Decision Support Systems Knowledge Management

Decision Support Systems Knowledge Management
HA Lecture 6 Decision Support Systems Knowledge Management Janet Guptill – HA 608 – October 1, 2007

MAJOR TYPES OF SYSTEMS EXECUTIVE SUPPORT SYSTEMS (ESS)
[Strategic Level] MANAGEMENT INFORMATION SYSTEMS (MIS) DECISION SUPPORT SYSTEMS (DSS) [Management Level] KNOWLEDGE WORK SYSTEMS (KWS) OFFICE AUTOMATION SYSTEMS (OAS) [Knowledge Level] TRANSACTION PROCESSING SYSTEMS (TPS) [Operational Level]

Key Terms Decision Support – analyzing data, often from different sources, to make better decisions Decision Support Systems (DSS) automate decision support Expert Systems automate decision-making Executive Information Systems (EIS) provide “dashboards” to assess operational performance Clinical Decision Support Systems (CDSS) enhance patient care decision-making Knowledge Management (KM) incorporates evidence- and experience-based information

Decision Support - A Possible Definition:
Decision Support - an organization’s use of data in order to improve its managerial and clinical decision-making effectiveness. NOTE: Above definition makes NO mention of computers!

Steps in Using Data to Make Decisions:
Formulate the Decision Problem Obtain Appropriate Data Summarize Data Create a Model Use Model to Evaluate Alternatives Choose an Alternative Implement the Alternative

Approaches to Incorporating Data in Decision Making
Manual – collect data and logically organize it to support decision process Spreadsheets, Statistical Software, etc. Request “IT Department” to generate a report Use Decision-Support System (DSS) that integrates needed data and provides analysis framework

A Sample Decision Making Problem
You are the Executive Director of a 21-physician multi-specialty clinic. You currently purchase MRI services on a discounted fee-for-service basis from a local hospital. You have begun to think about building the capability of providing these services in-house.

A Sample Decision Making Problem (Cont’d)
You are trying to decide when to begin installing the necessary MRI equipment and when to start a search for a radiologist with expertise in this area. You realize that this decision should be based on data. How do you make this decision? What data do you need?

Test the feasibility of a freestanding center
Map forecasted procedures by zipcode, overlay existing imaging provider sites Estimate demand based on 3-5 mile radius and realistic market share targets “Reality test” the demand numbers to be certain sufficient volumes are attainable Create the financials, staffing plans, and marketing strategies

St Louis 2001 Major Imaging Procedures by site of care

Major Imaging Procedures expected to grow over next 5 years in St Louis due to greater adoption of imaging technology in the market

St Louis area map—Focus on St Charles County

St Charles County - Existing Imaging Centers - 2001

What volumes are needed to be worthwhile
What volumes are needed to be worthwhile? What are realistic start-up volumes? (assumes 260 days/year) Breakeven Volume/Day Year 1 Volume/Day Year 2 Volume/Day Year 3 Volume/Day MRI 7 10 15 20 CT 5 PET 4 6 8 SPECT

What decisions would you make with these data?
2007 Proc Forecast Breakeven Mkt Share Capacity Market 1 CT 25,319 5% 21% MRI 14,277 13% 36% PET 529 196% 392% SPECT 5,022 26% 52% Market 2 11,225 12% 46% 6,329 29% 82% 232 448% 896% 2,191 59% 119% Mkt 1: 63301 63303 63304 63376 Mkt 2: 63385 63366 63367

Desirable Attributes of a Decision Support System
Easy Interaction With the System Executives Can Retrieve Data Themselves Data are Displayed in a Meaningful Format System has Modeling Capability System Generates Clear Reports

First, a look at Database Management Systems (DBMS)
Describe How Database Management Systems Organize Data Identify 3 Database Models, Principles Of Database Design Discuss Database Trends

Two Definitions: Database - collection of data carefully organized to be of value to a user Database Management System (DBMS) - software used to manipulate the database

Example Database Field Employee Name Date of Hire Social Security #
Language Fluency Ken L. Watt 03/03/86 None Jane Sargent 11/10/90 German Mary Smith 05/05/97 Spanish . Robert Cardin 09/12/92 French Record File

An Overview of Database Models
Hierarchical Data Model - stores data as nodes in a tree structure Department Employees Equipment Technician Maintenance Records ROOT FIRST CHILD 2nd CHILD

Use of “Pointers” to connect records
Field In One Record Is Address Of Next Record In Sequence POINTER RECORD 1 POINTER RECORD 2 POINTER RECORD 3

Types Of Relationships Found in a Hierarchical Data Model
ONE-TO-ONE: Department Employees ONE-TO-MANY: Equipment Technician Maintenance Records Supervisor

Network Data Model - stores data as nodes in a network Department Employees Equipment Technician Maintenance Records

NETWORK DATA MODEL Variation Of Hierarchical Model
Useful For Many-to-Many Relationships Example: Student Class Schedules - Many Students in many classes MANY-TO-MANY: STUDENT A B C CLASS 1 2

Relational Data Model - stores data in individual files, or tables Data In Table Format – each record is an event with a standard set of event characteristics Relation: Table Tuple: Row (Record) In Table Field: Column (Attribute) In Table

Relational Data Model

Comparison of the Models
Network Models - seem to have little application in health care; some research applications reported Hierarchical Models - appropriate where data form a natural hierarchy; radiology reporting system; data on individual patients Relational Models - emerging as the most popular and widely used; supports ad hoc queries

Healthcare example of relational databases
Hospital Patient ID Patient Age DRG Attending Physician ID Admit Date Discharge Date Discharge Disposition 42 465 1389 Home 75 110 3409 SNF 22 322 6704 6 201 3422 Transfer Physician ID Physician Name Physician Specialty Physician Practice Name Physician Office Zipcode Medical Staff Activation Date Physician Date of Birth 1389 Jones OB/GYN Jones PC 63144 3409 Richards Internal Medicine Medical Specialists 63106 5-1987 6704 Jackson Orthopedics Sports Medicine 63118 6-2000 3422 Craig Pediatrics Family Health 63105 6-2004

Comparison of the Models
Medium High Medium Medium Low High Low Low High High High Low Network Hierarchical Relational Processing Efficiency Flexibility User Friendly Program Complexity

Database Management System (DBMS)
Software To Create & Maintain Data Enables Business Applications To Extract Data Independent Of Specific Computer Programs

Database Management Systems
Data Definition Language (DDL) - used to define and describe the data elements in the database Data Manipulation Language (DML) - used to access, edit, and extract information from the data contained in the database Data Dictionary - used to store a detailed description of the data

Two Views Of Data Software Application or other data source
Physical View: Where are Data Physically? Software Application or other data source Drive, Disk, Surface, Track, Sector, Record Tape, Block, Record Number Logical View: What Data are Needed By Application? Information needed to make the decision(s) Name, Type, Length Of Field Ability to link or relate to other needed data elements

Data Definition Language
Creates a link between the “User View” of the data and the Physical View of the data User defines a schema, or view of the database Schema includes file description, record description, and information about fields

Data Manipulation Language
Provides ease of interaction between the user and the database Allows user to add new data; sort, delete, edit, or display data; generate reports Two methods for interacting: “Embedded Statements” Direct Interaction (Query Languages)

Query Languages Natural Language Queries - English-like statements
“Please give me the number, name and department name of all pieces of equipment that are associated with the department having the number 19.”

Query Languages Query-by-Example (QBE) – Microsoft Access

Query Languages Structured Query Language (SQL) - developed in the 1970s and adopted as a standard relational language in 1986 SELECT EQUIP_NO, EQUIP_NAME, DEPT_NAME FROM EQTABLE, DEPTABLE WHERE DEPTABLE.DEPT_NO=EQTABLE.DEPT_NO AND DEPT_NO=19

Data Dictionary File that stores detailed information about the data elements used in a database -- name type (numeric, alphanumeric, logical ...) storage allocation person authorized to change date of last change

Creating A Database Conceptual Design Physical Design

CREATING A DATABASE CONCEPTUAL DESIGN:
Abstract Model, Business Perspective How Will Data Be Grouped? Relationships Among Elements Establish End-User Needs

Creating A Database Physical Design:
Detailed Model By Database Specialists Entity-Relationship Diagram (ERD) Documents the conceptual data model Normalization - Process of making the database structure efficient Medication Order Physician Fills Out

Elements Of Database Environment
ADMINISTRATION DATABASE TECHNOLOGY & MANAGEMENT DATABASE MANAGEMENT SYSTEM DATA PLANNING & MODELING METHODOLOGY USERS

DATABASE TRENDS Object- Oriented: Data and Procedures Stored Together; Can be Retrieved, Shared Hypermedia: Nodes Contain Text, Graphics, Sound, Video, Programs; Organizes Data as Nodes Linking Databases Via The Web

DATABASE TRENDS Distributed Databases - a set of “smaller” databases into which an organization might choose to store its data. Benefits include: data are closer to user; multiple copies exist; data access is more efficient; applications are more balanced. Disadvantages: more complex; potential for loss of synchronization.

3 Final Concepts Master Patient Index (MPI)
Data Warehouse - enables the collection and organization of disparate data sources, both internal and external, to an enterprise Clinical Data Repository Master Patient Index (MPI) Standardization of Terminology & Data Format Data Mart Meets the demands of specific department(s) or decision types

Standardization Issues
Health Level-7 (HL7) – a set of standards designed to develop a cost-effective approach to system connectivity SNOMED (Systematized Nomenclature of Medical Reference Terminology) – a standard vocabulary of clinical terms EMPI (Enterprise-wide master person index) – a relational database containing IDs of all patients seen anywhere in the system

DATABASE ADMINISTRATION
Defines & Organizes Database Structure And Content Develops Security Procedures Develops Database Documentation Maintains DBMS

Conceptual Model of a Decision-Support System
External Databases Financial Databases Clinical Systems Other Data Sources DSS Database(s) DBMS Report Writer Model Library Model Manager User Interface User

General Uses of a DSS and the System to Support Each Use
Retrieve Data Item Perform Ad Hoc Analysis Present Aggregated Data Determine Impact of a Proposed Decision Propose Decisions to Management Make Decisions According to a Rule Type of System: Simple DBMS Generic Statistical Package Executive Information System DSS with “What-If” Modeling Capability DSS with Optimization Modeling Capability Expert System; DSS with Artificial Intelligence

Sources of Information for Decision Support
Internal Transaction Processing Systems (e.g., ADT systems) Specially Constructed Databases (e.g., medical staff roster) External Data Sources (e.g., market demographics data)

Storing the Information for Decision Support
Databases Example: Lab Data in a Single Hospital Many Databases throughout the System Often Represent Disparate Systems Critical to have a key field to link disparate databases together, e.g., patient ID, procedure code, etc.

Data Repositories Example: Clinical Data Drawn from Multiple Hospitals Related to Day-to-Day Practice Virtual vs. Physical Repository BJC Clinical Desk-Top (ClinDesk) System is a Physical Clinical Data Repository EMR would be a real-time data repository

Data Warehouses More Information than Repository Used for Retrospective Research Avoids “Bogging Down” Operating Information Systems Often “Interrogated” With Data Mining Classic example is risk-adjusted patient discharge data for outcomes analysis

Information Needed for Decision Support
Information to Support Strategic Planning Information to Support Marketing Information to Assist in Resource Allocation Information to Support Enhancement of Productivity and Operating Efficiency Information to Support Outcomes Assessment Information to Support Contract Negotiation

Examples of Data Sources for Health Care Managerial Decision Making

Approaches to Developing a DSS
Write the necessary programs from scratch in a suitable language Use tools such as spreadsheets, database tools, data “cubes,” etc. Customize a package Purchase a turnkey system What are examples of healthcare turnkey systems?

Expert Systems automate the decision-making process
Expert System: “A system capable of reproducing “the reasoning process a human decision maker would go through in reaching a decision, diagnosing a problem, or suggesting a course of action.” Mallach, E.G Understanding Decision Support Systems and Expert Systems. Burr Ridge, IL.: Irwin

Components of an Expert System
Knowledge Base (Rule Base) - contains expertise of the system Database - Information which knowledge base is matched against Inference Engine - generates conclusions User Interface - facilitates interaction between system and user Workspace - where system stores facts about a situation

Conceptual Model of an Expert System
User User Interface Inference Engine Workspace Knowledge Base Database

Typical Applications of Expert Systems
Program to find “fraud and abuse” in insurance claims Program to support hospital bed assignment Program to handle scheduling of outpatient procedures Program to check drug interactions or inappropriate dosages

Executive Information Systems (EIS)
Definition - “An information system which draws from multiple applications and multiple data sources, internal and external, to provide executives and other decision makers with the necessary information to monitor and analyze the performance of the organization.” Hoven, J. van den “Executive Support Systems and Decision Making.” Journal of Systems Management 47(2):48-55.

Typical Areas of Interest to the Executive
Financial Performance Clinical Outcomes Human Resource Utilization Access and Continuity Customer Satisfaction Market Share

Getting the Executive to Use the EIS
Executive Participates in the Design EIS Must Provide Relevant and Desired Information Output of EIS Must be Pleasing with High-Quality Graphics System Should be Relatively Easy to Use

Both Enhance Management Decision Making
Comparison of DSS & EIS Both Integrate Clinical and Financial Information from a Variety of Sources Both Enhance Management Decision Making DSS Supports Greater Depth of Analytical Probing & Modeling EIS provides performance indicators at a glance, similar to a scorecard

Clinical Decision Support Systems (CDSS)
Broad Definition: Any automated tool that helps clinicians improve the delivery or management of patient care Ideal Definition: A set of knowledge-based tools fully integrated with both the “physician component” of the computerized patient record and a repository of complete and accurate clinical data and test results

The Two Erroneous Extremes in DSS Design
Overly Simplistic - System is able to merely collect and aggregate data rather than to serve as a DSS Overly Sophisticated Computing Technology - Clever “bells and whistles,” but limited ability to interface with operational systems and to provide the executive with needed information

The Proper Balance Executives must look upon the installation of a DSS in their organization as one of THEIR strategic projects, rather than a necessary activity to be delegated to the IT staff!

Knowledge Management and DSS
DSS contain information to make managerial decisions. Data become Information; but to create Knowledge one needs Experience. Knowledge Management links user experience to data and information to enhance executive decision-making.

What is Knowledge Management?
John Seely Brown: “Because information is not knowledge, data is not wisdom, bits are not experience. The difference is us: we make knowledge out of information together, in our communities of practice.” The Social Life of Information We hear this confirmed across the studies of innovation and creativity in systems. James Surowiecki, in his current book, speaks of “The Wisdom of Crowds.” John Seely Brown (former chief scientist of Xerox, director of Xerox PARC) The Social Life of Information – communities of practice, trusted channels of information, stories, models for behavior. He calls Storytelling: “the Passport to the 21st Century”

Knowledge Management entails the use of “Online Communities”
What is a “community”? Why are they moving “online”? Why should this matter to you? What is hard about it? What makes it easier? Who participates in an online community now? What are they?

Knowledge Management: people connecting through shared needs
Who has expertise in this area? Who else faces similar challenges to mine? Is anyone else working on this same problem? What ideas have been tried and tested? How do you do this now? What would make this easier? How can I share what I have learned? Is there a recommended way to do this?

Knowledge Management Lessons Learned from Leading Business Managers
Define the desired performance outcomes – link knowledge transfer activities contributing to these results – APQC.org Saved “tens of millions of dollars” by creating a worldwide repository of “best practices” $1.5 million in savings from 2 of its communities of practice More than $1 billion in documented bottom-line savings since 1995 Gained $1.5B in annual wafer manufacturing capacity by sharing “best practices” $50 million a year in travel cost avoidance and $6 million annually by finding information more quickly through its KM initiative Saved over $150M in the first year of an initiative to identify and share marketing best practices

What are communities of practice?
Communities of practice are social networks Online communities are supported by web technologies They exist to solve problems Online communities or “social networks” run on trust – they are personal relationships that are created through shared experiences, situations, or work environments They are supported with technology tools like discussion boards, list serves, online libraries, wikis, blogs, expert directories, and the like They exist to solve problems – they help people do their jobs and they help companies address business objectives that require collaboration to achieve results, i.e., improved quality of care, enhanced operational effectiveness, or stronger financial performance Groups of people who come together to enable individuals to share knowledge pertinent to their field of practice or area of responsibility and to solve problems. Expose members to new and diverse sets of ideas, allowing them to learn before doing, to find and accelerate solutions, to think differently about problems, and to leverage the knowledge and experience of experienced practitioners. Can arrive at solutions more efficiently and effectively because of their ability to: Replicate proven practices, share lessons learned, and test innovative ideas; Improve access to relevant information sources to keep current on a shared discipline/topic; Leverage the knowledge and experience of experts and other members of the community; Foster an environment of collaboration and knowledge transfer that provide fertile ground for business process innovation.

What are online communities in healthcare?
Consumer communities – Disease support groups, weight loss/stop smoking, connect patients and families Professional communities – Professional societies, physician networking, hospital business alliances, software users Employee communities – Best practice adoption, process improvement teams, peer networking Consumer communities – Engaging consumers in support groups, behavior change communities, connecting people with similar interests Examples: Group Health Free & Clear stop smoking groups, United Healthcare disease management programs, CarePages tool to connect patients’ families, iVillage, WeightLoss, Cancer Survivors Network Other customer communities – Engaging affiliated physicians in discussions about care protocols, utilizing collaboration spaces to connect members in a hospital association, utilizing websites to connect professional society members Examples: Scottsdale Institute, Solucient, Partners Healthcare, IHI Employee communities – Engaging employees across hospitals within a system to share best practices, utilizing collaboration spaces for cross-hospital strategy implementation, supporting multi-disciplinary performance improvement projects Examples: Ascension Health, CHRISTUS, CHI, CHCA

Online communities are it!
MySpace Generation Collaboration Expectations Customer Interactions Engagement This is how current MHSA students and the MySpace generation communicates This is how the MySpace generation communicates They will expect this when they join your organization This is how your customers will expect to interact with you This is NOT about technology, it is about ENGAGEMENT

Virtual Communities are used across hospitals to:
Create relationships across time and space for peer learning and experience sharing Identify successful practices, lessons learned, and critical success factors for achieving better results Encourage and reward adoption of innovative practices and data-driven business processes We strive to hire the best and brightest, but once they are on board, we just go about teaching them our way. Communities are ONE way to harness all of the knowledge, wisdom, experience of our best and brightest. Build trust, create relationships across time and space, open up opportunities for learning from one another, build a social infrastructure, leverage all of the knowledge and wisdom of it’s employees.

Virtual Communities are used within hospitals to:
Collaborate across roles, departments, or functions to solve operational problems Simplify access to experts and expertise, encourage new ideas Save time and money by re-using work done in another department or area Collaborate across roles, departments, or functions to address shared issues, improve operations, and to drive organizational strategy Build on what has been done before, encourage new voices to be heard, and simplify access to experts Save time and money by learning from others throughout the organization

What are key building blocks for effective communities?
Value Add – both the individual and the organization have to see it as useful Culture – a new way of working – inherently more open and collaborative Infrastructure – making it look simple is hard work to begin with Communicating Impact – stories drive change Value Add The purpose for the community MUST add value to the members and to the organization. Without a clear value connection, target members will view the community as “just another thing I have to do on top of my real job.” Without a clear value connection for your organization, your potential community managers will feel the same way and your organization will not see a reason to support it. Culture People are reluctant to put themselves out as experts People fear communicating in public view This is uncontrolled communication – it is inherently risky It is a whole new way of working - need to work through the perception that it is an add-on to current jobs Infrastructure Integrating with existing IT tools and platforms takes time Thinking through how to support it takes time Need to strike a balance between “rules” and “flexibility” Make it as easy as possible for members to participate Communicating Impact Learning how to capture “so what” not just “what” is a new skill to acquire Gathering the data, the stories, the details compactly takes practice Communicating the successes and then marketing these stories will continue to drive understanding of the value deeper into the organization; ultimately, increasing support and utilization / participation. Critical Success Factors: Value to members and to organization Balance between community Leadership and Engaged Membership Effective technology to support the work of the community The challenges so often are very related to the critical success factors, but I see them as: Identifying what members will find truly valuable today Making it as easy as possible to participate (technology often gets in the way of this one) Overcoming a culture averse to being transparent – we learn more from our mistakes and sharing these can be difficult, especially in healthcare (Transparency within the organization) We may not be used to marketing internal successes, but this is a skill we need to adopt so that others can see the impact – it will help with the culture shift, increase participation, and ultimately help with adoption / institutionalization of the program as part of the way work is done. VALUE to MEMBERS!!! IHI Profiles in Improvement Who's improving health care? People are. Listen to the story of Jennifer Dunscomb of Columbus Regional Hospital. Source:

Examples of Knowledge Management Systems in Healthcare
CHCA 3 pronged approach to knowledge management: Peer Networking Forums, Performance Improvement Collaboratives, Race for Results Awards Program CHI Embedded knowledge transfer and learning: Knowledge Communities, Practice in Action, Calls to Learn, Relay Reports, LEARN

CHCA Case Study Background of CHCA
Overview of Forums, Collaboratives, Race for Results Strategic Impact to date Lessons Learned Improving the Performance of Children’s Hospitals

Knowledge Transfer to Improve Performance: A Case Study
42 non-competing hospitals US, Canada $14 billion combined revenue (1) Average per member revenue of $330 million If Fortune 500 would be ranked 142 IDN influence: 500,000 inpatients; 10 million outpatients (2) 102,000 employees (2) >20,000 pediatric physicians (5,162 medical specialists;1,985 surgical specialists(2) Top 5 among U.S. health systems/IDNs Sources: (1) Estimated from Goldman Sachs report to CHCA, July 2004; (2) Estimated from personnel report in AHA Guide 2003/ 2004

CHCA’s 3-pronged strategy
Peer Networking Performance Improvement Spread TECHNOLOGY Online communities Peer group meetings Collaboratives C, C, c RACE for Results Juried annual award PEOPLE & PROCESS Teleconferences List serves Forum directors Special reports Benchmarking PDSA approach Results reported to peers and executives Dedicated PI staff Awards process with external judges Peer reviewed publication Ambassador program External published results Real time tools and resources STRATEGIC IMPACT Individual employee improvement in productivity Satisfaction + individual hospital improvement in results Organization-wide improvement, e.g., cost reduction, error reduction, safety improvement Accelerate improvement Safe, efficient and effective Focus on spread Knowledge available when you need it Best practices Peer assistance

1 - Peer Networking Forums
Internet site for Forum members only Exclusivity, confidentiality, knowledge of colleagues Dedicated staff facilitator – Supports 3-5 Forums depending on content knowledge and required expertise Share documents, post weblinks, initiate discussions, find resources Technology combined with meetings keeps the group connected Teleconferences, webcasts, bi-annual meetings Ad hoc conversations, focused research, group problem-solving Rapid response to posted questions Benchmarking and identifying variation

Peer Networking Forums are Highly Active
2006 Hospital Participation in Forums Ambulatory 22 Materials Management 33 Cardiac 28 OR Directors 31 CFO 40 PACT 34 CHAPs 17 Patient Financial Services 21 CIO 36 Payor Contracting CNO Pediatric Practice Exec. COO Pharmacy Buyers Corporate Compliance Pharmacy Directors 39 Customer Service 20 PHIS 37 Dietary Physician Relations Executive Dialogue Quality and Safety Leaders 42 Facilities Management Radiology Directors Health Information Mgmt Respiratory Directors 32 Home Care Risk Managers 25 Human Resources SMAC 30 JCAHO 35 Social Work Community 15 Lab Directors SPBD Overall 2006 satisfaction 5.24 of 6.0 (87%)

Peer Networking Forums webpage example

2 - Performance Improvement Collaboratives
Dedicated Performance Improvement staff and resources Trained in IHI improvement methodology Hospitals agree to share results, post data and publish results Use industry and hospital expert panels to validate clinical direction Combine research and rapid cycle - essential for academic engagement Technology tools and partners integral to success Knowledge repository available real time improvements, tool kits, lessons learned, comparative data, audios of webcasts and lessons learned Strategic partners essential to spreading results and gaining credibility AHRQ Partnership for Quality Grant helped fund participation and training for all 42 hospitals Data-sharing agreements developed to expand comparative data sets (Vermont Oxford Neonatal Network and others)

Performance Improvement Collaboratives Example: Reduced Adverse Drug Events
Hospital Teams: Atlanta Birmingham Buffalo Cincinnati Columbus Corpus Christi Dayton Fort Worth Kansas City Miami Nashville New Orleans New York/ Morgan-Stanley New York/ Komansky Center Orange Palo Alto Pittsburgh St. Petersburg 16 teams (89%) had a reduction in ADE rate Average among teams with a reduction: 64% reduction Average for all teams: 49% reduction 11 teams (61%) had at least a 50% reduction in ADE rate Avg. CHCA Hospitals with reduction in ADE rate Goal BETTER

Collaboratives have own web-sharing spaces

Adverse Drug Event Collaborative webpage

Blood Stream Infection Collaborative webpage

Surgical Infection Prevention Collaborative

3 - Awards Program Encourages Spread
Formal RACE for Results awards program Formal application process with strict submission requirements External judges panel representing industry experts in quality and patient safety Results announced at award ceremony during annual Quality & Safety Meeting Winners required to serve as Ambassadors during subsequent year to teach techniques and encourage adoption of proven practices Formal marketing campaign to publicize event s, posters, web notices to promote the competition and publicize winners -based Relay Report to report progress as proven practices are replicated across the alliance Resources and contacts posted on the intranet to facilitate connections and encourage adoption Benchmarking reports regularly published to document improvements Improve Today Webcasts connect colleagues

RACE for Results Awards Program
2004 2005 2006 2007 Little Rock: Reducing Catheter-Related Bloodstream Infections through Repeated Rapid Cycle Improvements Cincinnati: Reducing Cost through Improving Quality Palo Alto: Decreasing ADEs By Implementing Safety Best Practices Washington DC: Using PHIS to Target Reducing Infections in VP Shunt Surgeries Omaha: "Asthma Attack“ Dayton: Reducing Catheter-Associated Bloodstream Infections in Children 11 Entries 12 Entries 17 Entries 30 Entries

RACE Results in Performance Improvement

Conclusions for CHCA Strategy Drives Approach
Informal peer networking builds a culture of sharing and collaboration Formal collaboratives are needed to create immediate results Systematic rewards and support are needed to spread initial results Knowledge Transfer involves Technology, People/Process, and Strategy Technology enables information sharing and people directories People processes ensure productive interaction and knowledge exchange Strategy determines impact measures and ensures organizational momentum CHCA Case Study Results: 42 children’s hospitals participate in 30 peer networking forums, regularly sharing improvement tools and resources, exchanging best practices and learning from industry experts 18 children’s hospitals averted 13,478 adverse drug events (ADEs), representing $2.7 million in net savings, and reduced PICU blood stream infections (BSIs) by 57% More than 60 intensive care units are working to sustain and spread improvements in ADEs and BSIs based on the initial collaboratives’ work

CHI Case Study Background of CHI KT&L Strategy and Scope
Relay Report results to date Lessons Learned

CHI Fast Facts Multi-institutional System of
 CHI Fast Facts Multi-institutional System of Catholic Healthcare Providers Dedicated to the healing ministry of the Catholic Church National Offices: Denver, Northern KY, and Minneapolis Market Based Organizations (MBOs) 19 states 68 rural and urban communities 71 hospitals (63 acute care, 5 behavioral, 2 rehabilitation, 1 long term acute care) 43 long-term care, assisted living facilities and residential units 5 Community Health Services Organizations Licensed acute care beds range from 15 to 1,546 $7.1 Billion in Annual Revenues 66,000 Employees (and growing) Holly Faith based Non-profit > 66K EE 19 States Rural & Urban 7.1 Billion Annual Revenues

Vision for CHI Catholic Health Initiatives’ Vision is to live out its Mission by transforming health care delivery and by creating new ministries for the promotion of healthy communities. * Holly Transforming healthcare

CHI Strategic Plan: 2007 - 2011 * Holly
- Two of those Distinguishing Characteristics are identified as KT & Innovation

Leveraging the Knowledge Within
“Our goal is for CHI to become known as an innovative organization. That will be our legacy for the future health care system – that CHI learns to leverage the wisdom of the whole, efficiently, effectively, and humanely.” - Kevin E. Lofton, FACHE, CEO, Catholic Health Initiatives Holly …and our CEO recognizes the importance of leveraging knowledge in order to be an innovative organization. We MUST innovate if we are to live up to our Vision statement to “transform health care deliver”

Knowledge Leadership Knowledge Leaders are Leaders who are effective at… Embracing and driving change Sharing experiences and applying learning Modeling the expected behaviors grounded in the culture of the organization … in order to tap into the intellectual capital of the organization and harness it to innovate and grow Tap into the Value Chain by identifying leadership competencies that will ultimately drive organizational behavior / culture change and result in impacting the customer experience. So if that is what innovation means to CHI and why it is important – how does it take shape? How do we create an environment where new ideas and successes are advanced every day? First we must fully exploit Knowledge Transfer & Learning and identify leadership competencies that will support this culture shift. We must expect our leaders to support and encourage innovation and learning. They must be competent Knowledge Leaders – leaders who are effective at…. If we have leaders who can do this, then we will be able to tap into the intellectual capital that exists in the organization; this is critical in a knowledge economy because effectively managing this asset as a key source of competitive advantage will help us to grow faster, better, more efficiently than our competitors Developing these capacities in our leaders also accesses a deeper level of learning that is key to creating change that serves the whole and drives us towards our desired future state of our health care ministry …tie in Transforming Healthcare Delivery again here… CHI strategies Highlight innovation (and what that actually means to CHI and what does risk-taking mean in healthcare) and how do we overcome this … what culture shifts have to take place…given this environment, how do we promote innovation Even the tools that support the processes and programs that enable innovation at CHI have to take risk into consideration (discussions in private area in collaboration communities). Leadership So providing the tools and resources that assist our leaders and all of our employees in learning from others, in sharing their own ideas and experiences, and recognize those who participate in both transferring and adopting is critical to the success of the organization *Be sure to tie in innovation here… KTL Vision: To improve knowledge transfer & learning across CHI, so that every part of CHI can leverage the strength and wisdom of the whole when we care for the patients and communities we serve.

Knowledge Transfer & Learning at CHI
Strategic Priority Consulting Knowledge Communities Formal Education Practice in Action Communication & Collaboration These are the components that Knowledge Leaders can tap into to … It is an integrated approach to learning and transferring knowledge Purpose: Accelerate learning so that our employees can learn from both the successes and mistakes of others so that we do a better job of providing a better health care experience in a constantly changing environment. CHI has a program of tools and resources to accelerate this learning: Knowledge Communities – opportunity to dialogue with peers to learn directly from each other’s experiences and develop new ideas Practice in Action – details of proven practices captured so that others can adopt these programs and achieve the same outcomes Collaboration and Communication – tools that enable virtual collaboration so that learning can continue on a daily basis even when people can’t be in the same location Formal Education – insure that education and training help employees learn the skills and behaviors they need to move strategic priorities forward Look at Leadership Conference Exchange forum slides

Communication & Collaboration
CHI’s KT&L Strategy Communication & Collaboration Knowledge Transfer Integrated Learning TECHNOLOGY Knowledge Communities Relay Report Live Meeting web-conferencing List serves Practice in Action - Proven Practices database Pathfinders collection of expert resources Calls to Learn Annual Events & Conferences System-wide LMS - LEARN PEOPLE & PROCESS National office sponsors KC Chartering process KC metrics reports Integrated into Annual Planning Budget Review process Formal process to confirm a proven practice KT&L staff support system-wide initiatives e.g., CHI Connect, service line development Centralized calendar of Calls to Learn across the organization and beyond LMS intended to address CHI-wide practices Integration of organizational effectiveness research with delivery of new education STRATEGIC IMPACT Enable innovation Focus on strategic priorities Defined and implemented new standards of practice Organization-wide improvement, e.g., cost reduction, error reduction, safety improvement Accelerate improvement Safe, efficient and effective Strategic Priority Consulting Compliance adherence Enable delivery of education in support of strategic priorities across the system The KTL Strategy has components of Technology, People/Process, and Strategic Impact

Knowledge Communities: Collaborate and Innovate
An environment that enables innovation, supports the development and spread of new ideas and builds the organizational social network to save time and reduce costs. Value of Pharmacist as part of bedside patient care team proved and $53 Million saved Leverage CHI expertise by assisting with the creation of new knowledge communities. Support and share the accomplishments of these communities. opportunity to dialogue with peers to learn directly from each other’s experiences and develop new ideas

Why CHI uses online communities
Connect peers and experts across CHI Common space across distance and time Supports the work of the Knowledge Community: Enable and leverage knowledge sharing Learn before doing Problem solving: find, innovate, and accelerate solutions Reduce costs, save time, and increase social fabric A strategic resource Not all KCs at CHI are online – about half use online spaces To connect people across space and time Groups of people who come together to enable individuals to share knowledge pertinent to their field of practice or area of responsibility and to solve problems. Expose members to new and diverse sets of ideas, allowing them to learn before doing, to find and accelerate solutions, to think differently about problems, and to leverage the knowledge and experience of experienced practitioners. Can arrive at solutions more efficiently and effectively Replicate proven practices, share lessons learned, and test innovative ideas; Improve access to relevant information sources to keep current on a shared discipline/topic; Leverage the knowledge and experience of experts and other members of the community; Foster an environment of collaboration and knowledge transfer that provide fertile ground for business process innovation. Can arrive at solutions more efficiently and effectively because of their ability to: Connect peers and experts Enable and leverage knowledge sharing Learn before doing Problem solving: find, innovate, and accelerate solutions Reduce costs, save time, and increase social fabric A strategic resource

Making it Easier to Connect with Knowledge Communities
Can mouse over names of communities and find out more information… this makes it easier for people to find out about communities they might want to join, or to decide whether a new community needs to be started and how to do that

Relay Report: Communicate, Connect, Celebrate
Improve connectivity, celebrate successes and increase awareness and utilization of KT&L resources. Accelerate the implementation of clinical imaging technology, resulting in accelerated NPSR of $1.5 - $3.0 M (Add back in the animation for the actual presentation) tools that enable virtual collaboration so that learning can continue on a daily basis even when people can’t be in the same location by facilitating Calls to Learn, collaboration space utilization, and publishing content and success stories Relay Report Collab sites Pathfinders Calls to Learn

Practice in Action: Transfer Critical Knowledge
Increase adoption of reliable, evidence based practices, identify organizational expertise, and recognize facilities that have achieved success. Avoided medication errors through improved reconciliation of home and hospital medications. Links can be made between KC’s and practices in the PIA database. details of proven practices captured so that others can adopt these programs and achieve the same outcomes Tell OE stories w/ the intent to connect with challenged facilities. Proven Practices by collecting, sharing, and publishing detailed information on proven and leading practices that exist across CHI. Support the sharing of these practices through a searchable, on-line database. Recognize facilities that have achieved success Reliable, evidence based practices that others can pickup a adopt Identify expertise Contribute to raising collective bar

Strategic Priority Consulting: Support Organizational Priorities
Accelerate achievement of strategic priorities by creating a plan to leverage available knowledge transfer and learning resources. Accelerate the implementation of ERP technology (Lawson) and the realization of projected savings KM team resources are allocated to support CHI strategic priorities…always leaving some capacity to continue to support KTL services for other initiatives – 80/20 rule. Those were the components we have in place and tools to deliver them. We are going to help you figure out how to use all of these tools and programs in order to drive your strategic outcome and we’ll help manage that plan for you. Drives use / allocation of KM resources Aligning KM resources with priorities Accelerate adoption of programs ands ability to meet strategic initiatives Resources to manage KT&L plan

Formal Education: Sustain Change
Coordinate and share system resources to insure that education and training help employees learn the skills, behaviors and competencies they need to move strategic priorities forward. Avoid dangerous / deadly events in OB through a targeted Advanced Fetal Monitoring curriculum Efforts of some KC’s result in formal education, such as a Perinatal community and a Patient Safety Officer community. They use online spaces to define their needs, begin to develop their curriculum, then ultimately tap into formal education tools (like an LMS) to deliver across the system. Advanced Fetal Monitoring… MRI Training – we have had incidents where a tech has brought metal into the MRI room (O2 Tank, Floor Buffer etc.) It cost several thousands of dollars to shut down the machine and lost revenue from pt transfers. By providing a computer based class we can reduce the number of incidents by XXX, …to be innovative / adapting in a changing healthcare environment. Ability to share content across system Collaborate to meet content needs Coordinated education initiatives reduce duplication, improve efficiencies and communication Improved ability to measure impact of education at system level Drive the CHI Formal Education Strategy. Support the implementation of a Learning Management System (LEARN) and create guidelines and processes to share education content and improve the ability to measure education impact.

Knowledge Transfer is both Organic AND Strategic
Accelerate Learning & Enable Innovation through… Knowledge Communities …leading to new models of care delivery and creative solutions… Communication & Collaboration Strategic Priority Consulting …resulting in improved outcomes: Quality & Patient Safety Employee Satisfaction & Engagement Increased Operating Margins Ultimately, it is an integrated approach that fulfills a need within CHI to leverage the knowledge and experience of our people, the best and the brightest, resulting in … Organic AND Strategic All of our components Continuous Informal to formal Learning Learning process / continuum of learning Organic growth only takes you so far, at some point, you must have strategic alignment and build in as a component of leadership behavior expectations in order to shift the culture and realize the value of these investments in KTL. Started with a seed Grew organically Strategic approach Purpose: Accelerate learning so that our employees can learn from both the successes and mistakes of others so that we do a better job of providing a better health care experience in a constantly changing environment. CHI has a program of tools and resources to accelerate this learning: Knowledge Communities – opportunity to dialogue with peers to learn directly from each other’s experiences and develop new ideas Practice in Action – details of proven practices captured so that others can adopt these programs and achieve the same outcomes Collaboration and Communication – tools that enable virtual collaboration so that learning can continue on a daily basis even when people can’t be in the same location Formal Education – insure that education and training help employees learn the skills and behaviors they need to move strategic priorities forward Formal Education Practice in Action

Conclusions for CHI Knowledge Leadership is at the core of CHI’s business strategy New Leadership competencies are based on collaboration & change Knowledge communities build a culture of sharing and innovation KT&L team has become core resource for national strategic initiatives Knowledge Transfer has become the way CHI works Web tools support connectivity and facilitate communicating about key knowledge resources and success stories New roles have evolved as collaboration has become embedded in the way CHI works Strategic initiatives rely on knowledge tools to speed adoption CHI Case Study Results: A total of 48 knowledge communities involve over 1600 associates across the system Knowledge communities have yielded both “hard” and “soft” dollar savings, impact patient outcomes through improved practices, increase reuse of proven practices After 5+ years, CHI leadership expect KT&L resources to be utilized as part of strategic priority projects and leaders will be held accountable to Knowledge Leadership competencies What is the compelling reason for embarking on this path in the first place… KC’s leverage organizational knowledge in a way unlike any other. KC’s – Write up some statements of benefit or value… Reduces duplication and improves the overall result b/c of the variety of input, Why does CHI Continue to invest in this?... (maybe put it on a new slide) CHI recognizes that it needs to have a core competency to build and supporting the infrastructure … Communication & Marketing – Sharing the impact, build peer pressure – Relay Report – describing the impact through narrative can be more meaningful than through statistics Stories: Successes from hospitals that have been written up as a best practice, stories of success within a KC – how it saved money, etc…, Stories about resources that hospitals might want to use related to a current strategy - Candace story re MTR – Registration Network / Certification - What Metrics are we using …

Communities Are Here! A 2001 best practice study (Using Communities of Practice to Drive Organizational Performance and Innovation) found: “…strong evidence that communities are the next step in the evolution of the modern, knowledge-based organization. Communities … are a legitimate way to spend time, engage an amazing percent of employees, are held accountable for producing and stewarding business-critical knowledge (and often results), and are assuming a formal voice in the organization, based on the power of their knowledge, not their position.” …Our challenge to you is to think about the context of your organization and what innovation really means, then build the infrastructure that will enable innovation to accelerate your organizational strategies and vision.

Knowledge Management Building Blocks in Healthcare
Peer Networking Performance Improvement Spread TECHNOLOGY Create MySpace for your employees, physicians, and customers Create public campaigns for targeted improvement goals Publish results on the hospital website – customize for each audience PEOPLE & PROCESS Create online people directories, create peer group moderator roles, highlight personal success stories Develop a dedicated PI staff – this may incorporate Six Sigma, IHI Collaboratives, etc – or may be internally developed Incorporate proven practice sharing into annual awards ceremonies, dept budget reviews, employee performance reviews STRATEGIC IMPACT Enhanced employee satisfaction and productivity, strong customer satisfaction scores Focused improvement in targeted areas, e.g., patient safety, financial performance, wait times, turnover, etc. Faster decisions, quicker adoption of proven practices, rapid innovation absorption

Key Topics Decision Support – analyzing data, often from different sources, to make better decisions Decision Support Systems (DSS) automate decision support Executive Information Systems (EIS) quickly assess performance and trends Clinical Decision Support Systems (CDSS) enhance patient care decision-making Knowledge Management (KM) incorporates evidence- and experience-based information

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