«Published Annually Vol. 6, No. 1 ISBN 978-0-979-7593-3-8 CONFERENCE PROCEEDINGS Sawyer School of Business, Suffolk University, Boston, Massachusetts ...»
And hence Laverde (18) proposed implementation of KM processes as a strategic alternative for hospitals to improve efficiency and performance. A similar observation was made by Goncalo, Jacques and Souza (19), who studied eight hospitals in Rio Grande do Sul involving multi-disciplinary teams organized around cardiology services and established that knowledge management should be used as an alternative for the development of advanced solutions to complex healthcare problems that are of interest to the society. They used the Acquire, Store, Distribute and Apply process of knowledge management to understand importance of medical-assistential protocols.
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It has been seen that generally, healthcare organizations put more emphasis on medical treatment than overall management of disease. But with changes in medical technology, there is a need to focus on more comprehensive management of patients rather than dealing with only medication and treatment. Healthcare organizations are facing plethora of problems such as rising costs, superior healthcare delivery, industry competition, the shortage of specialized personnel, the need to comply with government regulation etc. (20, 21). This has resulted in introduction of many corporate strategies and management theories to manage both tangible and intangible assets. Knowledge Management is increasingly being touted as a way to enhance competitive advantage by recognizing knowledge as a critical organizational asset and managing it in a systematic manner (22).
Thus, experts such as Davenport and Glaser (23), Powers (24) and Van Bevern, (25) have been advising for implementation of knowledge management in the context of healthcare management.
It is a well established fact that Healthcare is a knowledge intensive industry. Therefore, creation of new knowledge and continuous learning are two very important aspects of knowledge management in these organizations. Many studies show that healthcare organizations are now keen to manage and leverage their intangible assets and intellectual capital and are using knowledge management frameworks and techniques to transform a hospital or a medical home into a learning organization.
(6, 26, 27).
Anantatmula (7) discussed how knowledge is manifested in learning and argued that knowledge management and organizational learning are intricately related. Similarly, Silver (28), argued that KM is a multi-disciplinary paradigm that integrates business strategy with process, organizational culture, organizational learning and technology. A learning organization is therefore the one which acknowledges knowledge as its main strategic resource and creates new knowledge through intellectual capital with the knowledge worker as the critical component in the organization.(29) Paula Pinto Ferreira et al. (30) in their study established a link between knowledge management, organizational learning and leadership. They argued that the quality of care is proportional to use of knowledge as a resource and health organizations that share this resource effectively can reduce their costs, generate greater returns on investment, higher satisfaction and encourage continuous learning. Thus a well-defined knowledge management process, which focuses on learning is necessary for acquiring existing knowledge and creating new knowledge and promote learning at individual and organizational levels. (31) In the new economy, knowledge is the main strategic resource, while the main strategic tool is Organizational learning. (32) According to Pemberton (33), successful organizations create an environment where organizational learning is combined with knowledge management. The same concept was empirically proved in healthcare networks by Addicott, McGivern and Ferlie (34) Orzano et al. (35), conducted a qualitative analysis of transcriptions from observational and interview data collected in four U.S. Midwestern family care practices and showed that by helping sharing available knowledge among medical practitioners or by developing new knowledge for use by them, KM can increase the capacity of a practitioner to deliver better health care.
Another study confirmed that KM affects performance measures by enhancing learning, decision making, and task execution.
(36, 37). Similarly, Chang, Tsai, and Chen (38) conducted a study of Taiwanese hospital systems to identify the relationships among some factors that play a significant role in successful knowledge management implementation in the health care environment. According to them, they were able to establish an empirical correlation between knowledge characteristics and KM implementation measures. The study also confirmed the performance impact of people centric implementation measures.
The importance of a KM system has been demonstrated by empirical studies concluding that KM practices lead to higher organizational performance (39). They took three components of knowledge management systems that influence firm performance: the firm's ability to produce new knowledge, its ability to build on that knowledge, and its effectiveness in capturing a high proportion of the subsequent spin-offs. They showed that that a firm's growth rate is positively associated with its ability to generate rare and valuable knowledge, and to build on that knowledge.
Darroch (40) showed empirically that a firm with a knowledge management capability will use resources more efficiently and so will be more innovative and perform better. The main constructs used were knowledge acquisition, knowledge dissemination and responsiveness to knowledge. Findings showed a positive relationship between the three knowledge management components and it was also seen that Responsiveness to knowledge had a positive effect on performance.
Marqués and Simon (41) investigated the causal relationship between knowledge management practices and firm performance by an empirical study on 222 Spanish firms in the biotechnology and telecommunications industries. They employed the competence-based view of the firm and focussed on the importance of knowledge management as a sustainable competitive Conference papers © Knowledge Globalization Institute, Pune, India, 2012 advantage. They concluded that there is a strong and positive relationship between knowledge management practices and firm performance.
Gowen, Fenagan and McFedden (42) examined the simultaneous implementation of transformational leadership, QM, and KM and their impacts on hospital performance. The constructs used were transformational leadership, QM, knowledge acquisition, knowledge dissemination, knowledge responsiveness, and organizational performance. They concluded that KM and QM have direct impact on organizational performance.
In 2002, Davenport and Glaser (24), published their case study involving a KM implementation at Partners HealthCare in Boston. As per the findings, that KM implementation reduced medication errors found by 55% and showed that when physicians encountered medication allergies or conflict warnings in the new KM system, 33 to 50 % of the orders were cancelled. And this resulted in better patient outcomes and improved hospital performance.
ANALYSIS AND DISCUSSION
As mentioned before, Healthcare is one of the fastest growing industries in today’s world. As Abidi (43) pointed out, not only is healthcare knowledge being produced at an exponential rate, it is also consumed by a wide range of multidisciplinary healthcare stakeholders such as physicians, nurses, administrators, patients, policy makers in governments etc. But it has also been noticed that although, healthcare is a knowledge intensive area, the healthcare knowledge is largely underutilized and this is mainly due to lack of availability of specific knowledge, especially at the point of care. (44) And therefore many experts have called for and investigated the need to have more robust and efficient healthcare management thereby sparking a rigorous interest in using Knowledge management concepts and theories in this domain. (17, 45) The difference between a Healthcare provider organisation and any other is the fact that unlike other businesses, healthcare is not solely driven by profits but is motivated more by quality and service. Moreover, as Van Beveren (26) put it, these are highly professional institutions, having people with specialised knowledge that needs to be constantly updated, shared, and leveraged.
Thus, KM in healthcare can be defined as a discipline that promotes an integrated approach to identifying, managing, and sharing all of information assets, including database, documents, policies and procedures of the hospital, as well as unarticulated expertise and experience resident in healthcare practitioners. (46) Basically, the focus of healthcare knowledge management is to provide superior healthcare delivery by creating and utilizing healthcare knowledge and improving the quality of patient care. It has been seen that this is not so easy to achieve because of the complexity involved in providing the healthcare to the patients. The complex issues involved in healthcare knowledge management range from dealing with a large variety of knowledge resources, diverse medical stakeholders having different requirements, capabilities and expectations, ever improving cutting edge technology, newest and latest edical protocols, to unique clinical situations which require specialized manipulation of the healthcare knowledge.
With rise in both private and governmental support to healthcare sector, more and more hospitals and medical homes are focusing on the increasingly important question of how to improve healthcare delivery to the patients. Knowledge management is thus being recognized as one of the key approaches in managing the complex healthcare delivery issues.
Experts believe that KM can help the healthcare sector to overcome the information and knowledge explosion, by adopting a framework that focuses on both Technology as well as the People – an approach that previous healthcare management models did not explore. They relied heavily on information technology. A McKinsey survey of 40 companies in the US, Europe and Japan showed that many executives think that KM (Knowledge Management) "begins and ends with sophisticated IT systems" (47).
But this is far from true. Though IT is a great enabler for any kind of system, it is the people who drive KM techniques and practices. Many experts now agree with the notion that technology and IT are just one dimension of knowledge management and there is more to it than just technology.
Why KM in Healthcare?
Healthcare is one of the most knowledge intensive industry with high focus on both specialized knowledge and cutting edge technology to improve outcomes. Although many arguments can be given in favour of using learning based knowledge management model in healthcare delivery, in this paper we will present three major issues that require immediate attention.
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First based on Information load -- Though the large amount of information available to physicians is a boon, but sheer amount of clinical data available is more likely to overwhelm rather than help. As per Pavia (48), there are over "10,000 known diseases, 3,000 drugs, 1,100 lab tests, 300 radiology procedures, 1,000 new drugs and biotechnology medicines in development and 2,000 individual risk factors". Similar studies by Masys (49) showed that with the improvements in biomedical knowledge, 50% of current hospital admission requirements could be replaced by new pharmaceutical compounds in the next few years. It cannot be expected that a physician will be able to keep track of all these along with his/her routine tasks. In addition the amount of published literature is going up day-by-day. In 2009, Medline contained 17.9 million citations and, on average, about 400,000 new entries were being added per year. As of March 2011, 5,539 journals are currently indexed for Medline.
(http://www.ncbi.nlm.nih.gov/pubmed) Thus it can be safely assumed that it is simply not possible for the physicians and the other medical stakeholders to possess and be updated regarding all the knowledge in their domain of their specialty. (50, 51).
Second based on medical errors -- A number of studies conducted on medical errors show that though there has been a decrease in medical errors by physicians, it still amounts to quite a large number. As per a report by The Institute of Medicine, USA in 1999, there are more than 98,000 deaths each year that can be attributed to medical errors. Similarly there have been numerous instances of patients having adverse reactions to drugs because of wrong drug prescriptions and numerous complaints by patients that sometimes the common laboratory tests ordered by physicians are clinically unnecessary.
Therefore, it is important that medical practitioners have to acquire proficiency in understanding and interpreting clinical information so as to attain knowledge and wisdom while dealing with large amount of clinical data. (52) With lots of information available for patients, there is now an increasing demand for effective and accountable clinical practices and decisions, improved health outcomes, and provision for superior health delivery. (43) Third – based on size. In terms of sheer size, Healthcare is one of the key service sector in today’s world and is growing exponentially. In 2008, healthcare provided 14.3 million jobs for wage and salary workers and it is estimated that Healthcare will generate 3.2 million new wage and salary jobs between 2008 and 2018, more than any other industry, largely in response to rapid growth in the elderly population. The total global healthcare expenditure for year 2010 was approx $ 4.5 trillion.
The Indian Healthcare Industry