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

KMUK12 opening: taking the plunge

How do you set the tone for a two day event (KMUK) with a large gathering of skilled km practitioners many of whom can do such sessions in their sleep? Over a cup of tea at the National Gallery, Victoria Ward and I recalled an exercise Philip Gibson had run a few years back for an EDRM event I’d chaired.

‘Taking the plunge’ is intended to

  • Get people involved
  • Get them to interact with colleagues outside their immediate teams
  • Generate energy at the start of an event

Here’s how (with Philip’s help) I ran it:

I had six large signs, placed conspicuously around the room, reading:

pool side
changing room
diving board
shallow end
deep end
bar

I introduced the exercise with a picture of a swimming pool (actually Pells Pool in Lewes where I live which is the oldest outdoor pool in the country)

image

I then said:

I’d like you all to imagine that you’re at the KMUK swimming pool. Where would you be?

at the pool side – for those still observing rather than being involved

in the changing room – for people who are preparing but not yet ready to take on their km role

on the diving board – for those who are about to ‘take the plunge’

at the shallow end – for those who are ‘testing the waters’ and not too sure if they want to get deeper

at the deep end – for those who are already well and truly ‘immersed in’ their km role

at the bar – for those who are celebrating achievements.

Now please would each of you go to the sign which you feel best represents where you personally have got to with your km role. You have two minutes to do this. Go to the stations which best represents where you think you are now in your role and NOT where your colleagues are going to!

At this point there was a lot of tooing and froing as the delegates decided where they should assemble. Once order was restored I invited them to:

Please take a minute to reflect in silence about why you’re where you are.

And then

I’d like each of you to pair up with someone near you, preferably someone whom you don’t already know well and take a minute or two each to share with them your reasons for being where you are. Let the first person in the pair begin while the second listens.

image

Some of the delegates (including Arthur Shelley and David Gurteen) at ‘the Bar’

After a couple of minutes I asked them to switch and repeat the process. At the end of the first round (which took 6 minutes) I invited them to:

Now pair up with someone else near you whom you don’t already know well and repeat the exercise.

The session concluded after 15 minutes with this

I hope that’s got you thinking about your km role as well as helping you to get to know a few of your colleagues a bit better. I also hope that all of us will get further along through the day ahead. Now please take your seats.

Over the course of the 2 days many of the delegates and speakers referred back to the swimming pool and the individual locations became a good metaphor for discussions.

‘…it can be quite lonely at times’ I reflections from Henley KM’ers

‘Dear John, I never imagined 10 years ago the true impact of knowledge. The bureaucracies of the paper world are gone and communities are what deliver value at a local and a global level.  All my knowledge of technology was of only passing value. The networking skills are what are helping me thrive.’

Just one of the many postcards sent back from the future (2020) to today by the delegates at Henley Business School’s 12th meeting of their KM Forum. Putting learning at the heart of the organisation was the theme of the annual two day retreat and I was there running a Sparknow timeline exhibit that featured highlights of the evolving role of the ‘knowledge manager’ research we’ve carried out.  More of that in a future post.

This post is about the exhibit and how postcards were used as a technique to develop a delegate view on the changing environment and role of a ‘knowledge manager’.

why a postcard?

In many ways the postcard serves a powerful metaphoric role for key dimensions of knowledge management and of time:

  • It is personal/private but at the same time both shareable and publishable via a noticeboard.
  • It maintains its quality of having been individually authored, so the link to the originator stays explicit.
  • It is light, compact, and highly portable.
  • It is asynchronous, but interactive and annotatable
  • It is an ideal vehicle for messaging
  • It is time saving for the author.
  • It is an early form of multimedia, allowing an almost infinite range of attached images

Sparknow’s research into the use of postcards goes back over a decade. Victoria Ward and Professor Clive Holtham of Cass Business School and others from Sparknow wrote about the uses of the postcard in re-forming organisational time, place and meaning” for the ‘In search of time’ conference, held in Palermo in 2003. A copy of that paper and one presented in 2010 on slow knowledge can be found here.

why a timeline?

Our experience suggests people respond best when they are asked to situate comments against a time and place (and often an object or event) as a backdrop.

postcards and time lines as a combination.

The visual impact of a series of postcards on a timeline is visually compelling.

image

materials for the timeline

By putting up background material for the three focus points on the timeline (2002 > 2012 > 2020) we were able to provide context for the postcards people were writing; to get them thinking back from 2020 to today and then from today to 2002. We were particularly grateful to Andrew Curry and The Futures Company for letting us reference their work. Andrew wrote an interesting and thought provoking blog to accompany The World in 2020 publication we drew on to design the exhibit.

image

looking back from 2020

the questions posed were:

Imagine you are writing back to someone in 2012 from 2020 (or to 2002 from 2012). Tell them:

  • about your daily life
  • what’s changed about your job as a ‘knowledge manager’ and the environment in which you work
  • what kit and tools are different now from then.

image

looking back to 2002

and the outcomes

More than 25% of the delegates completed a postcard.  Each revealed something about the writer and their vision of the world.

A couple of revealing postcards from today back to 2002

You’re still in KM.  And for a while it’s even in your job title.  You do a lot of technology.  You spend a lot of time in “programmes” and service development, development in general, is project-based rather than continuous.  The KIM profession is government recognised, but frequently struggles to find direction and leadership.

Hello, we’ve almost forgotten how to pick up the phone or walk over to speak to people.  We spend a lot of time sending “texts” from our phones and reading about our friends’ activities from their “electronic” Facebook page.  It can be quite lonely at times.

Many felt strongly that being networked will be one of the key differentiators in 2020; that technological advances will continue to enhance our ability to work wherever and whenever we want to but that time savings (to enjoy more leisure) is a forlorn aspiration.

Few saw the ‘knowledge manager’ title as being around in 2020, it being best illustrated by this:

The Knowledge Manager is extinct. Culture and behaviors of the knowledge manager are embedded into all employees as the modus operandi.

though another said in 2020:

I am working as an advisor, consultant, advocate, counselor, co-creator. I work to Board level leadership but I roam The Organization, working to improve colleagues’ personal and group knowledge management.

Technology has simply become the channel, its just the ‘thing’.

a great piece of advice:

Try to write letters as much as possible because otherwise your handwriting will get even worse.

what would I do differently next time?

Actually not too much though I’d probably have more people versed in the material, able to explain the significance of the dates to ‘visitors’ to the exhibit. And I’d make sure I had enough people around to help put up an 18 foot poster when I arrived at the venue.

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.

image

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