why should Sudan’s health industry embrace Knowledge Management?

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 I an old wine in a new bottle?

I was back in Khartoum for a couple of days at the end of March at the invitation of the Sudan Engineering Society and University of Khartoum.  They’d asked me to talk about knowledge management, research into the evolving role of the ‘knowledge manager’ and the implications for Sudan.

Apart from the honour of addressing 150 or so engineers, acadamics and ministers on Wednesday at the National Telecomunications Center, my presentation at the Faculty of Mathematical Science on Thursday was made at the end of the working day (so at the start of the Sudanese weekend) to a crowd of nearly 200 including families.  It brought home to me how keen the Sudanese people are to learn and exchange ideas especially since the Campus had only just reopened after a period of unrest.

Knowledge management as a formal discipline is in its infancy in Sudan. There are pockets of good practice albeit under different labels and many companies are following the well trodden path of focusing on technology such as an intranet as a way of storing ‘stuff’.  It’s not easy though operating in an environment which restricts access to software updates as an example. That said there is a groundswell of interest led by Dr Gada Kadoda who is mobilising a group calling itself the Sudanese Knowledge Society who are about to meet formally for the first time.

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Photo Taken outside the National Telecommunications Center Khartoum with some of the founding members of the Sudan Knowledge Society

The Khartoum presentations prompted an interesting exchange with one of the participants who attended both. Here with his permission is an extract.

Hi Paul

Thank you. I have attended both sessions. All day on Wednesday and the Thursday evening session… Few years ago while I was working in the UAE, I came across The European Business Excellence Model and the work of Peter Senge at MIT ( The Learning Organization ). Is this KM a new Fad, old wine in new bottles or is it a real contribution to your management thinking? It seems to me I am getting mixed signals…. To this day I still remember Business Processes Reengineering, as advocated by Prof Michael Hammer at MIT
Best regards

Mustafa

The Rio Tinto video (about a Community of Practice) in my humble opinion is a Quality Circle drill, which was helped by the advance in ICT…

And my reply:

Dear Mustafa thank you for your kind words and the background.

You raise a number of interesting points, let me answer them in sequence:

  • Old wine in a new bottle: to continue the analogy, if it is then it is ageing quite well as some 10 years ago Professor T D Wilson at Sheffield University in a paper entitled ‘The nonsense of knowledge management’ wrote the following:

The inescapable conclusion of this analysis of the ‘knowledge management’ idea is that it is, in large part, a management fad, promulgated mainly by certain consultancy companies, and the probability is that it will fade away like previous fads. It rests on two foundations: the management of information where a large part of the fad exists (and where the ‘search and replace marketing’ phenomenon is found), and the effective management of work practices. However, these latter practices are predicated upon a Utopian idea of organizational culture in which the benefits of information exchange are shared by all, where individuals are given autonomy in the development of their expertise, and where ‘communities’ within the organization can determine how that expertise will be used. 

  • Yet today as our research has indicated people and organisations are organising themselves to make better use of what they know and if knowledge management is a convenient label to achieve that then who are we to complain.
  • Quality Circle vs Community of Practice: Yes and no would be my response.  However for me the concept of a quality circle is much more around a particular incident (yes that was highlighted in the clip) but the idea of a Community of Practice is that it represents an ongoing and dynamic resource. The bigger point here I think is that the engineers were able to post something onto the platform used to run the CoP and locate people who’d had the same experience.
  • As to BPR and the other management ‘fads’ I would say there is a difference.  I see km as a horizontal thread running across the organisation; its a way of doing if you like a common sense approach to improving the sharing of what people and organisations know.  BPR et al gave no consideration to the transfer of know how from experts about to depart or how to bring people who’ve just arrived in the business up to speed as quickly as possible. Where km falls down is that it is often put into a corporate siding – the place where communications, marketing and HR don’t want to tread and as a result does not have the institutional clout that more established disciplines have.

km has been written off many times and yet as research into the evolving role of the ‘knowledge manager’ has uncovered there are still a large number of people engaged in km type activity. Even with km in their job title (and many still don’t) they are having significant impact and reach across their organizations.

Yesterday for example I received a copy of the excellent Asian Development Bank Intersections digital newsletter and was drawn to an article entitled Ahead of the curve: the long reach of short tales by the Knowledge Management Center headed by Olivier Serrat which said

In 2010, ADB embarked on its most ambitious story-driven exercise yet. It launched the ADB Sustainable Development Timeline multimedia project, which currently hosts over 11 hours of sympathetic reminiscences and expertise rendered in video from 72 ADB staff. The material is broken down into 1–5 minute snippets covering a veritable plethora of topics, e.g., communities of practice, corporate governance, gender equity, forest conservation, knowledge management, renewable energy, sustainable infrastructure, etc. But, beyond these, the interactive platform also contains short documentaries of projects shot on location, sounds, B-roll footage, animations, graphics, voice-overs, videos, statistics, photo essays, etc. The product has been warmly received, both in and outside ADB, and augurs well for ready use in staff recruitment and induction, learning and development, conferences and other events, education, and external relations.

I am looking forward to continuing this discussion when I am at the 5th International Knowledge Management and Organizational Learning Summit in Bogota in May. More on that in a later posting.

a knowledge retention technique: importance of business trips and missions

By a stroke of serendipity (a meeting with one of the speakers while he was in London) I went to Khartoum early in the New Year to participate in an event run by University of Khartoum styled “Knowledge Management Capacity in Africa”.

It promised to be an interesting event since unlike a previous mission to Khartoum, Nyala and El Fashar I was to be based in one centre for the week. Also the list of practitioners and speakers is very heavily weighted in favour of the African continent and I was the sole European representative. An honour indeed!

I was asked to focus on a couple of topics: Missions and Creative Commons. More on the latter in a subsequent posting. Here’s a taster from the abstract I wrote with Victoria Ward for the event:

Missions are one of the key ways any development bank or agency can collect, disseminate and synthesize knowledge but the opportunities to do so are often overlooked or wasted.

Most of the processes are focused on producing a report (back to the office report- BTOR), managing risks and making decisions yet every component can be adjusted and fine-tuned or used in more than one way.

This presentation, based in part on a mission to Sudan conducted in 2010 by Sparknow working alongside the World Health Organisation (WHO), will examine a variety of mission collection methods and discuss how the ‘fire of the field’ can be brought back into an organization.

Imagine you are a bank looking to set up a new Islamic finance operation targeted at the private sector in West Africa. There are few peer groups you can look to for advice; it’s by and large unchartered territory. What are your options?

·       talk to the founding fathers of other Islamic institutions

·       undertake a scoping mission to the country

·       identify others in your own institution that have core skills you might draw on.

You actually do all the above but in addition you put in place a programme to ensure that you capture all the learning’s from this new venture; the nuances around operating ‘offshore’ from HQ; the peculiarities of the culture and the way things are done and; you create a missions guide and a mechanism for feeding back what you learn into your organisation. This charts Sparknow’s mission journey illustrated by some of the techniques we’ve found to be of value.

Oh and this time I am going to remember to take nice new shiny dollar bills and not my credit card.

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using postcards for post event evaluation

In January as avid readers of the Sparknow blog might recall, Sparknow attended the inaugural knowledge management capacity development in Africa event in Khartoum.  As part of the follow up to that event the conference chair and organiser Dr Gada Kadoda decided to use a postcard as a way of capturing some of the delegates perceptions. It showed a picture of some of the delegates on the steps of Freedom Hall Khartoum and an invitation on the reverse to submit comments and reflections.

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What follows is her candid account of how the exercise went and the postcards used as prompts throughout the evaluation session which was held in Khartoum on February 25th.

In due course I will publish something on how Sparknow used postcards at last week’s Henley KM Forum and invite Victoria Ward who pioneered the use of this technique in Sparknow to post her reflections.

Evaluation of KMCA2012 Using Post Cards

By Dr Gada Kadoda

For conferences and workshops, a survey is traditionally used to measure satisfaction rates of delegates with the programme content, event organisation, etc. against set criteria and predefined scales, as well as allow for narrative comments for respondents to elaborate or make a suggestion. The results of these surveys are usually published as numeric percentages reflecting satisfaction levels along the various parameters considered in the survey. In as much as many of us are more comfortable with scales and their apparent clarity, one could argue that they avert expressiveness rendering them inaccurate to map a memory or a feeling of the past.

The speed by which we fill these surveys can bear witness to how much we engage our memory while filling the evaluation form for an eager organiser. However, a creative or participatory evaluation method like using post cards can not only measure the same parameters, but it will also empower participants by involving them into defining their own parameters and bring out their vivid memories, good or bad, of the event.

We recently used this method to collect memories about the Workshop on Knowledge Management Capacity in Africa that was held from 4 to 7 January, 2012 in Khartoum, Sudan. We distributed a send-a-postcard-to-KMCA call to our mailing list to write back to the organisers and as with post cards, senders are free to choose what they write. There was a low response rate (5%) which is in part due to delay from our side in sending out the call, a month after the end of the workshop!

Notwithstanding this unimpressive rate, in this article I will explore the parameters that came out from our use of post cards that correspond to some of those commonly used in after-event-evaluation questionnaires. Ratings can only be felt as you read through the selection of post cards quotes.

General event assessment (e.g. relevance of content, personal benefits or difficulties):

Thanks for the great job you did and KMCA2012 was very successful …” Walaa Mahdi (Graduate)

Thanks t all those behind that great event and I hope to continue and organise more helpful and full of knowledge events.” Abdelrahman Idris (Participant)

Good things about the workshop were the exchange of international students and the collaboration between professor, students and even business people, trust and joy moments between people, we open our minds to philosophy, anthropology and indigenous knowledge systems…” Tybian Zaroug (Undergraduate Student)

Now after attending this conference, I can talk about knowledge management to my friends and colleagues. In fact I realised that KM is very important to any scientist…” Samah Makawi (Undergraduate Student)

Actually I learnt a lot of things from this workshop in leadership and research and I am ready now to take bigger responsibilities, and as Mr. Paul said why not Sudan lead the world in KM, I totally support this and in our group on facebook KM friendship, we asked for ideas to be active and to establish a team work to achieve something in this country.” Iram Oshari (Paper Presenter)

The only problem that faced me all the time, it was a lot of interesting paper and presentations and we couldn’t reach them all.” Islam Elhadi (Graduate)

Programme rating (e.g. quality of content and activities, schedule and time keeping):

Thank you! It was a pleasure of mind to participate… I remember almost all the new ideas, the multidisciplinary yet united tribe of knowledge guards. What was most fascinating for me was the ideas on indigenous knowledge. What was striking, well, an anthropologist, a chemist, a philosopher and a political scientist … all using the same language … KM.” Omayma Gutbi (Participant)

I remember since we moved from Kassala and we entered the hall of friendship, the movement of the people inside the hall from session to session and the ongoing debate about the topics presented in the various sessions … I hope these efforts translate to reality to develop health, education, environment, government and business in Sudan and Africa.” Alzubair Hassan (Postgraduate Student)

Event organisation (e.g. information to delegates, quality of facilities):

Thanks for the great leadership and all your hard work, being at the airport for everyone, taking care of visas and all the other little things that made this such a success.” John Trimble (Keynote speaker)

I would like to thank you all for the well organised workshop. All activities were impressive.” Awadia Awad (Participant)

I found strange being asked to opine on subjects at a moment notice and without any briefing and the sanguine acceptance of Africa time.” Paul Corney (Invited Speaker)

 “Please make sure to document every single second during the workshop on video. As time goes, few things could be remembered, so documentation is a very crucial part for the future.” Anwar Dafalla (Invited Speaker)

Notable quotes from frequent conference goers …

A true international Conference …

My time Sudan was one of the most enriching experiences that i have had the pleasure and honor to partake of. Despite some late starts(!), the little hiccups and the waits, there was tremendous energy in the air and the people, all, including and especially the students, the faculty and the practitioners, many who were all three! The diversity of participants and thematic areas addressed in the “workshop” transformed and elevated this workshop into a true International Conference on Knowledge Transfer and Management. I learnt a lot, met many engaged and enthusiastic individuals, and was privy to participating in much intense and engaged discourse on empowering people and building Africa’s capacity.” John Tharakan (International Participant)

Exhilarating and free …

In so many ways, it was one of the most exhilarating workshops I have attended.  This was for many reasons:  the range and diversity of topics contained within a KM framework; the diversity of the participants—in age, nationality, gender, institutional affiliation and field, etc.; and the free nature of the environment.  This is in addition to some very stimulating papers.  As a Sudan Studies scholar of many years, I found I still had a lot to learn and was able to find myself in an area of study outside my field.  I was especially impressed with the presence of so many students and with their presentations the first day of the conference.  Including art and crafts was a tour de force and tied in very well with the goal of the organizer of considering all forms of knowledge and knowledge production.” Sondra Hale (International Participant)

There was even some post card poetry:

You set stone in stagnant water

You lead us in calm weather

You carried the truck and set road map for our thinking

Km is set as part our future mission and state vision” Elfatih Wadidi (Paper presenter)

Lastly …

What was “exhilarating” about using post cards is the freedom of expression it brings to the evaluation. These were personal benefit, good or bad things with event organisation, hopes for the future, etc. The post card writings space compel respondents to focus upon and articulate their main points which results in a meaningful rating. For example, a rating of high to a survey question on how well the event offered opportunities to meet people and exchange information, would miss opening minds to new interesting topics and perspectives, or a rating of low to programme scheduling would miss the “late starts, the little hiccups and the waits”.

In my view, post cards complement and do not replace the survey method and performance evaluations especially for regular events.  On the other hand, post cards are insightful and delightful. Remembering the workshop trip on the last day with as “I marvelled at crossing the desert without breaking an axle, the fun bus and singing Bob Marley” or “I will never forget Albajarawia sand under the moonlight”, bring vivid memories in all of us who were on that trip.

Thanks to Paul Corney for introducing us to this fun-to-use tool and many thanks to our delegates who sent us a post card. Thanks for your fine personal memories and articulate descriptions that we can tag to our evaluation report and own memories, it was better late than never!

Best wishes to all.

Gada Kadoda

knowledge management in Africa: reflections on KMCA 2012

Its 3.30am and I am sitting at Khartoum airport waiting for the flight back to Heathrow at the end of one of the most exacting yet rewarding weeks I’ve had in over 35 years of working across many continents.

Sudan challenges you: its people are warm, inquistive with an insatiable desire to learn. And yet time management is a work in progress and the ubiquitous presence of officialdom and the ongoing sanctions a significant drain on effectiveness and enthusiasm.

Despite these constraints the young are vibrant, highly intelligent and moved to laughter and song with little prompting.  The society is very oral; stories are the currency of communication. External opinion is highly sought after and there is a work ethic that is both surprising and refreshing. By way of illustration:

It’s 5.45pm on the first day of Knowledge Management Capacity in Africa 2012 conference held in the Friendship Hall Khartoum.  This inaugural event on Knowledge Management which kicked off at 8am has attracted over 500 delegates and nearly 50 international participants though I am the sole European. The timing has gone awry by some distance.

I get to my feet to begin my presentation entitled “missions and knowledge production” and having summoned water bottles and moved everyone around, ask the assembled throng in the Omduran Room what they want to do.

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By a unanimous show of hands they indicate a desire to continue and we ultimately finish at 7pm in time for a Knowledge Cafe.

The audience listens attentively and I get a lot of positive feedback.

At the Knowledge Cafe I lead a ‘table’ of young Sudanese women who are keeping up the pace.  The session eventually ends at 8.30pm some 12 hours after the day began.  It is an indication of things to come over the following two days (and nights).

The Conference Chair Gada Kadoda, a woman of astonishing capacity and vision, has assembled an impressive array of speakers and presentations: from Washington to Malaysia via the UK with a big representation from Africa. I have two presentations to give and as it transpires to facilitate the closing conference session on Saturday morning before a caravan of minibuses sets off in search of the Sudanese Pyramids.

Over the next week or so I will be drawing on some of the conversations and highlighting examples of knowledge at work in Africa; for now here are some high level thoughts after 3 days of the conference.

  • Technology I the ongoing sanctions means that some of the essential foundations for a dynamic knowledge society are absent. Software and hardware are in plentiful supply but access to the latest upgrades are restricted and effective support is difficult to come by even though maintance is included in the original purchase.
  • e-commerce is constrained by the lack of an effective payment platform such as PayPal which is restricted.  While the new regulators can plan for a time when the situation returns to normality by setting up the distribution network now, it means they are unable to encourage the growth of an industry that would facilitate a faster move towards a knowledge based economy. To illustrate the importance of e-commerce, figures just released show that over 30% of all purchases over the holiday period in the US were conducted online.
  • Communications I the size of Sudan makes the laying of cable impractical; cell phone usage represents a high percentage of the communications media and some 22 million people have mobile devices (over 2/3 of the population).
  • Knowledge (and information) sharing I ‘my data is my soul’ is a phrase oft repeated. It illustrates more than any other the challenges organisations face in encouraging professionals to part with what they know.
  • Knowledge Management I is a discipline that’s attracting interest yet their are a fair share of cynics especially among those who seek substantive method and measurement. A number of prominent organizations have initiatives in train and like the citiens of many developing countries certification programmes are highly sought after. The term remains a deterrent for some and Knowledge Sharing was more readily endorsed.
  • Collaboration I group work is an accepted part of the culture and there is no reluctance to act as the spokesperson for the group or in expressing ideas and opinions. Most people have a Facebook account of sorts yet few have heard of TripAdvisor!
  • Food I plays a huge role in lubricating tongues. But everyone sits down at the first opportunity which tends to restrict conversation to those in the immediate circle.
  • Stories travel I in the past the travellers (or Bedouin) were the custodians of stories, today that role is being increasing filled by online connectivity which places an emphasis on effective means of collection, storage and dissemination.

I had the pleasure of working alongside/talking to a number of Sudanese graduates and undergraduates a number of whom presented papers on Wednesday. Two in particular interested me: one was about a process of measuring the effectiveness of km in a private company; the other an annual attempt at knowledge transfer by the students to rural areas in which they’d identified and engaged with a local stakeholder who became their voice and ears.

Perhaps though the highlight was interacting with so many people for whom the sharing of knowledge is critical for survival; where information that stays in someone’s head or laptop might save lives; where different techniques are needed to get the stakeholder buyin and ensure sustainability.