Knowledge Management in the NHS: half‐full or half‐empty?
| DOI | https://doi.org/10.1108/eb040771 |
| Date | 01 April 2000 |
| Published date | 01 April 2000 |
| Pages | 19-23 |
| Author | Andrew Booth |
| Subject Matter | Information & knowledge management |
Knowledge
Management
in the
NHS:
half-full
or
half-empty?
by Andrew Booth, Director
of
Information Resources
and
Senior
Lecturer
in
Evidence Based Healthcare
Information, School
of
Health
and
Related Research (ScHARR), University
of Sheffield
Healthcare
is a
knowledge industry
evidenced
by
substantial resources invested in
staff development
and
the production
of
research evidence. This article examines
knowledge management within the
NHS in
terms
of
explicit knowledge
and
tacit
knowledge.
It
concludes that whilst progress
with explicit knowledge
is
significant
management
of
tacit knowledge
is far
less
developed.
Healthcare
- a
knowledge
industry
"An organisation's ability
to
function
and
prosper
depends,
in
large part,
on the
knowledge
and
skills
of
its
people
and on the
knowledge base that
it
collectively develops
and
deploys"1. If this
is
true,
to differing extents,
of
all
organisations, then this
is particularly
the
case
for
those involved
in the
planning
and
delivery
of
healthcare.
Healthcare
is
a knowledge industry with
its
greatest asset being
the collective experience
and
expertise
of
its
staff.
Every year millions of pounds
are
invested
in the
continuing education
and
training of NHS doctors,
nurses, allied professions
and
management
staff.
Research
and
Development Programmes
in the
four Health Departments spend large sums
on the
generation of new knowledge
and the
synthesis
of
previous research. Clearinghouses, such
as the UK
Cochrane Centre
and
the NHS Centre
for
Reviews
and Dissemination, together with outputs from
the
NHS Health Technology Assessment Programme
bear testimony
to the
volume
of
activity.
Yet concerns still remain.
At an
individual level
"a
patient
has no
assurance that
his or her
doctor
is
able
to
take into account
all
relevant scientific
knowledge
and
integrate
it
with detailed data about
the patient's
own
condition"2. Hibble
and
col-
leagues3 asked 22 urban
and
rural general
practices
to
produce copies
of "any
written mate-
rial used
by a
doctor
or
nurse
in
primary care to
assist decision making
in
relation
to
health care,
excluding medical textbooks
and
electronic
databases". They found
855
different guidelines
-
a pile
68
centimetres high weighing
28
kilograms!
Writing
in an
accompanying editorial
in the
British
Medical Journal, Muir Gray, Director of the
National Electronic Library
for
Health, epitomised
the Knowledge Management dilemma, thus:
"Firstly,
the
probability that
a
disseminated
document will arrive
on
someone's desk
the
moment
it is
needed
is
infinitesimally small.
Secondly,
the
probability that
the
same
document will
be
found three months later,
when it
is
needed,
is
even smaller.
Too
much
knowledge whizzes past
the
clinician
to
become
but a
memory: "Now
I
think
I did
see something about...."
"4.
Booth
has
described5 some of these knowledge-
deficiency symptoms
as
"information pathologies".
Examples
of
these include "information thrombo-
sis"
where
the
free-flow
of
information
is
clogged
up
by
some impediment
and
"information haemor-
rhage" where
the
sheer volume
of
information
makes
it
impossible
for a
clinician
to
isolate that
part
of
it that
is
potentially useful.
A
further
example
is
"information anaemia" where, notwith-
standing free information flows, clinically useful
information
is
scarce
and of
poor quality. This
analogy extends
to
potential solutions
-
"filtering
of information" where
the
useful
is
extracted from
the useless
and
thereby given greater prominence
and utility
and
"fortifying
of
information" where
added value
is
provided through synthesis
or
evaluation.
At
an
organisational level, high-profile cases such
as
the
Bristol paediatric heart surgery inquiry
and
the Harold Shipman murder trial illustrate
a
knowledge deficit
as to
whether staff involved
in
the delivery
of
clinical care
are
treating patients
negligently
or
even, illegally. Typically
in
such
cases,
as
with recent outcries against
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