Thursday, May 21, 2015

What are the top three skills needed to drive knowledge sharing in healthcare today?

Always interesting to hear from colleagues on these types of questions. Is knowledge management in healthcare "old news" for hospitals? I heard that indirectly from a librarian at a recent conference. Maybe -- but I guess it depends on how you define KM. If we look at knowledge as what the "knower knows" (Prusak and Davenport, 1999) and place its management in the sphere of safety science, high reliability and systems thinking -- I am not so convinced it is old news. Either way, what would you say are the primary skills to help make knowledge (not evidence, not info, not data) more usable, accessible and reliable as a resource to support high quality safe patient care?

Friday, March 13, 2015

Evidence seeking and checklists: does it make sense?

Atul Gawande's The Checklist Manefesto placed the use of checklists as failure prevention mechanisms in the laps of health care professionals and management worldwide, Since the book came out in 2009, checklists have now been planted in the minds of many in healthcare as tools to improve patient safety that typically wouldn't have considered them. 

Take librarians, for example. "My work is too messy", they say, "to use a checklist."

I would submit that most of the functions that librarians deliver in the course of their work in hospitals are NOT complex -- but the world they function in is. (I would love to have that discussion with my peers in this forum -- if they are game. But I digress ... ). This isn't and shouldn't be taken as a insult--and I apologize up front if its received in that light. The notion of when a tool like a checklist is needed and **should** be used is an important question--and determining the type of process its being applied to is important. It certainly isn't useful to pile more paperwork and process into the daily work of anyone - especially if it doesn't really improve anything--or to do so for a process that is complex vs complicated. or even simple, for that matter.

For sake of discussion, I do think there may be applicability of a checklist in some areas of the clinical librarian / Informationist domain, such as in the reference review process. For instance, gaps that happen due to communication failures, cognitive biases and production pressures should cause us to think about ways to make the reference interview process more reliable via structured communication tools and/or a checklist. Especially in an emergent situation.

I do also wonder if the checklist idea would be useful in an organizational.system sense. Let's face it: librarians aren't the only ones doing lit reviews in hospitals and, as demonstrated by the gaps in the lit review process at Hopkins that contributed to the research volunteer death some years back that are discussed here, we know it can result in failure if not completed effectively. Perhaps a tool that would enable more reliable searching no matter **who** does the work, would have multidisciplinary impact.

One example of a review tool that may serve as the model for a checklist to help examine the robustness and reliability of the search activities at the sharp end is the CADTH Peer Review Checklist for Search Strategies.

I would say IRB activity, systematic review support and similar "project and task flow" examples of evidence and information seeking may be "complicated" (ie "building the space shuttle") rather than "complex" (ie performing surgery, raising children) If we consider complexity theory in all of this, the CADTH tool (complicated task review) would probably benefit from the application of "local context" to help us all understand how to apply it in real time to shore up the effectiveness of search that frontline info seekers--librarians or others--undertake to inform info seeking actions that take place in a more complex context--in the midst of clinical decision making. 

Its important for librarians, and the clinicians that require the best evidence/information to do their work in complex situations, to explore how such a checklist could be enabled to affect patient safety in this intersection of professions. Can we draw from existing safety tools and processes in other high-risk domains such as aviation and nuclear power plants-- to help enlighten a discussion around how the information/evidence identification, acquisition and dissemination process in hospitals can be made more "highly reliable" through the use of checklists?

Wednesday, February 18, 2015

The value of sharing stories ... a request to hear some!

What Flavor Lifesaver are you?
Barb Jones
(used with permission: )

As a health sciences librarian, your work buoys the diagnosis and treatment of many people in many different ways. What activities do you do that contribute to the safety of the patients treated in your hospital? Which of the following lifesavers apply to you?

Orange – You are on the team that develops protocols for the various units in your hospital.

Lime – You have worked with your nursing staff and your hospital has achieved Magnet status.

Pineapple – You often work with the Quality Improvement team.

Cherry – You attend the M & M meetings.

Grape – You are a clinical librarian.

There are several other lifesaver flavors, and many other library-related activities that contribute to the safety of hospital patients. Can you think of others that you are involved with? What flavor are YOU?

Share your contributions with your colleagues! Contact Barb Jones (jonesbarb or @BarbJones17) to tell your story. Or comment right here on this blog!

Friday, July 25, 2014

Searching for stuff: patient safety, DXerror and RCA info. Places to start

I had a colleague ask recently about finding information on root cause analysis in general and in getting started on diving into the diagnostic error evidence base. I recognize that this response is pretty quick and dirty and what I typically don't include on this blog -- but she liked it, so I thought others might as well.

I wrote ... This safety stuff is very messy to look for—as the language used to study, discuss and (ultimately) search for it varies due to the range of industries that touch it, where the materials reside and that the science of safety is evolving pretty rapidly.

As with any patient safety topic—I always suggest that folks start with AHRQ’s Patient Safety Network: Not because I help develop it – but it is a good entry way into primary safety topics,  the medical literature (to look for MESH subject headings) and non-pubmed indexed materials.

Check out the primers on both DxError, RCA and failure analysis – all three touch on your question:

Another tidbit if you REALLY want to have a more complete search strategy approach to a patient safety topic -- is to again draw from AHRQ. The released a comprehensive review of patient safety strategies last year:

There is one on DxError:
And what is REALLY helpful (again, if you are aiming to be comprehensive) the authors share the search strategies used to support the reviews in each chapter. See c78 to c80 for the search strategy for the DxError chapter.

The other thing about DxError is how you client defines it. Delay, over- and under-diagnosis, decision making, cognition, biases (availability and otherwise) etc all could play into a search—depending on what the person is really looking for.

Lastly -- here is an article --  (wish it was free: the first author happens to be a contributor to my new Patient Safety book: )-- that also provides some thinking about search in patient safety:

Now – this may be more than you want or need – but what I think is useful is the strategies not only give someone like you (and other librarians) a robust place to start, but it illustrates the complexity of searching for materials in the world of patient safety!

Hope it helps.

Thursday, May 22, 2014

Middle managers as boundary spanners: a UK study of interest

I have long believed that middle managers serve as boundary spanners (or knowledge conduits) – helping to connect the dots between departments, teams and organizations. I am curious to hear how the results of this new study from the UK might inform how organizations could work with middle management --or structure their role -- to improve the reliability of this knowledge sharing role to support high quality, safe care.

Ward V, West R, Smith S, McDermott S, Keen J, Pawson R, et al.
The role of informal networks in creating knowledge among health-care managers: a prospective case study. Health Serv Deliv Res 2014;2(12).
Information and free full text

A quick thought after a first glance at the publication:

This report highlights the importance of the water cooler “method” of sharing knowledge. In the work reflected in my recent book there has been concern voiced by front line care providers that there is little time to just talk to one another and that this could be detrimental to the safety and quality of care provided. I suspect that a lack of time on the administrative or “blunt” end for informal conversation (ideally face-to-face) could be detrimental as well.

Will the findings inform a different EI&K service delivery model? And also how librarians—who may serve as middle management—see their roles differently as both boundary spanners and information, evidence and knowledge service providers?

I look forward to diving into the report more deeply to identify other items of interest. In the meantime, sharing your thoughts here would be welcome.

Monday, May 05, 2014

Dialogue: a tool to facilitate the exchange of knowledge

Today’s environment for sharing information, evidence and knowledge is complicated--perhaps even complex. (A whole other topic all together ... for another time!) A variety of tools, styles, formats and time elements affect our ability to communicate clearly and efficiently. With the plethora of models that can be customized for specific needs, styles and wants, one would think communication would be more often successful – but its often not.

One method relied upon to share information and knowledge (depending on how you define knowledge) is the written text – in whatever format it is delivered. I had a colleague once suggest to me that librarians needed to embrace "dialogue" as a tool to share knowledge rather than the provision of articles and other stagnate information and evidence artifacts.

This is an intriguing idea. It certainly builds on the KM concepts outlined by Nancy Dixon in her 2000 book Common Knowledge (ISBN: 0875849040). In that classic text she promotes team discussion and feedback as mechanisms for knowledge transfer  -- which highlighting that a structured process is what helps make it successful. So shouldn't others consider it too?

This idea of transferring knowledge in small groups rings true in patient safety circles as well with the emphasis and interest in debriefs, patient and family-centered rounds, daily huddles, walkarounds and regular team/unit meetings serving as knowledge transfer opportunities in the acute care environment. These communication mechanisms allow for knowledge and information to be shared as needed -- in a context that allows real-time impact of the knowledge and information shared to be acknowledged through action.

In response to my colleague, then, can and should information professionals facilitate and contribute to the use of dialogue as a knowledge sharing activity? Should management and clinician leaders enable that engagement? If so, what is the best marriage of the librarians skill set with the function of dialogue? I recognize that at the sharp end it may be more difficult, but the closer librarians are to the clinical team the more likely it is to happen. Certainly participating in front line information exchange activities from time to time will help inform any dialogue that might result in trying to invigorate evidence, information and knowledge (EIK) services that seek to contribute to improving the reliability of care processes. Also participating in committees, not only from a service perspective but as an EIK strategist will strengthen partnerships and boundary spanning opportunities.

Lastly -- dialogue is a key systems thinking tool. If info pros are to be realized as systems thinkers, shouldn't they be adept and comfortable demonstrating AND explaining the art of dialogue as a tool in THEIR information and knowledge sharing arsenal? I think so.

Monday, December 16, 2013

Listservs: knowledge or info sharing? Effective use helps with both - a holiday jingle

I recently began moderating a new email discussion list. Now -- one  may say they are "old school" but for some communities they still serve a very useful function -- if used appropriately ;-).

In the spirit of the holiday season, the following reminders fell into order to align with the familiar cadence of a traditional Christmas tune. You know how to fill in the blanks. Enjoy! And if you have a group that is in need of gentle reminders .... Feel free to redistribute (attribution is appreciated).

12 ways of listserv etiquette (sung to the tune of the 12 days of Christmas)
© Lorri Zipperer 2013
(thanks to Ruth Ryan and Susan Carr for their editorial comments)

My first day on the listserv, the moderator said to me…
A proof-read reply is preferred

My second day on the listserv, the moderator said to me…
Please sign your name ... 

My third day on the listserv, the moderator said to me…
No “me too’s” ... 

My fourth day on the listserv, the moderator said to me…
This isn’t Twitter! ... 

My fifth day on the listserv, the moderator said to me…
Remove banners from other posts! ... 

My sixth day on the listserv, the moderator said to me…
No published attachments ... 

My seventh day on the listserv, my moderator said to me:
Search archives for answers ... 

My eighth day on the listserv, my moderator said to me:
Change “subject” as needed ... 

My ninth day on the listserv, my moderator said to me:
Always be polite ... 

My tenth day on the listserv, my moderator said to me:
Address as appropriate ... 

My eleventh day on the listserv, my moderator said to me:
Curtail repetition ... 

My twelfth day on the listserv, my moderator said to me:

Talk off-line and recap ... Curtail repetition ... Address as appropriate ... Always be polite ... Change “subject” as needed ...Search archives for answers ... No published attachments ... Remove banners from other posts! ... This isn’t Twitter! ... No “me too’s” ... Please sign your name ... A proof-read reply is preferred.

Happy Holidays!