Tim Berners-Lee changed the world, recently. He is credited by Time Magazine and others as the inventer of the World Wide Web. His vision and passion are evident in the TED presentation shown below. His vision is not limited to an innovative way for electronic devices to be connected. His vision extends to the connectivity of minds and the many possible transformations of the world. It often takes years for the knowledge produced by medical research to become applied in actual patient care. We are a society obsessed with the possession, protection and ownership of data, information and knowledge. It is a rare person who puts contribution before self enrichment. The coming revolutions in healthcare will largely be based upon the values of people like Tim Berners-Lee.
Showing posts with label knowledge management. Show all posts
Showing posts with label knowledge management. Show all posts
Monday, September 5, 2011
Sunday, July 10, 2011
Challenges beyond Jeopardy
IBM has an amazing history. It built its corporate culture and initial wealth building and selling mainframe computers to large bureaucratic organizations. IBM tried to make the adjustment to networks of microcomputers in the 1980s and had to shatter and reinvent its corporate culture in the process. IBM invested in Second Life apparently thinking that the next great thing might be in virtual worlds. Now it seems to be betting the store on its ability to move from the information business to the knowledge business and in so doing transform many industries including healthcare.
Let's assume for the moment that a comprehensive knowledge base of evidence-based clinical pathways has been build and that some very advanced computer like Watson has the software inference engine to make important decisions about patient care based upon the input it has instructed human medical providers to enter. And let's further assume that organizational changes have been implented in the United States that have resulted in a very high degree of medical conformance in implementing "Dr. Watson's" instructions. Would this necessarily be a good thing? What would be some of the consequences?
A Star Trek fan, I remember the episode titled Spock's Brain first broadcast September 20, 1968. Dr. McCoy is tasked with the responsibility to put Mr. Spock's stolen brain (being used to run the public works infrastructure of a city on some other planet) back in place and reconnect it to his nervous system. But the knowledge of how to do that, once known, has been lost. McCoy puts on a device known as, "the teacher" that allows him to recapture the knowledge needed to perform the work.
I cite the episode of Star Trek to suggest the if we did have a computer system like IBM's Watson loaded with evidence-based medical pathways we would in the short term advance medical knowledge but in the long run we would lose grasp of medical knowledge. Watson, as amazing as it is, does not have knowledge. It only processes patterns. The GPS unit that I sometimes use while driving seems to have a capacity for thought and I sometimes project into its voice the evidence of judgment. I sometimes image that its spoken word, "recalculating" is really its saying, "You dummy, I told you to turn back there!"
There is the knowledge that exists in individual human minds, and there is social knowledge that exists in social networks. While computers can facilitate human knowledge (both individual and social) they do not have knowledge and are not likely to gain that ability. My point is that as we become more dependent upon computer systems we risk losing "the old knowledge" that we will need to not begin to treat computers as if they have knowledge.
The risk resides not so much in the potentials of technology as in the capacity of humans to anthropomorphize computers and robots. Build an attractive robot (it does not even have to have human features) and put something like the inference engine of Watson behind it and people will begin to trust this entity that in fact has neither knowledge nor emotions. "Watson," in fact, understands nothing. Human care givers will become the interface between the technology and patients but will lack the ability to effectively judge decisions suggested (or made) by the technology. There will be no "teacher" device that one can put on to know what is represented in the computer system in forms that are less than knowledge. Computers are dumb but they have massive memories and incredibly fast processors. Computers can be networked together into massive arrays. Humans are smart but have tiny working memories, slow processing speeds and as of yet we have not created high bandwidth social networks. Clearly there is need to design more effective joint cognitive system (see book by Hollnagel and Woods) for medical and other purposes, while facing the prospect losing our knowledge of how computers are making decisions without knowledge.
Sunday, January 16, 2011
Reflecting on Evidence-based Management
This is an initial reflection upon an assigned reading by Kovner and Rundall in our textbook Health Services Management, Cases, Readings and Commentary (9th) by Kovner, McAlearney and Neuhauser. The essence of the reading is that healthcare managers should make decisions based upon evidence just as physicians should practice evidence-based medicine. Basically this means there should be close ties between scholarly research and managerial practices. My approach to this is shaped by my experiences as a academic person who teaches public administration.
If there is a disjoin between scholarly research and managerial practice the easy explanation is to fault practitioners for not reading academic journals. It is not that simple. Even in public administration (PA), which is an applied field of study and practice, there is a substantial divide between scholarship and practice. The best practitioners were often not outstanding students. Successful PA scholars are not necessarily able to make a transition to successful practice. Success in scholarship requires a deep, narrow focus. Success as a practitioner requires a wide variety of interests and abilities. Scholarly journals are much more geared toward the needs of academic persons than practitioners. Even in PA, an article seldom includes an "executive summary," to clearly identify the relevance of findings to practice. Getting a paper published in a scholarly journal often requires the use of advance mathematics in the data analysis. Few practitioners have either the need or the interest to work through the mathematics. The bottom line is that practitioners are more likely to learn through informal communities of practice than by reading articles written by academics as required to advance their academic careers. Peer-review does not usually include practitioners as reviewers and what is required by peer-review to get work accepted for publication is sometimes not as rational and scientific as the public may assume. Assuming that what I have observed in PA applies to healthcare management the status quo does not favor greater use of evidence based management practices. As indicated by Kovner and Rundall, healthcare managers claim to practice evidenced-based decision making but do not cite scholarly research as the evidence they draw upon.
If a disjoin exists between research and managerial practices I believe the scholars must accept at least part of the responsibility for closing the divide. Academic cultures are probably among the most durable of all organizational cultures. It is unlikely that in the near future tenured or tenure-track faculty members will be rewarded for their abilities to span related areas of knowledge or to contribute to successful practice. If this is correct, this is sad. There is a degree of distain for academic "ivory towers" among some practitioners. And there is a degree to which some scholars look down upon successful practitioners. It is cause for concern when former students who did not display advanced cognitive skills as students sometimes move quickly into high-paying positions with major responsibilities. While evidenced-based management practices are surely important they are probably not highly correlated with successful careers as practitioners. "Success" of course can be defined in different ways, but that is probably more evident to scholars than practitioners. If the major institutions of society were ever managed by persons with the most advanced cognitive abilities it appears that those entering the systems now may be less well prepared to practice evidence-based management. If there is a gap between research and practice it is the responsibility of all concerned to try to address that divide.
If there is a disjoin between scholarly research and managerial practice the easy explanation is to fault practitioners for not reading academic journals. It is not that simple. Even in public administration (PA), which is an applied field of study and practice, there is a substantial divide between scholarship and practice. The best practitioners were often not outstanding students. Successful PA scholars are not necessarily able to make a transition to successful practice. Success in scholarship requires a deep, narrow focus. Success as a practitioner requires a wide variety of interests and abilities. Scholarly journals are much more geared toward the needs of academic persons than practitioners. Even in PA, an article seldom includes an "executive summary," to clearly identify the relevance of findings to practice. Getting a paper published in a scholarly journal often requires the use of advance mathematics in the data analysis. Few practitioners have either the need or the interest to work through the mathematics. The bottom line is that practitioners are more likely to learn through informal communities of practice than by reading articles written by academics as required to advance their academic careers. Peer-review does not usually include practitioners as reviewers and what is required by peer-review to get work accepted for publication is sometimes not as rational and scientific as the public may assume. Assuming that what I have observed in PA applies to healthcare management the status quo does not favor greater use of evidence based management practices. As indicated by Kovner and Rundall, healthcare managers claim to practice evidenced-based decision making but do not cite scholarly research as the evidence they draw upon.
If a disjoin exists between research and managerial practices I believe the scholars must accept at least part of the responsibility for closing the divide. Academic cultures are probably among the most durable of all organizational cultures. It is unlikely that in the near future tenured or tenure-track faculty members will be rewarded for their abilities to span related areas of knowledge or to contribute to successful practice. If this is correct, this is sad. There is a degree of distain for academic "ivory towers" among some practitioners. And there is a degree to which some scholars look down upon successful practitioners. It is cause for concern when former students who did not display advanced cognitive skills as students sometimes move quickly into high-paying positions with major responsibilities. While evidenced-based management practices are surely important they are probably not highly correlated with successful careers as practitioners. "Success" of course can be defined in different ways, but that is probably more evident to scholars than practitioners. If the major institutions of society were ever managed by persons with the most advanced cognitive abilities it appears that those entering the systems now may be less well prepared to practice evidence-based management. If there is a gap between research and practice it is the responsibility of all concerned to try to address that divide.
Saturday, December 25, 2010
Patient Advocacy and Knowledge Management
This Christmas morning I am reading a blog post by Jacqueline O'Doherty titled, Dissecting the role of a patient advocate.
http://www.hospitalimpact.org/index.php/2010/12/22/patient_advocates_guide_patients_through
She writes as if she has real power in the decision making process. It seems to me that a patient advocate is in the midst of a very complex set of participants in which there really is no centralized power. I am thinking of dynamic models of complex adaptive systems that tend over time to switch between multiple patterns called "attractors." The situation was in one attractor prior to the patient's unexpected massive stroke. Then the entire system shifted into a very different attractor. The system has a life of its own, so to speak. No one is really in charge.
Jacqueline O'Doherty writes that she called a meeting attended by every doctor and other major caregiver. She writes that this meeting allowed everyone to understand and be on the same page concerning the patient's diagnosis and prognosis. I remember "calling" such a meeting once years ago when I was a patient advocate for my father. I was only a teenager and found myself alone in a room with perhaps eight physicians and other care providers. I was his family. To the best of my ability I spoke his preferences and values when he could not speak them himself. They took time to explain the situation to me from their professional perspectives. It was quite an amazing experience.
As I think about what Ms. O'Doherty has written I realize that patient advocacy is more than knowledge management. But it seems to me that knowledge management is a major part of it. I don't think it is possible or practical to always call a meeting. Otherwise, physicians and other providers would spend most of every day sitting at a table. It is like a dance in which the music sometimes suddenly changes. It is not a square dance with a caller. I keep remembering Mary Parker Follett writing about supervision and authority. In her view, it is not about which of us leads. It is about how we respond together to what we face. But to understand how this scales up to large numbers of medical providers, insurance companies, administrators, and family members (plus the patient, of course) is quite a challenge.
http://www.hospitalimpact.org/index.php/2010/12/22/patient_advocates_guide_patients_through
She writes as if she has real power in the decision making process. It seems to me that a patient advocate is in the midst of a very complex set of participants in which there really is no centralized power. I am thinking of dynamic models of complex adaptive systems that tend over time to switch between multiple patterns called "attractors." The situation was in one attractor prior to the patient's unexpected massive stroke. Then the entire system shifted into a very different attractor. The system has a life of its own, so to speak. No one is really in charge.
Jacqueline O'Doherty writes that she called a meeting attended by every doctor and other major caregiver. She writes that this meeting allowed everyone to understand and be on the same page concerning the patient's diagnosis and prognosis. I remember "calling" such a meeting once years ago when I was a patient advocate for my father. I was only a teenager and found myself alone in a room with perhaps eight physicians and other care providers. I was his family. To the best of my ability I spoke his preferences and values when he could not speak them himself. They took time to explain the situation to me from their professional perspectives. It was quite an amazing experience.
As I think about what Ms. O'Doherty has written I realize that patient advocacy is more than knowledge management. But it seems to me that knowledge management is a major part of it. I don't think it is possible or practical to always call a meeting. Otherwise, physicians and other providers would spend most of every day sitting at a table. It is like a dance in which the music sometimes suddenly changes. It is not a square dance with a caller. I keep remembering Mary Parker Follett writing about supervision and authority. In her view, it is not about which of us leads. It is about how we respond together to what we face. But to understand how this scales up to large numbers of medical providers, insurance companies, administrators, and family members (plus the patient, of course) is quite a challenge.
Subscribe to:
Posts (Atom)