Healthcare and Knowledge

Our Review in the App Gap →

As a community teaching hospital committed to academic excellence, a Trauma I Center, and a Magnet Hospital, we conduct a lot of high quality studies. However, it is not always easy to share results of those studies across the departments, locales, or shifts. Furthermore, when new knowledge “resides” on someone’s PC, it isn’t easily accessed by anyone else. There is no need to reinvent the wheel—we want to leverage that new knowledge throughout our system as well as nationally and internationally. We look forward to implementing Cortex to make that knowledge easily accessible, to discuss timely topics, and to interact asynchronously across shifts.

— Director of Research at a Pennsylvania hospital system

The new Cortex logo!

Note from a Former Healthcare Consultant

Hi David,

In my consulting work in the healthcare and clinical technology terrain, I’ve seen many situations where value is created simply by having the right people in the room talking to each other about the right issue.

A number of years ago, I was working with an advanced community hospital in the Southeastern United States that was looking to use its strong interventional stroke program to launch a regional stroke network of care by partnering with smaller facilities in the region. The basic concept was simple. By sharing clinical protocols and developing transfer agreements, the community hospital could help improve patient outcomes in the region and grow profitable volumes of advanced endovascular stroke procedures  

The issues surrounding program development – legal, operational, financial and strategic – were exceedingly complex and the executive team at the community hospital was struggling to develop the necessary agreements with potential spoke facilities. Rather than trying to help them reinvent the wheel, I put them in touch with the VP of Neurosciences from a Northeastern academic medical center who had led the maturation of a very similar stroke network several years earlier.

Over several days of conversation, the executives affected a direct knowledge transfer that had clear and measurable benefits for both institutions. The institutions discussed innovative methods for reaching out to smaller facilities, developing transfer agreements, partnering with local EMS providers, marketing the program and growing intervention volumes. This transfer saved the community hospital months in their planning efforts and over $200,000 in IT investments that were ultimately deemed unnecessary given the needs of the future stroke network.

The vast majority of complex problems facing hospital leadership have already been solved, at some hospital by some enterprising executive team. The challenge is to disseminate this knowledge by facilitating the right conversation at the right time.

Cleveland Clinic Once Again Takes the Lead

Right off the press: The Cleveland Clinic is planning a training academy for executives that weds hands-on experience with formal classroom training. This is exciting as such academies are wonderful ways to help knowledge transfer across the US healthcare system. The two week courses no doubt will cover a variety of areas, and I’d be very curious to learn what they are. I’m even more curious to know if they plan on developing a continued way for their students to share knowledge with each other, even after the courses have formally ended.

Healthcare management innovations happen everyday and so should be broadcast continuously and not only at discreet events (conferences, academies, etc).

User Experience Design, Diversity and Healthcare

An interesting article in the New York Times today entitled “At Hospitals, New Methods with a Focus on Diversity,” refers to efforts across the country to redesign care pathways to be more attuned to various cultures and their attitudes towards medicine. It might mean removing pens with red ink from Hmong patients’ rooms because that color indicates a curse or drafting bi-lingual paper form to make them friendlier and more usable.

This is really an important step in re-designing care itself to be more patient friendly and part of a larger movement in a field called Patient Experience. In my field of software design and development, one of the most important considerations is the user experience. Those that ignore UX, as it is called, do so at their own peril. We all, at the most basic level, enjoy and appreciate usable products, from hair dryers to complex machinery. And those products that don’t work well, go very quietly into the night.

In fact, the patient experience is already recorded by institutions in partnership with CMS through the Hospital Consumer Assessment of Healthcare Providers and Systems, and the results are publicly available through AHRQ. The Cleveland Clinic even created the role of Chief Experience Officer to focus on experience.

I wonder, however, what a hospital designed from the ground up with the patient experience front-and-center might look like. If anyone knows of institutions that fit that bill, please let me know.

Social Learning and Healthcare

Bill Ives, one of the great Knowledge Management bloggers, has written an interesting review of a book entitled The New Social Learning by Tony Bingham.

What struck me was what he said about the timeless nature of social learning—how it is independent of newer social media tools. I’ve run across research that concludes that most of workplace learning happens through informal conversations among colleagues. Clearly, this has been going on since long before the advent of social media tools. Our most basic social media application is actually our mouth, and the role of technology is to help us speak to the right people and listen to the right people across a distance.

I think social learning in a healthcare setting takes on a whole new level of interesting. Because the “customers” in a hospital setting are patients involved in a complex continuum of care, learning involves many factors from many stakeholders. The fact that care delivery is so community-based means additional voices often need to be considered in any kind of learning.

Enterprise 2.0 is Ideal for Healthcare Management

Social computing is useful across multiple business verticals. It can drive profitability, increase efficiency and broaden and deepen the organizational ties that drive innovation. But healthcare is a special case. It is marked by an extra layer of concerns, namely, patient care. Healthcare has additional bottom lines (not necessarily to be confused with the idea of the Triple Bottom-Line).

Collaboration across functional units in a hospital is critical not just to a well-oiled organization, but to ensuring quality care.  For example, quality campaigns rely on collaboration to collect data, analyze it and then institute cultural or process-related changes. Enterprise 2.0 has the chance to take quality campaigns to the next level by coordinating knowledge sharing across groups that might never otherwise interact in a meaningful way.

In “Crossing the Quality Chasm,” the IOM identified knowledge management as a means of supporting evidence-based practice. New ESS tools are emerging everyday and can do wonders for healthcare as it crosses that important chasm.

Crowdsourcing Patient Flow

I was just re-reading an old and interesting report by the GAO about patient flow and crowding in hospitals. Just before I started with the report, I ran across an interesting post by Andrew McAfee over at http://andrewmcafee.org/blog/ about how scientists are crowdsourcing the problem of figuring out how proteins fold. He writes:

So why not use computers to simulate the folding process, thereby gaining a better understanding? Why not write an application that takes a given protein’s fresh-off-the-assembly line shape, applies all known folding rules to it, and tests to see which ones get the molecule into its final (known) shape? Programs like Rosetta do exactly this, but they run up against a nasty problem: even simple proteins are so complex that the fastest simulations can’t test all possibilities.

The solution? A game called Fold.it. It draws from the massive success of online multi-player games and asks amateurs, with clear guidance on the tricks and rules involved, to attempt to fold proteins themselves. So far it is quite successful. So if it can work for modeling problems around protein folding, why can’t it work for modeling patient flow and optimizing facility design and processes? Of course, the inputs involved in industrial design are more complex, but with the right parameters and a simplified model, surely some clever people could discover new ways of moving patients through the ER.