Lois Ann Colaianni

For the past two to three decades librarians have been significantly expanding their roles. One of these new roles is knowledge manager. Knowledge management was identified as a key competency for medical librarians in the Medical Library Association's "Platform for Change" . This morning I will talk about what knowledge management is, why you should reinvent yourself into a knowledge manager, and how to start or increase your services in that direction.

If you were to approach several leaders in the medical library profession and ask them what knowledge management is, you would probably get a number of different answers. So, let's begin with one definition of knowledge management. According to Daniel Tkach in IBM's online series, Advances in Knowledge Management, knowledge management is "a discipline used to systematically leverage expertise and information to improve organizational efficiency, responsiveness, competency, and innovation" . Knowledge managers design and implement systems to use all the organization's key information resources. Here "systems" means an organized process. It is not limited to computer systems; however, technology makes knowledge management more feasible. Mr. Tkach states that the three essential components of knowledge management are knowledge discovery, knowledge organization, and knowledge sharing. Knowledge is stored in people's heads, in organizations' policy and procedure manuals, in data collected by the organization, or in external resources such as the published literature or Web sites. Put another way, the knowledge manager identifies resources for information throughout an organization, provides access to the information in those resources, and implements a method, preferably an easy and convenient one, to share the information with all who might need it.

Managing the integration of information in health sciences institutions was identified as an important activity in the 1980's report by Cooper and Matheson, "Academic information in the academic health sciences center. Roles for the library in information management." . Librarians saw in the this report an important and much needed role for them to take in their institutions. Since then a number of medical centers in the United States have undertaken the complex task of integrating their important academic information systems.

Over a decade later the Joint Commission on the Accreditation of Health Care Organizations delineated a similar role for librarians in hospitals and other healthcare organizations in their standard for information management. The Commission is the national accrediting body for healthcare organizations in the United States. Jacqueline Doyle describes the change in the Commission's approach to information management in her article "Knowledge-based information management: Implications for information services". Initially, librarians were disappointed that the Commission eliminated the section on Professional Library Services. Library services are now incorporated in a new Management of Information section, along with medical records, information systems, and other information resources within the hospital. As Jacqueline points out, incorporating the concepts of knowledge/information management offers hospital librarians many new opportunities.

The Commission identified seven key processes in information management:

1. Identifying the healthcare organization's needs for information
2. Designing information systems
3. Defining and capturing information, especially data created within the institution
4. Analyzing the data
5. Turning the results of the analysis into information
6. Reporting (sharing) the information
7. Using the information to improve performance

The last and most important step is using the information to improve performance or outcome. The Commission's vision was that healthcare organizations both generated and had access to large amounts of information which could be turned into knowledge and used to improve patient outcomes.

Thus knowledge management starts with a needs assessment. This requires that librarians become skilled at designing and conducting needs assessments and then analyzing and reporting the results, or they must obtain someone else to do all or parts of the assessment. The goal, of course, is implementing programs or services to meet the needs identified through the assessment. In my hospital the assessment showed that most users wanted the ability to order articles electronically. It has taken about nine months to get such a service implemented for the hospital. Most of the time was spent getting the approval of legal counsel and advisory committees, since the National Library of Medicine already provides the mechanism for ordering documents through PubMed's interface to MEDLINE. Some of the users' other needs will require more time and effort since there is developmental work to do.

The standards emphasize services, ways to get information to users. Many librarians provide some current alerting through distributing tables of contents from selected journals or sending articles of interest to users. This kind of service will probably continue for a while in smaller libraries. Generally this service reaches a small number of users. Knowledge managers look for services that can reach larger numbers of users when and where they need them. One way is to provide users' electronic access to the full text of journals. Other services are providing material on evidence-based medicine or links to really useful Web sites. Bireme provides a number of information resources in their Virtual Library that you can make available to your users. A searchable database listing access information for journal titles available on the Web not accessible through Bireme could be useful to a large number of users, if you cannot afford to license access to full text from a vendor.

The Commission's standards call for networking and connectivity, Tkach's knowledge sharing. Connecting to external databases and resource sharing through regional interlibrary loan are ways libraries network. If your institution has an Intranet or e-mail, there are their ways you can use this connectivity to communicate new information such as new government studies or PAHO/WHO reports with a large number of your users. Can you think of other types of information to which you have access that users would welcome receiving?

In our haste to adopt the newest technologies let us not forget the importance of people to people networking. Knowledge management requires knowing what others are doing, what data is being collected and analyzed in other parts of the institution, and determining how you and others can access it. This requires good people skills. It requires work to get others to make their information accessible. Information is considered power! Sharing the information is sometimes viewed as giving away power. It often requires considerable skill to overcome this difficult barrier especially if the political environment in the institution is not providing a powerful impetus to share. Many people feel overworked and sharing requires spending additional time. Once you find someone with valuable data, you may need to help them find a way to share this easily.

Can you see how this role of knowledge manager is an evolution of the traditional role of a health sciences librarian? This evolution is irrespective of the institution in which one is working and even if one is not in charge of a library. For most librarians a new role requires a change in philosophy and/or practice of the traditional role. Medical librarians have usually viewed their role as facilitating access to information to be used for clinical, educational, administrative, or research needs. If you focus on "access to information", this new role is not so new. It is adds opportunities. Even if you are a cataloger or an acquisition librarian, your role can take on aspects of the role of knowledge manager. Identifying and providing a bibliographic description of information on the Web and the access to this information is a modification of the traditional acquisition and cataloging roles. Then putting this information in a database and sharing it throughout an organization is part of knowledge management.

Why is it important that you undertake this new role? You are probably comfortable and feel competent doing what you are currently doing. Sometime in the future when you leave the library, the institution can hire a knowledge manager if they want one. You may not feel that you can be successful as a knowledge manager in your institution. You may not think that you have or can acquire the skills to change your role. You may not think that your users want these changes. You serve a group of users that have become accustomed to your library and its services. They are happy. You've worked things out with your administration. Why, as the expression goes, "rock the boat"?

There are two reasons why each of you should consider the knowledge manager role, if you aren't already engaged in it. The most important reason to become a knowledge manager is your users deserve it. Knowledge management produces excellent, useful information to effect positively clinical, education, and administrative outcomes. Knowledge managers think of not just the traditional library users but all the potential users in the institution. Chances are, if your institution is like most others, only a small percent of the potential users are your users now. Second, you deserve it. The new role will bring growth and excitement to your professional life. It will also bring frustration at times. This frustration is usually overshadowed by making the librarian's information skills known by and available to a larger group of people.

Right now many of those of you who are not knowledge managers are mentally listing the barriers to changing your role. I can almost hear your mental protests. No money, no status, no access to administration, no internet, no time, no staff, not paid enough, no way to learn these skills, no support. No! A few are enthusiastically making notes, ready to begin as a knowledge manager next week. The next section of my remarks, based on personal experience, is addressed to both groups.

For both the reluctant and the enthusiastic, the important word is gradual evolution. How gradual depends on your skills and the institutional support for these changes. The evolution starts with three things. First, is a change in your philosophy, a realization of the power resulting from integrating information resources. Second, is finding out what your colleagues are doing. Talk with other medical librarians in your region and in attendance at this meeting to find out what knowledge management activities they do. How did they get started? Find out what resources are available to you in your institution, locally, nationally, regionally through BIREME, and internationally through PAHO, WHO, the National Library of Medicine in the U.S., and others? It doesn't make sense initially to think of starting activities that you must start from ground zero. For example, it is my understanding that librarians in Chile have access to Loansome Doc and can electronically request articles from the University, saving time in the mail. Learn how and do it. Increase your skills. It should result in a better service to your users. This would be a great beginning.

Third, find out what your users want. Again the term users is not limited to those people who actually have used the library. They are significant and should not be overlooked, but it is essential to talk with potential users. Who are the movers and shakers in your institution? Can you talk with them about their information needs? A good, well-respected champion cannot be underestimated! Such persons are essential to expanding your role. And before you talk with them you need some ideas of two or three things you might do that you know others in your community or region have done. But don't limit your talk to telling them your ideas, get theirs and then try out one or two ideas on them. I call these first steps a needs assessment or environmental scan.
After the environmental scan, pick a small number of projects you want to undertake. Pick a couple of small ones you and your staff can do without much administrative support. Identifying journal titles available on the Web is one. Identifying sites with clinical practice guidelines is another. See if someone in the area has done this and you can share the work and the results. Pick one larger project such as identifying the top ten conditions treated in your institution and develop a way to post abstracts or links to full text to important new review and evidence-based medicine articles for these ten conditions so medical and nursing staffs have access to them. Pick a project both that users want and you can do. Pick successes! Involve users in the project.

When you have developed the service, publicize it. Publicize it in ways that users will pay attention to. Give recognition to the first user, the 100th user, etc. Publicize the ways the service has improved clinical outcomes. Tell users how to access the information or push the information at them - post the abstracts or send them to appropriate medical and nursing staff electronically

Evaluation is important. Are the new services being used and for what? Did any of the information make a difference? In my biannual user survey I ask users about the ways information from the library have helped them clinically. Last year over 50% of those replying to the survey indicated that the information had been used to confirm or change diagnoses or treatment decisions. Almost half reported that information from the library led to the use of less expensive medications and/or a reduced hospital stay. This data is useful in showing administration the usefulness of information services.

Enlist the support of your information systems staff. Get to know people in that department. In the universities they often are conducting research projects involving the Internet, building web sites, teaching the use of software, trying new software, etc. Get them to think about the library as a partner in applied research. Involve them in working on sending and receiving full text articles over the Internet. Get help in setting up or improving a Web site so you can communicate with more people. Take courses to enhance your skills. Insure there are Internet terminals in the library for students and staff to use. These provide a great opportunity to teach users some skills, show them a new database, explain new services, and the like. Some librarians have undertaken helping users with their Palm Pilots.

Knowledge management is here to stay. Different business terms to describe knowledge management may be developed but the basic concept is essential. All your institutions collect vast quantities of data. The processes by which they collect it, analyze it, integrate the information that results from the analysis with information from other resources, and share this information is knowledge management. Institutions must engage in knowledge management if they are to benefit from all the data they collect, if they are to improve clinical outcomes, and if they are to improve productivity. Remember: knowledge drives action.

You have a part to play in the knowledge management processes in your institution. You can choose to be an active player in knowledge management or not. You have at least some of the skills. You understand the information needs of health practitioners, researchers, educators, students, and administrators. You understand how to assess information resources. You understand retrieval strategies and techniques. You understand methods of information delivery and access. You understand the need for standardized terminology and how to develop it. You understand evaluation. You understand the importance of indicating the sources and date of data. You understand how to share resources. If there are any of these skills you do not have there are wonderful resources for acquiring them. These resources are articles, courses, and colleagues, including the BIREME staff.

What you may not know is what data is being collected, how it is collected, when and by whom. You need to learn this. The best way is to be involved in some key committees or network with people in your organization involved in medical records, quality management, risk management, and information management. Also, find out what is collected by public health agencies and hospital associations. Think about how you can make the connections between the published literature, including that on the Web, and the decisions that are made daily in your institution. You have a great deal to contribute to knowledge management in your institution; you can be a knowledge manager. You just have to convince yourself, find the way to improve knowledge management in your institution, and then demonstrate your skills to others in specific, beneficial projects.

Let me close with a personal note. I began my career in 1966 just as automation and computers were being applied to library work. Then bibliographies were prepared by hand, citations from the printed Index Medicus or other indexes written on 3 X 5 slips. My first job was as a MEDLARS searcher when searches were run as batch jobs on mainframe computers. A colleague told me I was crazy to take that job; but my career vision was getting information to health professionals. It was not limited to caring for books. I have kept that vision for over 30 years. It has meant that I had to keep reading, going to meetings, talking with colleagues, and learning. It has meant moving with the technology. As searching became free and simple searches could be easily done by health professionals, I spent more time emphasizing teaching them how best to get the results they needed. It hasn't always been easy. Others feared that sharing this information would somehow demean their value. Quite the contrary, it has made them more professional. Now that I am working in a one person hospital library I have an opportunity to apply the skills of a knowledge manager. There are a lot of barriers in my institution to this but it is clearly my vision. It's the next evolutionary step in my career. Won't you make it yours?


Advance in knowledge management. Online Series. Source: http://www-4.ibm.com/software/data/km/advances.

Tkach DS. Information mining with IBM intelligent with the IBM intelligent miner family. An IBM Software Solutions White paper. IBM, 1998. http://www-3.ibm.com/software/data/iimer/fordata/download/whitefam3.pdf

Burroughs C. Measuring the difference: guide to planning and evaluating health information outreach. Seattle, Washington: Pacific Northwest Regional Medical Library, 2000. http://www.nnlm.nlm.nih.gov/evaluation/guide