I recently had the opportunity to participate in a conference with Nancy Dixon, the author of Common Knowledge: How Companies Thrive by Sharing What They Know (Dixon, 2000). One of the handouts contained a quote that poignantly struck me:

No one should be dying or suffering because knowledge that already exists in one organization has not reached another organization. It is up to each of us to take the responsibility to ensure the knowledge flows easily to where it is needed.

Sharing knowledge has become easier in some fields. For example, the 14 states who made up the Centers for Medicare & Medicaid Services Care Transitions pilots openly share the wisdom (the good, bad, and ugly) of what was learned. Many of the "products" are in the public domain. There are also several Internet sites that add valuable information to the knowledge pool, such at the National Transitions of Care Coalition (http://www.ntocc.org). Others are not so open about "sharing," especially in corporate cultures where competition is more important than decreasing suffering.

But let's pretend that in "our" world, everyone shares for the betterment of the patient. And let's say, for a moment, that everyone has something to offer. But you are not convinced that you have anything worthwhile to put forward: you are "new" at case management, you are young, and there are "gurus" and experts and pioneers!

One strategy is "Tapping the Long-Tail." The term "long tail" was coined in around 2003, and it has gained popularity in recent times. This has to do with the power law curve, which states that the most value is derived by the few, but there is a lot of value to be gained from the many. To the right is the long tail; to the left are the few that dominate. In the conference, the long tail was used contextually about transferring knowledge. One the left is the "highest" section that was coined "the chosen few." The long tail with the broader group, or the "many."

A story I heard many years ago suggests that the value of "the many" may be the key to unlocking the solution. It was said that a rather large truck was going through an underpass when it got stuck. A large crowd gathered, and one person boasted of being engineer, whereas another was an architect. For an hour, the adults argued various solutions, including those that would cause harm to either the bridge or the truck. Finally, a young girl whose father had just taught her how to change a tire stepped forward and asked why they don't let the air out of the tires.

Sometimes experts do not have the whole solution. Everyone has much to offer, and "tapping the long tail" is essential in our fast-paced health care environment. To make changes without this important strategy may lead to more problems, poorer quality of care, and greater costs.

Imagine that your director of case management tells you to put a new process into place. The director got marching orders from "corporate" because auditors have found too many 1-day stays for chest pain patients. This has to stop, or the hospital will be cited (it has already had money "recovered"). Now, this process comes to your department fully mapped out, as this process was deemed "successful" at another system hospital.

But no one asked the front-line case managers for input. And the effort is less than successful for several reasons-the most obvious is because you, the front lines, with deep knowledge of the challenges and culture of your hospital, were not asked. Therefore, your important information was left out of the solution.

But what if corporate decided to "tap the long tail?" What if they had a teleconference or a webinar between the "ailing" hospital and the "successful" hospital and encouraged open dialogue? This is not a resource-intensive initiative, but can lead to solutions that perfectly fit the culture of the ailing hospital and even may through in some good ideas for both hospitals. Another potentially wonderful outcome would be relationships with other case management colleagues.

Let's go even further and tap the knowledge of health care organizations outside your system. Here is a story that made me want to take a visit: According to Scott Kashman, Chief Executive Officer of St. Joseph Medical Center in Kansas City, Missouri, the hospital addressed the problem of costly readmissions through use of the model known as Re-Engineered Discharge (RED):

Project RED interventions redesign the workflow process and improve patient safety by implementing specific procedures and action steps that enhance the discharge process and decrease hospital admissions. The three key elements of this program include the discharge advocate, the after-hospital care plan and a follow-up phone call from the clinical pharmacist to the patient to review medications. (Kashman, 2011, p. 1)

They focused on patients with congestive heart failure (CHF). Prior to the Project RED pilot, they had a 19% readmissions rate for CHF patients; during the pilot, the readmission rate dropped to zero. Zero CHF readmissions! I want to know more.

Stories like this are becoming more common. But other hospitals are struggling and patients are suffering. We can learn from each other. We can literally visit and share our success and lessons learned-peer assist with one another remotely, through webinars, teleconferences, listservs. No matter how long we have been in case management, we know more than we think. We share less than we could. Holding back knowledge is no longer an option-and we need everyone's contribution.

Professional Case Management journal wishes you a safe and special holiday season.

References