I’d like to acknowledge some human and technological resources that have been important in the development of my thinking and activities. I have had the benefit of participating in Lorri Zipperer’s knowledge management class as well as learning from her written works. Lorri’s wonderful chapter in the new MLA Guide to Managing Health Care Libraries discusses the theories of knowledge management, especially the “people side” of tacit knowledge sharing and also gives practical ideas for ways librarians can be involved in their organization. Charles Bandy’s web site provides a wealth of documents, videos and links for information on systems that support knowledge management.
Definitions of knowledge management abound. Here is one that might be useful. Knowledge Management is the explicit and systematic management of vital knowledge – and its associated processes of creation, organization, diffusion, use and exploitation - in pursuit of business objectives
Before: Here is where I brainwash you. This video is a commercial, but quite effective. After: I’ve shown this video to several groups and they seem to “get it” when I talk to them about managing their knowledge. With the aging workforce and people leaving the organization it has become even more of a concern. The knowledge possessed by their workforce is one of the organization’s most important assets. This video also captures the idea of the “flow” of knowledge. In The Social Life of Information Brown and Duguid offer the insight that, “where people treat information as independent and more or less self-sufficient, they seem more inclined to associate knowledge with someone.” They point out that “Focusing on knowledge turns attention toward knowers. . . .Increasingly, as the abundance of information overwhelms us all, we need not simply more information, but people to assimilate, understand, and make sense of it.”
Several experiences have contributed to my interest in helping my community with their knowledge management needs: I took an SLA class on knowledge services in June 2007; I participated in Lorri’s class in 2008; and In preparing a presentation as guest lecturer for an Organizational Learning class at the University of Denver in November 2008. (SLIDE 5) For the DU class I was asked to speak as a hospital librarian on the topic of knowledge management. The text for the class was the second edition of 5th Discipline by Peter Senge, and this book got me thinking about how I could contribute to my hospital becoming more of a learning organization. Some of Senge’s ideas include: Knowledge is social Collaboration and helpful tools can assist with knowledge sharing and capture Transformative relationships can solve complex problems Organizations are living systems, and the question What is the leader’s new work in building a learning organization
Lorri’s class introduced me to the work of Nancy Dixon who consults with companies on knowledge management strategies. I shared these ideas in my lecture at University of Denver. Librarians have many of these skills: Interviewing--much like the reference interview Analysis—through repeated lit search requests, we can see patterns in activities such as patient safety and performance improvement Knowledge Transfer—we already participate on clinical teams, improvement teams, and with other groups
Here are some potentials roles for librarians. I am highlighting the last bullet, Supporting communities of practice through in person collaboration and application of technologies
Here is a definition of Communities of Practice from the work of Etienne Wenger. (small pause) Wenger gives examples: a tribe learning to survive, a band of artists seeking new forms of expression, a group of engineers working on similar problems, a network of surgeons exploring novel techniques, a gathering of first-time managers helping each other cope. Communities of Practice have usually formed within a single discipline in order to focus efforts in sharing knowledge, solving problems, or innovative ventures. They often form spontaneously or can be formed for a specific purpose.
Given the complex health care environment, multidisciplinary communities of practice provide an advantage in these efforts because the members bring the richness of their varied experience to help achieve goals. The teams we work with are formal teams, usually with charters and other agreements. Because Exempla librarians participate over a long period of time in these groups, we learn about their issues and concerns and we help them learn together and find solutions to problems. Often our outsider perspective can help; as Smith, co-author of Digital Habitats says, we can ask the stupid questions they may help group members clarify the problem. Participation has also given us a growing awareness of the gaps between what some practitioners need to know and what we know others know. I am sure you all have had similar experiences: Repeating literature searches—for example, multiple searches over a period of years on “falls prevention.” What happened to the information previously retrieved? Was it disseminated and applied or just filed away? Sharing with the other librarians the knowledge gaps between the teams Attending meetings where people say “we are always reinventing the wheel,” “working in silos” “not knowing who to contact to communicate changes.” Learning from colleagues and the literature that this is not unusual in organizations, but especially is a critical problem in health care where clinical quality and patient safety can be jeopardized.
We also have typical technological impediments to effective knowledge capture and knowledge sharing Multiple storehouses Lack of clarity on where electronic documents should be filed and difficulty in locating what you need even if you think it is there Current information and archival information is mixed together Difficulty in deploying effective technologies to assist in knowledge sharing and collaboration For example, my organization has a shared network drive. I call it the Dreaded U Drive. Folders and documents are put there and rarely go away and it is almost impossible to find what you are looking for. One day I started looking for a document on the U drive at 10am and at 3pm that little Microsoft dog was still scratching away.
Our intranet is a Broadvision portal. There are many challenges in keeping pages updated and the search tool is inadequate. While technology isn’t the same as knowledge sharing, effective technology is a tangible tool that can help groups think differently about their work and what needs to be captured and shared for their team as well as for benefit of the whole organization. If you have access to a tool such as SharePoint you can offer to help the teams you work with capture and organize their knowledge. It can be a way to start small with this work. Web 2.0 technologies offer additional ways to provide this service. We expect to get SharePoint in the near future but currently the tool available on our portal is called a Microsite. As Wenger, White, and Smith suggest in Digital Habitats, use what you have. Although microsites have several drawbacks, they have served some small teams effectively.
These are some of the groups I participate in, and for which I have set up microsites. Some of these groups are formed for a specific purpose and may last only a few months. Others are together for many years, sometimes because of institutional requirements.
The microsite for the Nursing Research and Evidence-Based Practice Council gives the group a place to conveniently store the tools they are using in learning how to apply EBP techniques and tools. It also helps in the orientation of new members to the team.
Leadership WalkRounds have been used for many years in other health care organizations and is a practice encouraged by IHI. I learned about the plans for this activity because I participate on a system patient safety committee. WalkRounds engages leadership in patient safety and solicits the knowledge of front line staff. I view the opportunity to scribe as a way to observe knowledge sharing between front-line staff and our senior leadership. I also think that I might be able to offer ideas on effectively capturing what is learned during this activity. WalkRound Questions can include: What aspects of the environment might lead to patient harm? Can you share ways in which the system or your environment fails you? What processes are in place that are working well? Do you know what happens to the information you report in the online occurrence system? What keeps you awake at night? My work with the Interdisplinary Shared Decision Making Steering Committee helped the rest of the members understand the importance of knowledge management. Yes, I showed them that video. Knowledge Management has been identified as a critical function in building a learning organization.
When I submitted the abstract for this presentation I hadn’t yet read Digital Habitats, the book I mentioned earlier. The subtitle of the book is “stewarding technology for communities.” The authors describe the role of technology steward. This is an individual who is enough of a member to “get” what the community is about; who understands the issues, purposes, and often history of the group. They have both an insider and an outsider perspective. A key aspect of the steward’s work is being able to scan the environment to see what is out there and what technological tools can further the purpose of the community. There is no doubt that my role with these teams could be described as technology steward; another broader concept could be knowledge steward.
I spoke earlier about 5th Discipline and the question, “what is the leader’s new work building learning organizations.” My question is What is our new work promoting knowledge sharing in our organizations and perhaps serving as a technology steward for our communities? The time is right for us to define our new role as we step forward to assist our organizations.
Use Your Expertise to Help Your Community with Their Knowledge Management Needs
Use Your Expertise to Help Your Community
with Their Knowledge Management Needs
Margaret M. Bandy, AHIP, FMLA
Joyce E. Condon, MLS, AHIP
Ellen D. Graves, MLS
Lorri Zipperer, author of “Knowledge Services” chapter in
the MLA Guide to Managing Health Care Libraries, 2nd ed.
Charles Bandy, creator of KMConnect.net web site that
explores systems that support knowledge management.
Knowledge Management is the explicit and
systematic management of vital knowledge –
and its associated processes of
• use and exploitation
in pursuit of business objectives.
David Skyrme Associates: http://
Video: Discover What You Know
The Fifth Discipline: The Art & Practice of
the Learning Organization by Peter Senge
Reflecting on Librarians’ KM skills
Nancy Dixon, author of Common Knowledge highlights the following
skills she brings to organizations as a KM consultant
• Sharing of stories (narrative approach to KM)
• Participating in journal clubs
• Promoting integration of knowledge resources
into the electronic medical record
• Developing knowledge repositories
• Supporting communities of practice through in person
collaboration and application of technologies
Communities of Practice
Communities of practice are formed by people
who engage in a process of collective learning in a
shared domain of human endeavor . . .
Communities of practice are groups of people who
share a concern or a passion for something they do
and learn how to do it better as they interact
Communities of Practice
Exempla Librarians Participate in
• Heart Failure Microsystem
• NICU Journal Club
• NICU Microsystem
• ICU Microsystem
• System Patient Safety Committee
• Interdisciplinary Shared Decision Making
• Multiple storehouses
• Lack of clarity on where electronic documents
should be filed and difficulty in locating what
you need even if you think it is there
• Current information and archival information
is mixed together
• Difficulty in deploying effective technologies
to assist in knowledge sharing and
• Shared workspace for teams
• Knowledge repository for “lessons learned.”
• Not a full-blown content management
• Leverages available technology—”Use what
• ICU Microsystem
• Exempla System Patient Safety Committee
• Nursing Research & Evidence-Based Practice
• Interdisciplinary Shared Decision Making
• Ethics Committee
References & Readings
Bandy, Margaret, Joyce Condon, and Ellen Graves. 2008. "Participating in Communities of
Practice." Medical Reference Services Quarterly 27, no. 4: 441-449.
Brown, John Seely, and Paul Duguid . 2000. The Social Life of Information. Boston: Harvard
Business School Press.
Frankel, Alan,et al. 2005. "Patient Safety Leadership WalkRounds at Partners Healthcare:
Learning From Implementation." Joint Commission Journal on Quality and Patient 31, no. 8
O'Dell, Carla S., and Cindy Hubert. 2011. The New Edge In Knowledge: How Knowledge
Management Is Changing The Way We Do Business. Hoboken, NJ: Wiley.
Senge, Peter M. 2006. The Fifth Discipline: The Art and Practice of the Learning Organization.
New York, N.Y.; London: Currency Doubleday.
Wenger, Etienne, Nancy White, and John D. Smith. 2009. Digital Habitats: Stewarding
Technology for Communities. Portland, OR: CPsquare.
Zipperer, Lorri, and Geri. Amori. 2011. "Knowledge Management: An Innovative Risk
Management Strategy." Journal of Healthcare Risk Management: The Journal of the American Society
for Healthcare Risk Management 30, no. 4: 8-14.
Zipperer, Lorri. 2011. “Knowledge Services.” In The Medical Library Association Guide to
Managing Health Care Libraries (pp.301-319), edited by Margaret Moylan Bandy and Rosalind
Farnam Dudden. New York: Neal-Schuman Publishers.