By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer
“Those who do not remember the past are condemned to repeat it.”
-George Santayana, Philosopher
One casualty of the Covid pandemic is institutional memory. There has been a big turnover in staff, management, and leadership positions in many health centers, offices and hospitals in the Partnership HealthPlan of California (PHC) service area.
Example A: A new clinic manager tries to increase provider access by making provider appointments shorter. This results in more patients being seen per day. However, over time the provider feels burnt out and quits to join another clinic, resulting in even longer waits for patients.
While new staff can bring new ideas, they often don’t have the benefit of knowing what has been tried before, and how well it worked. Often problems are approached as if no one has ever tried to fix them before. As a result, they repeat previous ideas and the lessons learned are no different from the first try.
The concept of Knowledge Management includes three components:
- Using existing knowledge to inform pilots and interventions, instead of starting from scratch.
- Generating new knowledge by processing and analyzing information and existing knowledge in new ways.
- Capturing new knowledge in a way that can be searched and accessed easily in the future.
The first component can be summarized succinctly: “Don’t reinvent the wheel.”
When mentoring new staff with shiny new ideas, show them how to find out what is known about that idea. This includes internet searches, talking to staff and outside experts with more institutional wisdom, and looking though company files about past projects.
Background research also includes subjecting articles and papers to scrutiny, to identify bias and statistical fallacies that could reinterpret their findings.
Example B: A new physician decides to implement a scribe system to improve provider efficiency. They consult articles and talks to a colleague at a neighboring health center to look for additional information. This results in phone conversations with clinical leaders at several other health centers, where they learn that clinic productivity does not tend to improve with the use of scribes, but that chart accuracy, clinician happiness, and quality scores improve when a scribe program is implemented well.
Sir Isaac Newton (a co-discoverer of calculus and father of the field of physics) understood this principle of building on prior knowledge. “If I have seen further, it is by standing on the shoulders of giants.”
As leaders we must model this framework, setting an expectation for the new staff that join our organizations, that they will search out existing knowledge and apply it to the problems they confront.