Decision Support Systems, 31(1): 39-54.<br />Lee, C. K., and Al-Hawamdeh, S. (2002) “Factors impacting knowledge sharing”, Journal of Information and Knowledge Management, 1(1): 49-56. <br />22<br />
    24. 24. References<br />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" <br />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. <br />Polanyi, M. (1966) "The tacit dimension", London: Routledge.<br />Ruggles, R. (1998) "The state of notion: Knowledge management in practice", California Management Review, 49(3): 80–89.<br />Ryu, S, Ho, S. H. and Han, I. (2003) "Knowledge sharing behavior of physicians in hospitals", Expert Systems with Applications, 25: 113-122.<br />Stake, R. E. (1995) "The art of case study research", Thousand Oaks, CA: Sage Publications.<br />Stefanelli, M. (2004) "Knowledge and process management in health care organizations", Methods of Information in Medicine, 43(5): 525-535.<br />Yin, R. K. (2003) “Case study research: Design and methods”. 3rd ed. Newbury Park: Sage Publications. <br />Walz, D., Elam, J. J., Curtis, B. (1993) "Inside a software design team: Knowledge acquisition, sharing and integration", Communications of the ACM, 36(10): 63-77<br />Wenger, E., McDermott, R., and Snyder, W. (2002) “Cultivating communities of practice”, Boston, Massachusetts: Harvard Business School Press.<br />Knowledge Sharing Processes & Tools Alajmi et al. Oct, 23rd 2008<br />23<br />

    ×