A proposed architecture for implementing a knowledge management system in the Brazilian National Cancer Institute.
| Autor | Barbosa, Jose Geraldo Pereira |
| Cargo | Report |
Introduction
Brazil currently has a complex cancer scenario. General incidence and mortality rates are elevated, with the particularly high incidence of prostate cancer in men and breast cancer in women. Theses cases have been responsible for over one hundred thousand deaths per year. There are approximately 480,000 new diagnoses of cancer each year in Brazil, and the vast majority of these patients have had some contact with hospital services. However, research also shows that in several regions of the country long waiting lists for diagnostics and treatments have become commonplace, which leads to a situation of people being diagnosed with cancer at a very advanced stage (National Cancer Institute [INCA], 2008). These sad findings have moved the national health care ministry in recent years to initiate a series of challenging reforms in order to implement early diagnosing clinical procedures. The management of cancer treatment is a long and complex process and the reduction of the patient's waiting time to start cancer treatment plays an increasingly important role. Therefore, any environment focusing on the accessibility to the treatment of a chronic illness like cancer should make every effort to avoid medical errors and fragmentation of care delivery.
The huge number of cancer cases in Brazil means that information is highly sought after by patients and the clinicians involved in their care and those responsible for cancer services, which opens an opportunity window for implementing hospital information systems [HIS]. Hoping to bring together people involved in care planning and delivering - clinicians, managers and patient representatives, the Instituto Nacional de Cancer (National Cancer Institute [INCA]) has been implementing an oncology care network. The network, as conceived by the INCA, is a partnership of both private and public cancer care delivery organizations, whose success will depend heavily on the collection, analysis and exchange of clinical and managerial information or knowledge within and across the partners' organizational boundaries. Its intention is to generate valuable information by answering the requests from patients, government and regulatory bodies with regard to clinical and medical services. Moreover, the integration of key data would help the evaluation of medical procedures and protocols, streamlining the organizational processes and bringing improvements to cancer treatment. Specifically, the network's objectives are as follows: (i) to improve access to information and knowledge at all levels (physicians, hospital administrators, patients); (ii) to create a community of cancer practice knowledge; (iii) to develop an environment of easy and friendly access to relevant information; and (iv) to collaborate with the decision-making process related to cancer care delivery.
In fact, the oncology care network is increasingly becoming a knowledge-based community of health services and patients themselves that share their knowledge, helping reduce administrative bottlenecks and improve the quality of care. As a result, an environment that helps translate information into knowledge is under construction and constitutes, in itself, a driver for quality improvements.
All the above comments bring to mind the need for a knowledge management system that will identify, capture, structure, share and apply an individual's or organization's knowledge, which will result in a competitive advantage and create sources of sustainable development, according to Nonaka and Takeuchi (1995). Therefore, the purpose of this study is to propose a conceptual framework for a knowledge management system in the Brazilian National Cancer Institute. To accomplish this, knowledge management [KM] enabled health care system is envisioned that will integrate clinical, administrative and financial processes in health care through a common technical architecture, as well as provide a decision support infrastructure for general decision-making.
Knowledge Management
Knowledge management is associated with intellectual capital and the process of creation and diffusion of knowledge embedded in business processes (Wigg, 1993), and constitutes a critical success factor in the current challenging and innovative business scenario. The main premise of knowledge management is the recognition of knowledge as the central point of organizational performance (Drucker, 1993).
In order to enhance organizational performance and create value, knowledge management includes all the processes that deal with the creation, structuring, dissemination and application of knowledge. In the words of Hedlund (1994), these processes can be analyzed at various levels: the individual, group or organization. For Nonaka and Takeuchi (1995), knowledge management is predicated on shared learning, collaboration and the sharing of knowledge at the strategic organizational level. According to Davenport and Prusak (1998), knowledge management not only involves the production of information but also the capture, transmission and analysis of data, as well as the communication of information based on or derived from the data to those who can work on it.
The Nature of Knowledge
Concerning knowledge itself, there are two main kinds: tacit and explicit. Tacit knowledge is the personal, unarticulated, unexpressed knowledge possessed by an individual. It is the knowledge and expertise that a person has gained over the years through experience, by interacting with others, and through a process of trial and error. This knowledge lies in the individual's brain or in his personal notes, computer files or desk drawers. It has never been completely articulated, recorded, documented or written down in a comprehensive format. Generally found in non-structured form, such as an individual's ideas, insights, values, experiences and judgments, it is more difficult to identify and to manage. Thus, it needs to be structured before it may be stored and processed. On the other hand, knowledge, sometimes, may be explicated, codified and set down in manuals, written procedures, records, notes, graphic representations, audio and visual materials. Stored in databases, explicit knowledge is suitable for access and processing (Nonaka & Takeuchi, 1995).
Reber, Nonaka and Takeuchi (1992 as cited in Spender, 1996) picture explicit knowledge as the small tip of a huge iceberg of pre-conscious collective knowledge. The major part of it would be formed by tacit knowledge, invisible and completely incorporated into social identity and practice. An individual will understand a message completely only if he understands the body of his organization collective tacit knowledge. In other words, the physical reality is socially built. By similar reasoning, Spender (1996) concludes that interpretation (knowledge) of experience comes from the interaction among the variables that surround the environment and the individual's perception enhanced by experience.
According to Tsoukas (1996), people are co-producers of their own reality, and this will help them to form their attitudes and behaviours. Attitudes are norms and values that the individual perceives as favourable or not, and the behaviours are the expression of these attitudes which can be shown as coherent or incoherent towards its related attitude. Tacit knowledge is one of the main foundations of the individual's attitudes. Therefore, detecting tacit knowledge is complicated by the fact that the individual has the autonomy to decide what and how much should be transmitted to others.
Almost all activities require some combination of explicit and tacit knowledge, and effective knowledge management is the one that captures both of them. In fact, the real challenges to knowledge management lie in being able to identify and capture tacit knowledge so that it can be retrieved when needed. While explicit knowledge is easy to record and transfer, tacit knowledge is difficult to identify, capture, and transmit. Although converting tacit knowledge to explicit knowledge is difficult, it is not impossible. The employee's tacit knowledge is generally transmitted under the form of organizational best practices, which are often documented and put into a network, which is subsequently accessed and used by other employees.
For Spender (1996), the big challenge of management is to distinguish the systemic activities that really increase the collective tacit knowledge from those that only generate local and limited knowledge. In the opinion of Hayek (1992 as cited in Spender, 1996), good managers know how to use organizational knowledge efficiently, the kind of knowledge that, although incorporated into people and processes, does not belong totally to any collaborator. So managers must build an organizational space that facilitates the selection of and interaction among different tacit and explicit knowledge available to the organization, both within its internal and external environment.
The Strategic Value of Knowledge
The health care industry itself is increasingly becoming a knowledge-based community that is connected to hospitals, clinics and patients for sharing knowledge, reducing administrative costs and improving the quality of care. Thus, the success of health care depends critically on the collection, analysis and exchange of clinical information or knowledge within and across organizational boundaries. It is recognized that the spread of new practices is shaped by multiple influences. In this process, physicians play an important role. They can be thought of in terms of very sophisticated knowledge workers (Wickramasinghe, 2000). Like others, (i) physicians "make sense" of this wealth of knowledge (Borghoff & Pareschi, 1998); (ii) they own the means of production, e. g., their specialized knowledge; (iii) they possess specialized skills and training, which they have acquired by investing significant resources towards their...
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