Quality in Primary Care Open Access

Introduction

Although knowledge management is a term that first appeared within the commercial sector it is pertinent to many organisations, not least those involved with healthcare. Broadly speaking knowledge falls into two categories: explicit that is often represented in document format, be that electronic or hard copy, and implicit that resides within the individual and is developed through a diverse combination of factors. The concept of knowledge management came about due to a growing recognition of the value of the implicit knowledge which individuals within an organisation hold, and the realisation that a valuable knowledge resource leaves the organisation every time an individual moves on. Knowledge manage-ment in practice is about putting systems in place that empower individuals to share their implicit knowledge and enable others to make best use of the knowledge shared. The terms enable and empower are used because for a knowledge management system to work it must engage and be useful to its target population, otherwise it simply becomes an additional workload which adds little to the organ-isation as a whole. The knowledge management resources listed below vary in application from a simple system to put individuals with similar professional interests in contact, through to online discussion groups and distance education resources. The one element they all share is that in some way they attempt to move the knowledge of the individual into a wider forum, an important action in the world of healthcare where so much of our organisational wealth is in the expertise of our people.

The Knowledge Xchange: www.knowledgexchange.co.uk

The Knowledge Xchange service is a subscription-based routing and storage system for the exchange of information between individuals in health manage-ment positions who would probably not commun-icate under other circumstances. The system allows individual members to send questions to others in a similar position or concerned with similar issues. Each query is directed to the most appropriate members of the Xchange who are identified through the subject area(s) and associated role(s) information that has to be supplied with every question. All members can limit the number of questions they receive each week; there is no limit to the number of queries an individual member can send. The site has a subject-based, searchable archive of previous ques-tions and the members’ responses to these.

Subscription is by organisation rather than on an individual basis and allows any number of the subscribing organisation’s employees to register. As a guest on the site it is possible to see examples of how the question system and the archive facility work, and view the names of all the subscribing organisations.

The major limitation to the system is that no forum exists for sharing information between members that does not comply with the question and answer format. It is not possible, for example, to post information relating to current best practice within an organisation. It could be argued that busy professionals are more likely to use a system when they have a question to address rather than simply to disseminate good practice. The only way to ascertain the veracity of this opinion would be to create a section on the site that allows such postings and to monitor its use. There are no data available to the visitor about how widely the system is used or about the size of the archive. It is therefore di¤cult to judge if this system o¡ers value for money in terms of likely use and the current breadth of questions stored. Nevertheless this is a good example of using information communication technologies (ICTs) to give individual employees access to the distributed expert knowledge base of the NHS.

National electronic Library for Protocols and Care Pathways (NeLPCP): www.nelh.nhs.uk/carepathways/

NeLPCP is one of the tools available within the National electronic Library for Health (NeLH). It allows the user to access information about care pathways developed from around the UK. The database system does not give direct access to the care pathways but rather details their subject cover-age, current stage of development, and who to contact to obtain a copy of the pathway. Access to the records is via an alphabetical listing system. While the tool is not comprehensive, those developing the pathways have to let the system administrators know about their activities, it is the nearest thing to a national register of care pathways currently available.

It is a good example of a knowledge management tool because it seeks to achieve two ends: firstly to stop the duplication of e¡ort, a major concern within an organisation the size of the NHS, through making the details of local work available nationally; secondly by facilitating the communication between indi-viduals who are geographically dispersed but con-cerned with similar areas of work.

NHS Beacon sites: www.modernnhs.nhs.uk/nhsbeacons

The Beacon website is hosted as part of the NHS Modernisation Agency’s information provision. Bea-con sites are usually individual departments that are using innovative approaches to address problems or promote best practice. The Beacon website is designed to share the practice of the Beacon departments across the NHS. There are three main tools on the site designed to meet this end:

•Information Exchange

•Sharing Good Practice

•Theme Focus.

Each of these tools is accessible from the menu on the left side of the site’s home page.

The Information Exchange is a sign up system that allows users to share information and questions within defined subject areas. The registration process for the exchange gives users a list of subject areas from which they can select and also requires that the user supply an email address. Users receive all the information posted to their selected subject areas via email. Posting information or questions to the site is achieved through the use of a set form located in the log-in section of the exchange. As with the Know-ledge Xchange, detailed above, this system is a prime example of a knowledge management tool that crosses geographical and temporal boundaries to allow the sharing of knowledge outside the users’ standard information spheres.

The Sharing Good Practice section of the site is an archive of material previously published by the Beacons programme that gives details and case studies of the practice of various Beacon projects. It operates through a simple list system. Theme Focus lists the contact and operational details of all the Beacon sites across the UK, grouped under theme headings such as ‘cancer care’ and ‘coronary heart disease’. Once the user has selected a theme, a drop down list appears in the main body of the page giving access to all of the Beacon departments that deal with this area. The Theme Focus list is available as a drop down menu from the home page of the site as well as from the Theme Focus link on the website’s main menu.

The National Research Register (NRR): www.update-software.com/National/

All the research work Referenced on the NRR is partially or fully funded by the NHS. Unlike the majority of research databases though, this resource contains Reference for work that is still ongoing as well as that which has been completed. The obvious advantage to this database is that it allows researchers to check that they are not replicating work already being undertaken. Each record within the database gives a summary of the research, its title, where it is (or was) being conducted, when it should be (or was) completed and who to contact to find out more about it. The potential for this system is to put researchers within the same field in contact with each other. A search conducted around any research topic will indicate who is currently working within the field on NHS-funded projects. There are other resources that o¡er similar services but none of them focuses purely upon the NHS, and therefore UK-based research.

PRODIGY: www.prodigy.nhs.uk/

PRODIGY is a multiple information resource website designed for primary care. The site has recently been redesigned so elements of it are not yet complete. Nevertheless it does have some tools that promise to grow into e¡ective knowledge management re-sources. Currently the email lists, the message board and the user group sections of the site are under-developed. The email list has only two main subject headings that are lightly used. They deliver messages sent by an individual member of the list directly to all other members, i.e. to members’ home or work email addresses. The message board allows members to post and reply to messages at a central, web-based point. The user group facility was not operative at all at the time of writing but will bring together members of similar interest to share information.

The PRODIGYsystem also hosts online education facilities about e¡ective use of the computer in the consulting room, clinical governance and other elements of the system. This site is a resource to keep an eye on as it holds the potential to grow into a powerful tool for information use and knowledge management.

The Knowledge Management Virtual Library on NeLH: www.nelh.nhs.uk/knowledgemanagement.asp

NeLH has a range of virtual branch libraries (VBLs) that re-arrange the links from the main site into a system that re• ects that subject of the VBL and also add unique resources particular to the subject focus. This particular VBL is a long way from being the most comprehensive and still appears to be a work in progress. The explanation about the di¡erence between the management of explicit and tacit knowledge and the table listing the di¡erences between the two should prove helpful to anyone trying to come to grips with the complexities of the subject matter. This VBL needs further development as the majority of the links lead to resources that are on the fringes of knowledge management rather than at its core. It should however develop into an interesting and useful resource.

The National Primary and Care Trust Development Programme (NatPaCT): www.natpact.nhs.uk/

NatPaCT is a system for individuals and organ-isations within the primary care economy. As with (see above) there are a large number of tools hosted through this site which are combined to give a wide range of possibilities for sharing, retrieving and applying knowledge as well as training to assist with the development of quality practices.

Some of the resources to be found on the site are used to support knowledge management tools that have their main focus in other media or non-virtual environments. ‘The Connectors’ is an example of an e-learning resource designed to help primary care trusts (PCTs) connect with and involve their patient populations. A new document is produced twice monthly and its contents re• ect the subject matter of the regional meetings of the ‘Engaging Communities Learning Network’; the purpose of these meetings is to promote the same ends as ‘The Connectors’ e-resource.

Other facilities on the site exist purely within the virtual domain. A discussion forum allows users to start on-line discussions about challenges they face, questions they have to address or good practice information they wish to share. The competency framework section of the site gives access to documents supporting PCTs in addressing the requirements of the framework, and contact details for groups currently meeting to discuss such considerations.

It is still too soon to judge whether NatPaCT’s new site and the tools therein will prove popular enough with their potential user population to be e¡ective. All knowledge management tools, as they have the concept of sharing knowledge at their heart, rely on an adequate population base to make them work. Currently the community of users for NatPaCT does not appear to have reached this point but this should not be read as a predictor for the future or a judgement on the quality of the tools themselves.

Conclusion

The ongoing sta¡ recruitment and retention prob-lems and the person-centred knowledge culture within the NHS make strong arguments for the use of e¡ective knowledge management. The resources above give an indication of some of the possibilities for knowledge management on a national scale. These should not be considered the only solutions available nationally or locally. Indeed the potential for modification or redesign increases when a tool is intended for use across a single area or trust. The heart of knowledge management lies in the develop-ment of tools that create a symbiosis between the needs of individuals and the organisation. A tool that grants advantages to both parties stands a greater chance of success and local scaled initiatives have the

• exibility to ensure such advantages. Such tools do not have to be complex or even electronic, function-ality should be the key. Knowledge management does not end with the creation of such tools, no matter the scale; they need to be reviewed, upgraded and shared beyond the boundaries of their inception.