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Just-in-Time Delivery
Comes to Knowledge Management
by Thomas H. Davenport and John Glaser
The Best ofIntentions
John Humphreys
Let’s Put Consumers in Charge ofHealth Care
Regina E. Herzlinger
Management by Fire: A Conversation
with ChefAnthony Bourdain
When Paranoia Makes Sense
The Growth Crisis – and How to Escape It
The Mismanagement ofCustomer Loyalty
Campaigning for Change
Just-in-Time Delivery Comes
to Knowledge Management
Thomas H. Davenport and John Glaser
Make Your Values Mean Something
Patrick M. Lencioni
by Thomas H. Davenport
and John Glaser
stantly changing. Clearly, it is difficult generated in his field and still do his job.
This is not a trivial problem. It is, quite literally, a matter of life and death. Over a series of studies on medical errors. The Medicine’s 1999 report To Err Is Human each year are attributable to medical er- rors. Partners’ own research in 1995 sug- ical literature. Even if he were to consult tient reactions were serious, life threat- other hospitals and physicians’ groups), Copyright 2002 by Harvard Business School Publishing Corporation. All rights reserved.
B E S T P R A C T I C E • J u s t - i n - Ti m e K n o w l e d g e M a n a g e m e n t
tory tests ordered by physicians in Brig- bitious and risky project to link massive to success, we’ve found, is to bake spe- ported doctors’work processes. The proj- to address Dr. Goldszer’s problem. Part- believe, occur because the clinicians must in a given profession is not restricted to similar to Dr. Goldszer’s, though gener- ally theirs are less life threatening. No quality of physicians’ decision making – tient care. But it was also risky because spotty record of success in their first in- all the rage in the mid- to late 1990s, is same philosophy. In this article, we’ll Partners didn’t really know if it would still a good idea, but it needs a new ap- few Partners hospitals. We’ll also con- narrowly at first. Partners professionals possible–or impossible–to bake knowl- pected to participate in these activities in addition to doing their regular jobs.
Partners’ Ambitious Project
expensive. It’s not an undertaking that without a very good reason. A decade ago, have been only marginally successful.
Thomas H. Davenport is the director of
Accenture’s Institute for Strategic Change of treatment, they’re translating their in Cambridge, Massachusetts, and a man- agement professor at Babson College in actions at Partners hospitals. That these Wellesley, Massachusetts. John Glaser is
the vice president and CIO of Partners ing in direct opposition to their healing J u s t - i n - Ti m e K n o w l e d g e M a n a g e m e n t • B E S T P R A C T I C E
nurses’ station, and the nurse can decide may note that a particular test is gener- toms identified or that it has been per- this system, but it’s not the only one.
Partners’ approach is built on a set of nologies. Such practices are still in their records systems–that physicians can use phisticated screens for the physicians’ from a single database of clinical infor- precipitously. By the time he is flown to series of checks and decision rules.
Cape Cod Hospital, it might be too late.
Here’s how it works. Let’s say Dr.
If a specialist in Boston, or for that mat- tory arrest, but, as long as the history ter in Tel Aviv, can interview the patient of sleep apnea is noted in the patient’s the physician to that potential problem.
scan results, the likelihood of effective It also takes into account the patient’s lergic reactions to any medications.
ication, but she once had an allergic re- brings that reaction to Goldszer’s atten- view of patient medical records as well.
out. The organization’s on-line sources For example, the system alerts the physi- (collectively called The Handbook) in- cian, as he or she reviews Mrs. Smith’s a rash, or major, like going into shock.
Mrs. Johnson’s reaction was a rash. Gold- szer decides to override the computer’s her cholesterol levels. In addition, it may their use, and even on-line textbooks.
weighs the negative effects of a relatively through an integrated intranet portal.
physician isn’t treating a patient directly It’s an unusually good set of resources, tals can consult. The Handbook is ac- cessed, across all Partners institutions, is linked not just with the clinical data- talized patient’s monitored health indi- base but also with the patient’s records B E S T P R A C T I C E • J u s t - i n - Ti m e K n o w l e d g e M a n a g e m e n t
though it’s invisible to the clinicians, the practice figures changed. However, Part- tice, has some early data suggesting that Keys to Success
for more than a decade, it’s still not com- Developing a system like Partners’ isn’t mittees. Teams of specialists design care easy – from either a technical or a man- ble within the organization’s two flag- has not yet been codified for all the dis- eases that Partners physicians treat. But the approach is clearly beneficial. A con- trolled study of the system’s impact on Prioritized Processes and Knowledge
Domains. Since these initiatives are dif-
patient-record system, a clinical-decision cial, but important decisions still needed ties, but Partners’ real-time knowledge specialist–and in what order. Fields with are more difficult to include in the knowl- Several of these aspects – each of which edge systems. In general, it’s preferable given fewer times per day, the percent of to develop systems in fields with low lev- Support from the Best and Brightest.
tients requiring bed rest also needed the Building a system like Partners’ is a chal- Final Decisions by the Experts. With
vironment or field they’re in, to support lives, they also save money. For starters, the system and the new way of working.
the system if it challenged their role – hospital stays and repeat tests that result can easily lead to mistakes, Partners’ sys- An Expert and Up-to-Date Knowledge
Base. If Partners’ clinical database in-
lete knowledge, it would put patients – and Partners itself – at high risk. Thus, that U.S. insurers have not yet seen their J u s t - i n - Ti m e K n o w l e d g e M a n a g e m e n t • B E S T P R A C T I C E
are generated, a third to a half of the or- ders are canceled. The hospital’s event- 3,000 alerts per year; as a result of these never successfully build a system of this health care, this discipline is called med- A Culture of Measurement. In order
cruited leaders in this field. It has several fessionals are different from other know- to assess how well it’s working, an orga- Clinical Information Systems R&D. The they’ve historically enjoyed high levels of autonomy; they’re sufficiently power- cians are also researchers. Its knowledge ence, statistics, and medical informatics.
In general, it’s easier to embed knowl- ers; the higher you go, the harder it gets.
ple illustrates that it is indeed possible as justifications and progress reporting highly skilled reps at high-tech firms like The Right Information and IT People.
applied to business problems, it’s tempt- ing to attribute any success to the tech- nology. But in the case of Partners’ sys- signers – depend increasingly on knowl- To place an order, call 1-800-988-0886.

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