Category Archives: Business Culture & Process Issues (Operational)

why should Sudan’s health industry embrace Knowledge Management?

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A few month’s back during a Skype call with Dr Gada Kadoda a Professor at University of Khartoum she told me: ‘at last year’s KMCA Sudan many of the health industry delegates who attended expressed an interest in understanding what knowledge management might do for them. How might we do that?’.

Gada is one of those special people who when they pose a question you feel compelled to answer it. Which is why in a week’s time I am going to be back in Khartoum to participate in a two day Workshop on Knowledge Management for Health Care in Sudan.

Knowledge management in health is not new. The NHS Modernisation Agency was one of the early adopters and used a lot of Chris Collison’s thinking from Learning to Fly to build a pretty effective knowledge management operation with one of the first Chief Knowledge Officers in charge of it. Sudan’s health industry does not (yet) practice km in any formal manner so as part of the research for my presentation and the sessions I am facilitating I asked some of the actors in the NHS km story to reflect on more than a decade.  Here’s what they said (names omitted):

I have said on several occasions that when you multiply the number of employees by the years of professional learning,  the NHS is the world’s most knowledgeable organisation.  Or it should be.  With better networking, more curiosity, joined-up systems, a culture of improvement and leaders who value national above parochial, it would live up to its potential.

What I have seen is wonderful pockets of excellence – hospitals with a determination to improve, a passion for learning, and a curiosity which can even transfer lessons learned from Formula One pit teams to the operating theatres of children’s hospitals.  Pockets of excellence indeed, but in threadbare trousers.

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The idea of KM in that particular agency of the Department of Health was to ensure that the knowledge produced by one team (silo) would reach other teams (silos), that the whole organisation had a sense of who knew what, and that we could reuse knowledge across the Service.

We had a team of people and a CKO…a CoP with members from all different teams in the organisation; knowledge audit and SNA that involved quite a few people across the org and which changed the way they perceived the work of the KM team. Yet …our work became too focused on documents and content creation disguised as gathering of lessons learned.

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In my regular interactions with physicians in the NHS, a key frustration has always been the flow of information between doctors and commissioners. Differing agendas, treating patients vs cost-effectiveness, cause breakdown in communication. The problem usually arises from the discrepancies between the notion of an ideal patient and the realities of people walking into the clinic. Pharma is not particularly helpful in addressing this through the research conducted, however the shift in emphasis to real world data by health technology bodies such as NICE is creating a cultural shift in the sector.

A great story of information exchange relates to a melanoma patient who was being treated in London. The patient was a successful business man so he continued with his work. He was treated with a very new drug and experienced severe side effects while on a business trip in Switzerland ending up at a hospital there. Mismanagement of this drug’s side-effects can result in death. The Swiss physicians had never used the drug before, and most were not even aware of its existence as it is a specialist therapy. However, there was extensive global information exchange driven by the company, which meant that as soon as they saw the patient card which all patients on the drug were advised to keep on their person, the Swiss physicians were able to access a database of information and a 24 hour network of world experts in the condition. Luckily for the patient the KM network worked thereby saving his life.

The shift towards greater use of data and increased use of technology (from other industries) is where I hope much of the Khartoum health discussion goes. One of the leaders in Health Information Systems shared this quote:

‘In the next ten years, medicine will be more affected by data science than biology.’

Mobile & Internet penetration in Africa

Mobile & Internet penetration in Africa

Today’s Economist article on the use of mobile technology in Africa is a timely reminder of the strides being made on that continent and how widespread adoption will present huge opportunities as well as challenges for the health industry there.

I am also  going to share this clip from Grey’s Anatomy (US TV drama) about the use of Twitter in an operating theatre. Though fictitious it gives as good an illustration as any I’ve seen about the potential benefits of using mobile technology to share knowledge and mobilise a global community in the same was as the story of the melanoma patient above does.

As the F1 season is nearly upon us I was really struck by this clip from the BBC which shows how the Maclaren F1 Team’s driver and car monitoring system is being adapted/used in a children’s hospital in Birmingham.

And yet for the Sudan health system to adopt some of these technologies (against a backdrop of isolation) there has to be a huge mindshift. I recall with chilling clarity a phrase uttered by a health professional at KMCA Khartoum last year in response to a question I posed as to the barriers to the sharing of knowledge: ‘my information is my soul’.

In an environment where:

  • sharing of information (let alone knowledge) can have serious consequences
  • admitting a lack of current knowledge can cause a loss of face and prestige
  • continuing medical education is not a core requirement for the right to practice
  • the major drug companies have no presence and sell via distribution channels
  • the physician is beyond reproach

we have our work cut out if we are to get positive outcomes from the event.  Its an exciting prospect.

 

knowledge management is dead but it won’t lie down: a 10 year review of a KIM initiative

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In the past few months I’ve heard talk of a resurgence in knowledge management.  km conferences are once again burgeoning; the UK’s Civil Service now has knowledge & information management as one of 22 recognised professions; last week while in Portugal I learned that the legal industry is now km aware; and many of my peers in the industry are finding themselves busier than ever providing advice to help organisations set up km initiatives across the globe.

One downside of providing external advice and assistance to organisations is that you are not always around to see the outcomes of your work especially when its  knowledge and information management related.  Occasionally you get the chance to get back under the covers and see how clients have implemented km style tools and techniques.

back under the covers

Such an opportunity took place at the end of December when I went back to the 7th largest global reinsurance broker (BMS) to see Phil Hill the Chief Information Officer I first worked alongside in 2001.

Reinsurance brokers are arbitrageurs: they place risk on behalf of large global organisations. They use knowledge of a client’s specific needs and apply that to find the best market to take the risk. They must know about clients and markets and manage relationships in both.

At the turn of the Millennium BMS was a top ten broker with aspirations to grow internationally and make better use of the combined knowledge of its dozen or so operating entities. It was dipping its toe into the document, records and information management waters and attempting to provide a technological backbone to support a growing demand for relevant and timely information. It had a very embryonic intranet.

Today BMS has broadened its business focus; it has expanded beyond reinsurance into underwriting working with a number of trusted partners. And it has focused much of its activity on building US based business development and transactional processing capability.  Seamless connectivity and access to internal and external information on clients, markets and BMS’ own resources are support prerequisites.

So how has it managed this transition and what are the significant milestones in its journey that has seen it become one of the most admired and technologically advanced practitioners in the market? One that is:

  • at the forefront of electronic placement; is regularly up for awards for innovation;
  • whose CIO Phil is a frequent and sought after speaker and panellist on industry platforms?

BMS is now an institution where joiners get a preloaded iPad with 24×7 access to the latest global and internal information as well as the ‘big data’ (catastrophe modelling in BMS’ case) that has become must have software in the insurance/reinsurance industry.

a decade reviewed

In the 2001 knowledge and information audit I conducted I noted that:

  • More than 60% of all items saved on the common H drive had been put in the ‘miscellaneous’ folder; there was no common terminology about how documents were to be named or catalogued; and no central place to find information on markets and clients.
  • As was common around that time there was limited collaboration between the various businesses and as a result potential for pursuing the same clients.
  • New joiners relied on traditional role shadowing and a tour of the building (s) to get up to speed.
  • BMS was spread out across a couple of locations and on different floors in a building at Aldgate which discouraged informal interactions.
  • Recognition of the concept of critical knowledge assets was a long way off and the words knowledge management dismissed as being jargon.  Busy people at the business end had no real interest in filing documents let alone thinking about how they might be reused; even in 2001 everyone expected the system to do it for them and the idea of ‘drag and drop’ from one platform to another was still in its infancy.

The shocking events of 9/11 in the US provided the ‘burning platform’ moment for a change in attitudes. Everyone wanted up to date consolidated news and opinion. The Intranet, website and content management system were approved as a combined project and with my assistance the newly formed Marketing & Communications (Marcoms) Team set about creating BMS Today and building up a cadre of volunteers willing to help identify the critical knowledge and information that should be captured and stored.

A definition or aim for the system emerged:

adopting a publish once use many basis provide a one screen view of activity with clients and the markets in which they operate and a central hub for knowledge and information on the organisation and its operations.

Here’s what BMS Today eventually became:

Intranet Home Page

Corporate Calendar

Though at the cutting edge of intranets BMS Today was not enough. The Marcoms team needed to go further to encourage knowledge sharing so concurrent with a relocation to One America Sq they began a series of Learn@Lunch and Breakfast Briefings aimed at showcasing different aspects of the business.

Still collaboration was a distant objective though the move to One America Square in 2008 did throw up an interesting opportunity to introduce social media.  One of the team (who been enrolled on a journalist programme) was deployed among the builders and fitters on site to provide a regular ‘blog from the battlements’.  Widely read at the time it provided an insight into life at the soon to be occupied premises and a metaphorical bridge to help people acclimate to the new surroundings.

One America Square enabled BMS to plan collaborative physical spaces in which to hold breakfast briefings and learn@lunch sessions. There was a lot of discussion about the efficacy of such a space.  ‘Connexions’ as it became known was a hub for meetings and with a business lounge in close proximity it enabled serendipitous meetings at the coffee machine (and water cooler) to continue in a relaxed but more formal setting.Connexions 600x400

And of course the best coffee, subsidized snacks and rapid internet access were made available to encourage traffic to the site and make external visitors feel welcome.

changing focus & new technologies

A change of focus combined with the arrival of disruptive technology proved a challenge and an opportunity. The broking teams needed improved access to information on the move and an easy way to demonstrate the modelling systems that enable risk to be better evaluated. But technology costs and the benefits of investment are not always easy to quantify. So CIO Phil (aided and abetted by Philip Gibson of Sparknow) used a traditional storytelling technique and the idea of developing a set of personae as a way of illustrating what BMS’ world might look like in a few years time if some technological improvements were introduced. Here’s an extract from one of the scenarios:

Jade Thompson is 35 and has worked in the London Market for 14 years. She has agreed to join BMS as a senior underwriter, moving on from one of the big managing agents. She wants to work for a company that really supports her initiative and drive – not one that swaddles her in red tape.

The week before Jade joins, she receives at home via courier a package from BMS.

Inside she finds an iPad, with a BMS logo with the slogan: “Using clever technology”. There’s also an iPhone, also with a BMS logo and her name.

She reads the attached note, welcoming her to BMS and giving her the logon and password information she needs to use the equipment. “Wow!” she says to herself, “this is great – they really know how to make you feel special.” Jade switches on the iPad and logs on as instructed. There‘s an icon on the first screen, “Welcome”. Touching the icon starts a video of the CEO welcoming her to the company. Various members of the board and HR provide insights into BMS and what she might expect in her first few days.

There is also a pointer to other information on the iPad, such as all aspects of the induction procedure including health and safety. Thrilling, she thinks to herself…

This scenario has come to fruition thanks to the investment in technology (in this case iPads) made by the BMS board which has continued to support further development on BMS Today and a decade on, this is where many of the ideas and initiatives outlined above merge.

BMS Box Office Soon all 9 BMS offices will be able to log into the new intranet irrespective of domicile. It will meet the original aim of providing a one screen view of all activity with a client as well as providing real time access to the latest social media applications and real time information.

Submission to the corporate document storage system is a simple drag and drop process that recognises and acknowledges peoples preference for an Outlook Mail style filing BMS Searchstructure. ‘Stuff’ can be easily located via a search engine that accesses all operating systems via iPads which permit electronic placement.

 

takeaways

The team and I drew on techniques found in business development, communications, marketing, information and project management, engagement, facilitation as well as knowledge management to provide an infrastructure and ways of working that formed a backdrop to the continued expansion and development of the business.

Many who work in the knowledge & information arena would recognise most of the above activities, its what they do on a regular basis.  Yet at no point during the years I worked alongside the team at BMS was km used as a phrase or established as a discipline.

That a decade on BMS is thriving is an illustration that km by any name takes time but has value.

And finally by way of acknowledgement I should mention the names of those people with whom I worked most closely during my time as Advisor.  They were from BMS: Phil Hill, CIO; Roger Cooper, COO; Jeff Martin, Director; Anne-Marie Hawtin, Manager; and John Spencer Former CEO. From Intranet Focus: Martin White, CEO.

“four legs bad two legs better”: when people leave they take their knowledge with them…

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One of the big topics that comes up time and again in conversations with businesses is how to handle the loss of knowledge when people leave or get relocated. I took these notes during an interview a couple of months back with a former CEO about how he felt having exited the business after 8 years at the helm:

Too often an outgoing official feels let down by the process: using an analogy from Animal Farm, he described the environment in the aftermath of his departure as being ‘four legs bad two legs better’. The new team had little interest in understanding how decisions had been reached and maintaining the networks he considered it vital to maintain.

I remember reading Animal Farm a couple of times: the pigs take control and the mantra changes from ‘four legs good, two legs bad’ to ‘four legs good, two legs better’ as they adopt the practices of the old regime they’d previously rubbished.  It was a vivid illustration of how damaging a process leaving a business can be.

It’s not just about suddenly making provision to capture knowledge for people about to leave. Effective knowledge retention starts when a new member of staff joins: they bring fresh ideas and in many cases experiences that can be valuable additions to an organization’s corporate memory. It continues throughout their tenure (when they are involved in projects, have to make decisions, handle difficult situations, engage with stakeholders, develop policy, etc) and beyond – when they leave to become part of the alumni network.

As part of my ongoing association with Sparknow we are going to be running a knowledge retention masterclass in Singapore. To find out more about that and look at the latest blog on this subject posted today on Sparknow’s site please go to ‘knowledge retention in Asia’

It promises to be an exciting few months.

3 great toolkits and a facilitation tip for Knowledge & Information Management professionals

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Toolkits are much in vogue. Three I’d recommend are:

While knowledge managers are not short of reference points or advice on how to go about things there is no one size fits all template to describe the role, where it sits and the skills to discharge it.

Yet so many km professionals in emerging markets are thirsting for the certification that goes with having completed training in an industrial discipline such as km. With few exceptions (KMI Institute in Washington being one) the km profession unlike CIPD or CIM has no recognised industry body. Those that might be closely related such as SLA or CILIP have not claimed the km space. Instead conference organisors award ‘gongs’ at their events and others rely on the MAKE awards to signify progress.

Most km discussions though tend to land in the same place: what does a knowledge manager do, where do they sit in the organisation, what are there crossover points (Organisational Development, Learning, HR, IT, Strategy, Communications/Marketing) and how do we measure impact? Success depends on individuals, the passion they bring, their ability to judge what to do and when and the way they present to/influence many stakeholders.

Here’s one example of good facilitation from France:

 

 

 

 

 

 

 

 

 

 

This picture, a typical wedding scene, shows the bride to be greeting all the guests before they enter the church for the ceremony. She introduces friends and family to each other so that there is no ‘bride and groom’ side of the church. People who have been introduced mingle and are more likely to converse at the wedding breakfast thereafter. This simple act of facilitation (a ingrained tradition) helps shape the event.

So while not every km professional can be a bride we can suggest that a core competence in putting the km tools to work is facilitation. Toolkits are vitally important but without the skill and processes to deploy them they are a wasted investment.

Its why perhaps CIAT‘s km team who are much admired have titles such as Leader, Capacity Strengthening and Knowledge Management Initiative. Theirs is a focus on helping to equip others in their organization; faciltation skills are a huge part of the core competencies they use to help others.

knowledge tours = knowledge transfer (understanding puffins and olefins)

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Today under the ‘people I admire (and why) section of the site I posted an anecdote from a meeting I once had with the then Vice President of Mobil. It brought back recollections from a posting I made a year ago on Sparknow’s site about the value of knowledge tools  for encouraging good knowledge retention and transfer. Here’s that updated posting:

Ahead of a trip to the ECCI creativity & innovation event in Portugal I was looking for examples of good knowledge transfer from km practitioners. Let me share one anecdote from an interview with Barney Smith a former CKO and CIO and champion yachtsman in response to a question on measurement.

Barney: 80% staff have attended a knowledge tour. Oh yeah, we did knowledge tours. That was cool.

Sandra: What’s a knowledge tour?

Barney: They were great! Natural England owns and manages about 0.6%% of  England’s surface, its natural resource…we actually got people to leave their day job and come down literally. And rather than them doing job shadowing and things like that, we got them to build a day where staff could turn up and then could actually experience what that person does. And they could take 10-15 out. So if a person is responsible for monitoring environmental impacts around the Lundy islands, he would take people on a boat around Lundy island and looking at birds with a Lundy Warden.

Barney: Lundy (Norse for Puffin Island) is part of a Marine Conservation Zone managed by Natural England. The warden who lives on site managing it is actually an employee. We took our staff out to spend a day on the islands with the warden talking about puffins and things like that.

But the point was for those people sitting in finance or those people sitting advising farmers on agri-environment schemes or those people who are promoting or designating the  South Downs national park or New Forest national park, that’s what they’re doing at Lundy. And of course that was the pilot, great stuff. But we had the chief executives and senior staff who said everyone’s got 15 development days. One of those days must be knowledge tour.

And we even created one that’s virtual. So it was actually a guy walking land with a video camera, looking at things. And then he did a talk-over. It was done like a documentary.

It reminded me of a time long past when I was a lending banker managing a portfolio of energy clients.  I knew little about hydro crackers and cat crackers, even less about olefins, polyamides and bottoms all of which were about to become part of my expanding oil and petrochemical vocabulary.

My boss, a visionary and talented Yale educated and very well travelled American who could and did argue vociferously in Arabic, Cantonese and English reasoned that if I were to be of value I needed to understand the practices and language of the industry I was working alongside.  So courtesy of Mobil I attended a programme designed to educate financial people into the workings and economics of oil refining.

I never thought about that week at a refinery in Paulsboro New Jersey as a knowledge tour but now looking back I can see the connection and the importance of experiencing what others do in order to make better decisions. That this was a one off initiative and never replicated by the bank was regrettable since it gave me an insight into a world that would otherwise have been opaque and because I had a modicom of knowledge, the ability to have more meaningful dialogue with my clients.

Barney’s knowledge tours have become regular events, measurable as KPI’s and part of the knowledge charter used to mobilise and shape Natural England’s approach to knowledge management. That they are built into the calendar with compulsory attendance is key.

And finally and perhaps not unrelated the Lundy Puffin is no longer on the endangered list as a result of a programme to eradicate the island of rats.