Knowledge Management to Systemic Wisdom Development

All three papers in this edition are authored by students of a course from the Auckland University School of Population Health in New Zealand.

New Zealand has one of the most technology enabled and integrated health sectors in the world.^[1,2]  This course aimed to further develop the capacity of the New Zealand academic, health care and health information technology (IT) sectors to collaboratively innovate and strategically apply electronic technologies to health knowledge management.

The course drew on the combined expertise of the students selected from a mixture of clinical, business and IT backgrounds and teaching staff from the Schools of Population Health, Business, and Computer Science, complemented by invited speakers from the health care sector, New Zealand Ministry of Health, academia and industry.

The major course requirement was that each student prepared a paper of publishable standard that conceptually or practically described an aspect of the application of electronic technologies to Health Knowledge Management.

An Ideal Health Knowledge Management System: Closing the C.A.R.E. G.A.P.S. F.I.R.S.T.

There may be a number of views of what an ideal health knowledge management system might look like or how it might be defined. However, such a system may have a number of core features or guiding principles that are independent of place, time or technology that can be captured in the mnemonic C.A.R.E. G.A.P.S. F.I.R.S.T. The system should seek to enhance all stakeholders’ capacity to C.A.R.E., that is to perform the integral Clinical, Administrative, Research and Educational functions of health care. The system should be Fast, Intuitive, Robust, Stable and Trustworthy. The system should integrate, enable and value all the key stakeholders not just General practitioners (primary health physicians), and Allied health care services (including hospitals), but the often forgotten Patients and their Supports that are central to the health of our communities.^{[ 2 ]}

The three papers in this edition seek to illustrate and attain some of these core features of a health knowledge system.

Bloomfield reports on the development of the "Current Consumer Viewer", a low-cost but high utility integrating tool for the multiple mental health teams across Auckland that facilitates the timely transfer of key "explicit" and "tacit" knowledge between relevant care providers. The paper reminds us that, in a crisis situation, simply being able to rapidly identify key contacts can be a critical factor in obtaining essential information and insights as to what interventions a consumer may best benefit from.

Hodgson describes a proposed project to utilise text messaging as a support tool in medication adherence and chronic disease management. She introduces the concept of how technology may be used to facilitate behavioural change and how patients may be increasingly integrated into and benefit from electronic health knowledge management systems.

Cook’s focus is on clinical algorithms and flow charts as representations of guideline knowledge. Cook highlights the potential benefit of algorithms to guideline development, implementation and, not least, end user utility. However, he argues that the current lack of shared language and understanding and subsequent "semantic soup" that surrounds some of the emerging concepts in the area poses a potential barrier to ongoing developments. Cook, by evaluating the purpose and quality of algorithms utilised in a sample of New Zealand clinical practice guidelines, seeks to stimulate a discussion of the key factors in the area and hence begin to bring some clarity to that "semantic soup".

When the course was initially envisaged, the aim of the publication was not to provide a "perfect", after the fact "offering", but for the students to present a picture of where their thinking had progressed to on a particular matter, and to provide an opportunity for others from the global community to network with them and shed or share some light. These papers illustrate just how developed these pictures are and the quality of some of the innovative thinking in the area.

Knowledge Management to Systemic Wisdom Development

Although this editorial introduces a focus on knowledge management, it will end with a discussion on the likely demise of the term.

The general area of knowledge management has been an evolving concept, not without controversy or criticism. It can be considered to be a set of tools or conceptual models to help us make sense of the world.

However, one of its major risks and failings is when attempts are made to blindly apply it as some form of linear simple technical solution in what is a non-linear complex ambiguous world. All human interaction and function typically occurs within a context and process. Knowledge management systems that focus solely on technical content management, or collecting and storing data, or controlling users in some externally perceived conceptually improved way without any reference to the context and process issues of the users, are likely to be characterised by increasing futility and decreasing utility.

Clinicians and their communities relate within a system characterised by complexity, variability, ambiguity and emergence and require electronic systems that increase their capacity to C.A.R.E by recognising and embracing these realities.

The implementation of a "Health Knowledge Management System" requires not just a selection of technology but context and needs analysis and potential changes in underlying processes. Central is trust and the development of a culture that respects values and protects the acquisition, sharing, creation and utilisation of available knowledge in order to achieve better health outcomes for our communities. The broader knowledge management literature recognises the importance of these factors.^{[3-5 ]}

However, there is a likelihood that the term may be eventually killed off by its association with technical content management or the idea that knowledge management simply involves telling people to store data in databases without consideration of the associated process or dynamic issues.

As time has progressed we have had data managers, information managers, knowledge managers and undoubtedly, just on the horizon, wisdom managers. Professional practitioners of each era to date including the data mangers would likely tell us that their role involved an understanding of people, context and processes, not just data collection. However, we have repeatedly found the need to move our terminology and "management" focus up the "hierarchy of making sense" of our world from data to information to knowledge to next wisdom to repeatedly recapture that focus on people context and process.

Wisdom involves the application of knowledge with common sense and insight. There is often an inference that this common sense and insight is derived from personal innate attributes and/or experiential learning and that it is closer to the art than science of a practice. Wisdom recognises context, ambiguity and emergence, human emotions, relationships and processes. Certain aspects of wisdom are undoubtedly able to be electronically mapped and reproduced. However, if we immediately focus on how we can codify wisdom, break it down to its essential elements and store it in a database, then we run the risk of making the same mistakes as our predecessors. If we instead focus on how we can collectively utilise the common sense and experience of our systems and move from a focus on data collection to people connecting within a context, then our electronic technology may contribute further to systemic wisdom development. Although one can be cynical about the changing terms and focus from data to information to knowledge to wisdom, systemically developing the capacity for wisdom is probably what our aim always was and should be.

References

1. Protti D. Local clinician involvement in clinical information systems: luxury or necessity? A review of two international experiences. Br J Healthcare Comput Info Manage 2003; 20(10): 28–30.

2. Orr M. Evolution of New Zealand’s health knowledge management system. Br J of Healthcare ComputInfo Manage 2004; 21(10): 28-30.

3. Standards Australia. Knowledge Management: A Framework for Succeeding in the Knowledge Era. HB275. 2001.

4. Sveiby K-E. Knowledge Management – Lessons from the Pioneers. 2001. Available at: http://www.sveiby.com/KM-lessons.doc.

5. Wyatt, J., (2001). Top Tips on Knowledge Management. Clinical Governance Bulletin 2001; 2(3).