Importance of KM in Health: the story of Doctor Anwar and making use of what he and others know in Sudan

Meet Anwar, a Sudanese doctor. Just one of 5 fictional characters created by delegates at the Knowledge Management for Health in Sudan event I spoke at, helped plan and run.

Sudanese Doctor

Anwar

This exercise, Scenarios for the future, was set in 2020 and invited the 80 or so delegates drawn from across the whole of the health industry in Sudan to consider what a day in the life of each character might look like.  This was a new and warmly embraced concept in an environment where my information is my soul and much of the debate about the future takes place against a backdrop of uncertainty and increasing austerity where:

  • 2/3rds of all drugs are purchased ‘out of pocket’ not from health system
  • drugs are proportionately more expensive than in other domains
  • funds from external sources are available to assist with health informatics.

Having settled on a description of each character the delegates who were by this time in groups of 8-10 then set about imagining what their day might look like on January 1st 2020. A vivid imagination is required and was evident in the quality of the stories that were told by each group’s nominated storyteller.

The story of the Health Worker

Ismail’s story – Health Worker

I will in due course and with the organising committee’s permission publish the two ‘winning’ stories; yes we did do voting while the storytellers left the room.

One of Sudan’s leading pharmacists noted in a one:one conversation how important listening was and how difficult a technique this is for many to use when prescribing drugs.

By inviting each of the storytellers to play back the story to each of the other groups it was good to hear them say in the summing up that by the end they really felt they were the character.

 

The previous day I’d invited the delegates to change the way they looked and think about issues and barriers.  Using when you change the way you look at things, the things you look at change exercise conducted in the best breakout rooms I’ve ever worked with, the delegates who are naturally loquacious soon grasped the concept of seeing the room through the lens of different professions.

Breakout room

Breakout room

This change of mindset was important: it allowed the subsequent round table (well round conference room) session that discussed:

‘What are the biggest issues we face in sharing knowledge and information about the health of our nation and how can we overcome them’

I’d invited each delegate to introduce themselves to three people they didn’t know. This worked well and encouraged a very frank discussion. The main issues highlighted were:

  • no systematic collection of information and limited understanding of its value
  • transparency of process (where do the figures go) and credibility of the data
  • lack of human resources to do the collection
  • limited statistical information to undertake scientific research on
  • ownership of data and the whole process – fragmentation
  • accountability to deliver
  • communication/awareness of what each organisation is doing – lots of ‘stuff’ is happening but there is a real risk of duplication of effort e.g. many of the disease control programmes are creating their own informatized information systems

Delegates recognised the tremendous strides being made by the Public Health Institute (one of the event’s sponsors and host of the official dinner) in developing professional public health administration programmes, the creation of a Data Dictionary and the publication of the first Annual Health Performance Review though many bemoaned the lack of official  support for research projects where Sudan has a prominent global position, Mycetoma Research Centre an example.

I came away from reflecting on a discussion I had around the event:

Its all about ‘informization’ – the ability to report from a health centre level with ‘point of sale’ data collected via PDA’s / mobiles as well as computers; about logistics management as a result to ensure supplies get to where they can do the most use.

This can be monitored by the minister, routine reports can be prepared showing which centre reported, which district has complete reporting, which state has complete and timely reporting and % of stock outs of basic drugs or vaccines etc.

And inspired by many of the presentations I’d seen on the morning of the second day from University of Khartoum’s research centre and of course the Public Health Institute who are reaching out to try and create greater awareness through public forum, newsletter and other events.

Perhaps the presentation that struck the biggest chord was from EpiLab
who have achieved impressive results in helping to reduce the incidence of TB and Asthma and whose research and community communication techniques are highly innovative. I loved the cartoons they developed on how to self treat and prevent the incidence of illnesses which were drawn up BY the local communities.  Their pictures and their words are published as guides for the nation and I know they will make them available so I can share them in future blogs.

It was an honour, a challenge but nevertheless great fun enhanced by the warmth of the welcome and a genuine sense of appreciation. Sudan’s people are among the most engaging and intelligent I’ve met. One anecdote from a conversation with a young professional in the communications business illustrates their dilemma:

‘…of the 95 people who graduated in my year a few years back 90 are now working overseas, the majority in highly paid good positions…’

In my address I acknowledged the support I’d had from many people in preparing for the event. They were: Ahmed Mohammed, Dr Alim Khan, Dr Anshu Banerjee, Ana Neves, Andrew Curry, Archana Shah, Chris Collison, David Gurteen, Dr Gada Kadoda, Dr Ehsanullah Tarin, Dr Madelyn Blair, Sofia Layton, Steven Uggowitzer, Victoria Ward

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.