KNOWLEDGE MANAGEMENT SYSTEM IMPLEMENTATION AND KNOWLEDGE TRANSFER PRACTICES THROUGH SYSTEMS THINKING: A CASE STUDY IN A NHS HOSPITAL (26)

The paper aims to contribute to the understanding of Knowledge Transfer (KT) through implementing a Knowledge Management System (KMS) as a case study in the field of healthcare, leading to theory extension. The concepts of system thinking were used to explore in what way a hospital practically achieves and implements a KMS. To do so, a case study was conducted as a qualitative approach, and data was collected by in depth semi-structured interviews with different stakeholders, including strategic management, technicians and end users, in addition to reviewing related documents and observation. Template analysis was also used as data analysis method. This case study provides evidence that system thinking provide benefit for KMS at both planning and implementation stages. Moreover, an emphasis on the understanding of KT would be to bring about the integration of care. Also, the findings illustrate that implementing KMS requires not only the theoretical awareness of the concept, but also requires learning through practice for a smoother implementation process. Flexibility, distributed leadership and end-user involvement are important, and communication technologies and strategies should focus strongly on the transparency, including communications tools and methods

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Systems Thinking: Analysis of Electronic Patient Records Implementation and Knowledge Transfer Practice. BP Trust in the UK, NHS

This paper aims to enlighten a new approach to study the Knowledge Transfer (KT) through Systems Thinking (ST) in relation with the implementation of Knowledge Management System (KMS) at the practice of the healthcare. Thus, integration between the KT and ST aims to open a door for a new literature about Knowledge Management theory in the healthcare context. This paper used many key philosophical concepts drawn from the ST theory and KT to investigate deeper understanding of the issues around KMS implementation practically in the context of the hospitals. In favour of these objectives, this paper conducted a case study on the implementation of the Electronic Patient Record (EPR) at BP Trust in the UK. Base on the business case of the project, EPR is perceived as a representative of KMS initiative project in the Trust.The paper reviewed the literature on ST, KM, and KT to proposal of new KT approach. In the fieldwork, qualitative approach and case study was conducted in order to collect empirical data through a series of in-depth, interviews with different stakeholders, including management board, IT specialists and healthcare professionals as actual users. In order to have a comprehensive understanding of the case, and to validate the findings, direct observation was used and documents related to implementation were reviewed. The observation was taken place in the A&E department to see the actual interaction between the people and technology, and to understand the EPR in practice. The primary and secondary data were analysed by using template analysis method and approach.The case study considers that ST provides beneficial understanding(s) alongside with the decision and sense making for implementing EPR project. The case study shows that understanding KT practice contributes to the integration of complex nature of healthcare practice. Furthermore, this paper argued that implementing EPR requires not only a particular intellectual conceptualization, but rather learning through reflection on the actual practice. Learning by doing and studying KT practice allows an implementation to become more adaptive and responsive along with day to day practice and contingencies. Thus, the findings outline for the decision makers, many important aspects to be considered, such as distributed leadership, flexibility, and practice analysis and end-user involvement.This paper is limited on single case study, and more comparative case studies in complex situation would help to improve the study model. Therefore, this study suggests doing more studies around communication technologies and strategies in relation with KT practice by testing more communications tools and methods in the healthcare and in other context(s)

An explorative Study of Knowledge Transfer Mechanism-Processes and Factors (Enablers and Barriers): Conceptual model

The practice of the healthcare including, treatment, policy planning and decisions, should be based on evidences (explicit knowledge) and experience (tacit knowledge) whenever possible. This might be achieved through investment in studying Knowledge Management (KM) in the healthcare practice. However, the studies of KM in practice and specifically in the healthcare is still limited for some reasons. One of the most important reason relates to looking at KM from the angle of technological solution without considering KM functions from the social aspects. Thus, this chapter initially tries to provide an in depth framework to a specific and fundamental function of the KM, which is knowledge transfer. Knowledge Transfer (KT) as a mechanism aims to facilitate producing, accessibility and application of tacit and explicit knowledge and may provide solutions to this challenge. However, based on longitudinal and systematic reviews, robust research into the KT mechanism is limited (Pentland et al., 2011). This chapter proposes a conceptual framework of a multilevel process-based of enablers and barriers of KT mechanism. On the basis of extensive literature from many fields and mainly sociotechnical model of Levite (1964), this chapter moderates the KT mechanism into five main elements related to characteristics of knowledge, source, recipient, relationships between them, tools (technologies) and context of the actual transfer. It will discuss how the different factors (i.e. enablers and barriers) can impact on KT mechanism at three levels; personal, team/ divisions, and organisation. Giving the longitudinal nature of KT processes and drawing on Szulansky’s (1996), Lane et al., (2006) and Minbaeva, D. B. (2007) models, this chapter proposes a sensible process model of different factors during stages of KT (i.e. starting from dissemination, reaching to assimilation). This model is conducted to notify the design and implementation of KT systems and mechanisms for public organisations including healthcare

Towards safer healthcare: qualitative insights from a process view of organisational learning from failure.

From PubMed via Jisc Publications RouterPublication status: epublishThis study adopted a process view of organisational learning to investigate the barriers to effective organisational learning from medical errors. Qualitative data were collected from 40 clinicians in high and low performing hospitals. The fit between the organisational learning process and socio-technical factors was investigated systematically from a pre-reporting stage to reporting and post-reporting stages. The analysis uncovered that the major stumbling blocks to active learning lie largely in the post-reporting stages and that they are rooted in social rather than technical issues. Although the experience of the higher-performing hospital provides valuable pointers in terms of creating more trusting environment and using the potential of small failures towards ways in which the organisational learning process in the lower hospital might be improved, due to lack of local mangers' proactive engagement in integrating changes into practice the active learning takes place in neither of the hospitals. To ensure that the change solutions are firmly incorporated into the culture and routine practice of the hospital, we need to focus on fostering an organisational culture that encourages positive cooperation and mutual interactions between local managers and frontline clinicians. This process will lead to double-loop learning and an increase in system safety. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Knowledge Management Systems Characteristics that Support Knowledge Sharing and Decision Making Processes in Organizations

With the advent of the knowledge economy and the growing importance of knowledge societies, organizations are constantly seeking new ways of leveraging and sharing knowledge to support Decision Making (DM) processes. This chapter presents an initial insight to the little-researched phenomenon of how Knowledge Management Systems (KMSs) can facilitate knowledge sharing (KS) to support DM processes in organizations. In this chapter authors aim to extend the existing literature of Knowledge Management, Decision Making and knowledge sharing by proposing a new conceptual framework, namely “ECUA” (Easiness, Communication, Unification and Analytics Characteristics). In this study, 42 semi-structured interviews have been conducted. The proposed conceptual framework will benefit managers in both public and private sectors in finding new ways of leveraging and sharing knowledge to support DM processes via using KMSs. This framework can be used to explore KMSs characteristics that can support DM processes by facilitating knowledge sharing in organizations

Apparent Young’s modulus of vertebral cortico-cancellous bone specimens

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