AFA FIAB MIHM MAMS FinstCPD
Independent Healthcare Consultant
Director of Primary Care
National Services for Health Improvement
Steve is a former Royal Navy Officer, and joined the health service as a chief management accountant in 1984. He has worked at all levels of the NHS. He was an associate tutor at the Institute for Health Policy Studies at the University of Southampton and has worked for the professional development committee of the Institute of Healthcare Management
“I have so much I need to know, so understanding knowledge management means my life flows more smoothly and my practice benefits.”
What is “knowledge management”? A phrase that was coined many years ago, it has found its way into the NHS vocabulary. A collection of data is not information. Information does not mean you have knowledge. Having knowledge does not make you wise. Knowledge management has many definitions, reflected in the following quote:
“Knowledge management is a conscious strategy for moving the right knowledge to the right people at the right time to assist sharing and enabling the information to be translated into action to improve the organisational performance.”(1)
Being a practice manager in a modern general practice requires a vast amount of knowledge. You only need look at the competency framework to see the extent of knowledge expected and the level of competency in each area. While the primary care trust (PCT) has entire departments dedicated to areas such as human resources and finance, in general practice you are expected to have a good working knowledge of all these areas and more.
How times change. I recall working to transform a Family Practitioner Committee into a Family Services Health Authority. At that time, I was responsible for finance, patient registrations, premises, IT and prescribing, and having knowledge of the statement of fees and allowances. How many people now provide these roles in a PCT?
Keeping up-to-date about key issues is important, and having access to up-to-date information is also critical. In general practice, you not only have to understand local contractual issues, but you must also ensure you comply with legislation applicable at that time.
To achieve the best balance of what information to retain and what information to have available for future reference can be difficult. There is a danger that you will end up with reams and reams of paper, which have not been properly updated, and which will, over time, fail to deliver what they were set up to do in the first place. This defeats the idea of becoming a paper-lite practice.
One way of managing information effectively is by using the internet. In many cases, information will have already been sorted or highlighted for you. You can then prioritise this information and choose how you are going to use it.
One very simple way of managing information on the internet and ensuring that you exercise the best in knowledge management is to summarise the key information you require. Having done this, the information should be broken down into three categories:
Using the above examples, one could take the area of health and safety. First, general information and current legislation about health and safety can be found at the Health and Safety Executive’s website (see Box 1). Second, by utilising the Department of Health website, guidance can be obtained regarding health and safety generally within the NHS. Last, you can combine the information available from both of the above to generate and maintain a practice-based procedure that can be used in the practice on a daily basis and form part of the practice procedures and staff handbook. However, you must ensure that this does not reach the point where you end up with a collection of data. Too often, information is not updated and, as such, invalidates the whole process, which would need to be repeated.
Maintaining key information
The above principle can be applied to almost every competency area and contractual obligation of the practice. This will allow the practice to create a reference manual of key data that will show the practice is maintaining good and current levels of knowledge. This process can be automated by using either your PC or a website.
This principle is not new to the NHS, though it has been partly necessitated due to the constant introduction of new guidance and legislation. In the NHS, most formal guidance is first issued as a news item, which succinctly summarises the proposed change. Then a formal directive letter or circular will be issued, which will have specific implementation instructions. In some cases, where legislation needs to be introduced, statutory instruments will also be published that may then get summarised into a letter or circular.
The NHS has its own library resource, now known as NHS Evidence (see Resources). This adopts the principles of knowledge management and conveniently sorts data into relevant specialist libraries. Users are free to adapt this information into their own personalised collections.
Knowledge management is about using and interpreting information for your own practice purposes, not for someone else. Ultimately, you are using this information to make sure your practice fulfills its contractual obligations, therefore it must be appropriate to your organisation.
That is not to say there may not be procedures that can be adapted for use from one practice to another. However, some procedures are unique to your practice, which only you can be responsible for publishing.
When Agenda for Change was introduced into the NHS, it was to be supported by the NHS Knowledge and Skills Framework. This framework is a good illustration of how knowledge management principles can work. It was designed to be easy to use and understand, and was therefore capable of being properly implemented. Too many ideas become overcomplicated, and as such end up being discontinued.(2)
In order to be an effective manager, it is necessary to know that the above principles have been applied to your own position. If you can recognise the different parts in relation to your own role, you will find it considerably easier to assess the other members of staff and set realistic objectives that will benefit the overall efficiency of the practice.
Knowledge management is not just about using information from other sources; it is also about extending this knowledge into the practice environment. The result is that the practice will have its own intellectual property, which may be retained by an individual member of staff.
It is vital that this information is retained by the practice, and roles should therefore be developed for the practice, not the person. If a member of staff were to leave, you would be recruiting for a replacement for the position, which will have a full job description and person profile. You would not be recruiting to replace a person. Different people will have different characteristics but the position will be fundamentally the same, whoever is appointed. Too often, failure to manage information correctly leads to situations where people are appointed into general practice with no clear definition of role or responsibility.
Management of the intellectual capital of the organisation has become increasingly important in the knowledge-based society. Both commercial and public organisations recognise the significance of being effective learning organisations. There is a growing need therefore for individuals with appropriate training and experience in knowledge management.
General practice is no different. With the introduction of registration with the Care Quality Commission and increased competition between practices, it is vital that you ensure your practice stays ahead of the game.
The practice manager working at a strategic level must be able to understand the importance of knowledge management in an NHS that is now so knowledge-based in its approach. General practices are almost independent centres of learning, and this needs to be harnessed by the practice so that skills and key information are not lost.
To achieve this, the manager must be able to demonstrate a good working knowledge of how the use of the internet can assist his or her duties. A practice policy should be developed and key information utilised at the outset. This policy should be kept simple at the beginning and developed overtime.
Effective use of this resource could be invaluable to the already busy practice environment. Not only will it create efficiencies for the practice, but it can also contribute to a better working environment for staff, which in turn could lead to even greater potential for the practice.
Another option is that you can purchase bespoke software solutions for various aspects of the practice, which means that someone else is ensuring updated information is available to you when you need it.
Whichever route you decide to follow, remember you will not be wise by having knowledge and you will not have knowledge if you just collect information. You can apply yourself and turn what is available to you into a productive resource for yourself and your practice.
1. O’Dell C, Grayson CJ. If We Only Knew What We Know: Identification and Transfer of Internal Best Practices. Houston: American Productivity and Quality Center; 1997.
2. Department of Health. The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process. London: DH; 2004. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
NHS Evidence – Knowledge Management
NHS Evidence – Health Management