A Positive Deviance Perspective on Hospital Knowledge Management: Analysis of Baldrige Award Recipients 2002-2008

Article excerpt

EXECUTIVE SUMMARY

Knowledge management (KM) is emerging as an important aspect of achieving excellent organizational performance, but its use has not been widely explored for hospitals. Taking a positive deviance perspective, we analyzed the applications of nine healthcare organizations (HCOs) that received the Malcolm Baldrige National Quality Award from 2002 to 2008. Baldrige Award applications constitute a uniquely comprehensive, standardized, and audited record of HCOs achieving near-benchmark performance. Applications are organized around leadership, strategy, customers, information, workforce, and operations. We find that KM is frequently referenced in all sections, and about two thirds of each application addresses KM-related issues. Many specific KM activities, such as strategic and action plans, communications, and processes to capture internal and external knowledge, are addressed by all nine applications. We present examples illustrating these frequently appearing KM concepts. Baldrige Award-recipient HCOs apply continuous improvement to KM processes, as they do to their organizations as a whole. We conclude that these HCOs have developed sophisticated, comprehensive KM processes to align both culture and specific procedures throughout the organization. KM in these organizations is a deliberate effort to keep all relevant knowledge at the fingertips of every worker, characterized by frequent communication, careful maintenance of content accuracy, and redundant distribution. We also conclude that the extent and rigor of their KM practice distinguish them from other U.S. hospitals.

INTRODUCTION

Modern healthcare practices require substantial use of knowledge management (KM). KM is a broader term than data management or information management. Whereas information or data is the qualitative or quantitative description, respectively, of an object, a concept, or a process, knowledge is the result of the evaluation, abstraction, or synthesis of information (Alavi & Leidner, 2001). Knowledge includes comparisons, opportunities for improvement (OFIs), and inferences about causes or corrections. For example, clinical care requires assessment of patient needs, coordination among a large number of providers, and the application of complex technologies. KM for care must manage information from ongoing patient assessments and treatment records (compare with Bohmer, 2009) as well as hundreds of professional guidelines and protocols integrated into lengthy, multi-step processes. KM involves not only the storage and use of information but also the evaluation, effectiveness, and continuous improvement of both the individual steps in care processes and their integration into treatment plans. Consequently, KM must go beyond data and information to include reporting structures, analytic processes, and strategic coordination.

More specifically, Alavi and Leidner (2001) define the four major elements in KM systems: knowledge creation--formal research, literature review, or field observation that leads to discrete statements of findings (consensus-building activity and the resulting agreement are part of knowledge creation); knowledge application--use of specific knowledge in an economically valued service or production activity; knowledge storage and retrieval--recording specific knowledge in a manner that captures its unique characteristics and supports its recovery; and knowledge transfer--communication of knowledge by voice, sign, or messaging system and by explicit training.

In this article, we examine these four elements of KM in high-performing healthcare organizations (HCOs). White and Griffith (2010) conclude that high-performing HCOs pursue consistent strategies that include measurement, benchmarking, and continuous improvement in all areas. These high-performing systems also empower their workers to challenge practices on subjective and qualitative grounds, and they monitor challenges and unexpected events. …