My Master's Dissertation
A knowledge management oriented healthcare's visual model: the healthcare's diagram.
University of ABC (Universidade Federal do ABC)
Master in Biomedical Engineering
MY WORK AT THIS PROJECT
Dr. Harki Tanaka (supervisor)
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I am particularly proud of my Master's Dissertation. I ventured myself into this new world called Biomedical Engineering to develop my master's research. It was two years of intense hard work that ended in this humble piece of work.
Healthcare systems are facing constant challenges to ensure their sustainability and innovation. Even though technological solutions are often considered relevants and priorities, their implementations not always promotes significant changes within the system that in fact innovates them. The main reason for that may be that technological solutions are typically built to manage information while complex problems, like healthcare, require knowledge management. The present dissertation has as main objectives to present a new perspective towards healthcare organisations throughout the elaboration of a visual model oriented to knowledge management, relates the role design plays in complex problems and suggests ways to apply the visual model in problems solutions, using the example of the extension project case, developed in a partnership between the University of ABC and the Secretary of Health of a city in the metropolitan region of ABC (São Paulo). The result of this dissertation is the design of the Healthcare's Diagram as a visual model oriented to knowledge management in healthcare and its application in real situations. As future challenges, it is possible to highlight its application in diverse problems in complex systems.
Key words: biomedical engineering, design, knowledge management, complex systems.
Understanding Brazilian healthcare system
The first part of my dissertation explores how the present Brazilian healthcare system (SUS) is structured and works. It is based on three organizational principles ( decentralization, hierarchy and regionalization).
The SUS framework is organised by it's complexity: the user usually enters the system by the primary healthcare entrances and is directed to more complex structures if necessary.
Basically, there are two mainstreams in the SUS framework: an adminstrative and a health service mainstream.
Healthcare systems main activities depend on specific knowledges regardless whether they are managerial or medical activities (MORR and SUBERCAZE, 2010). That means, the main asset of a healthcare organisation is the knowledge that exists within it.
The complexity of the system makes it difficult to understand the flows of knowledge that exists within it, and it is even harder to manage them. Being able to manage knowledge may be key to optimise workflows, costs and quality of the services provided.
Therefore, my research proposed to combine knowledges from two different areas to enable the understanding of the complexity of a healthcare system: knowledge management and design.
Designer: the interpreter
The design origins reveals that the designer is an interpreter, a person who can understand different parts of a system and integrate them through an interface. As the interactions between the parts of a system become more and more complex, the need of an interpreter becomes more evident. The modern designer works in sensemaking, which means he works to bring meaningful experiences to life.
Meaningful: to whom?
Whenever we think of something meaningful, we must have in mind: to whom is it meaningful? That is key into understanding why is it so hard to find and track knowledge within a complex organisation. As a designer, I had to find out what piece of information and knowledge should be available or accessed by whom, and I came to identify four main actors in healthcare: patients, health professionals, managers and scientists.
These four actors interact with each other in every healthcare activity. Depending on the activity, not all actors may be directly involved, but basically they represent four major sectors of knowledge that are independent from each other but, within a healthcare system they interface.
The Healthcare's Diagram
At this work, I propose a diagram to organise these interfaces between actors.
The diagram is divided into four sections: Sp, Ss, Sg and Sc. They represent respectively the Patients, Health professionals, Managers and Scientists.
Each section is subdivided into three arches that represents the structures of each sector.
The structures of each arch are oriented based on the knowledge level involved.
To understand how the diagram was designed and why, it's important to know three important knowledge management concepts:
Nonaka and Takeuchi's Knowledge definition
Based on Nonaka and Takeuchi's theory of Knowledge Management, there are two types of knowledge: tacit and explicit. Tacit knowledge are related to feelings, to the "know-how" of things, and insights. The explicit knowledge, however, is related to data, information, verbal communication, anything that could be expressed, structured or verbalised.
Nonaka and Takeuchi's Knowledge conversion
They believe that knowledge can be converted from tacit to explicit and vice versa by some processes: socialisation, externalisation, combination and internalisation. That means that the knowledge can flow (pass from person to person, or from group to group) within an organisation throughout these processes.
Nonaka and Takeuchi's Ba definition
The third very important contribution of Nonaka and Takeuchi is the definition of Ba. Ba represents where this processes take place. Its is not specifically a place, actually, it is more of a virtual ambiance where the exchanges of knowledge may happen. In other words, the Ba is the shared context where knowledge can be exchanged.
The center of the Healthcare's diagram is the Ba. Any Ba. Depending on the activity, service or situation someone wishes to look upon to identify or track knowledge within a healthcare organisation, the Ba may change.
For example: If someone wishes to develop a new EMR (Eletronic medical record) the "Software Design Project" will be the Ba. If someone wants to re-design the nursing workflow of a hospital, the "Re-design of nursing" will be the Ba. So, whatever the issue is, it will occupy the Ba (central) position.
The sections represents the knowledges that each of the four actors may have towards the Ba. In the "Software Design Project" example, each actor would have an array of knowledges to contribute to the project:
The arches of the diagram
The inner arches (Ai) represents the people who are directly involved in the Ba situation. These are the people who are directly affected or who affects directly the problem evidenced in the Ba.
Middle arches exemples by sections:
The exterior arches (Ae) represents the mindset of each section. Society, Medicine, Government and Science are respectively related to each section Sp, Ss, Sg and Sc. They usually are the collective, they have no responsible person or entity: they are the mob mentality of each section.
The knowledge dynamics
Once we understand the main Knowledge Management principles and we learn how the diagram is designed, we can understand the dynamics of knowledge within the system. They can be:
This page is a brief explanation of my Master's dissertation. If you have an interest in learning more, please, do not hesitate to contact me! I'll be thrilled to provide you further information on the subject.
Want to know more?
You can download the complete dissertation by clicking on the link below! (Available in portuguese only.)