LtF Chapter 8 - Learning Whilst Doing

Half term week makes for rapid and quiet bus rides - ideal for zipping through this brief chapter detailing the use of After Action Reviews.

These were developed by the US army during the war in Vietnam as a rapid means to learn in the field. (The image on this page is from the US Military Flickr account and is of an AAR taking place in Iraq). The full details of how these are operated in the army are published online "A Leader's Guide to After Action Reviews".

It boils down to four questions:

• What was supposed to happen?
• What actually happened?
• Why were there differences?
• What can we learn from that?

It is a quick process - around twenty minutes and to be carried out in the immediate aftermath of whatever you are examining. Most of the documenting is of the actions.

I like these a lot and I am certainly going to try and make use of them within my working life.

I wonder to what extent this sort of practice is formalised in processes around care? It should be happening around adverse incidents and near misses but what about in the everyday? Organisationally we are working on the Productive Ward model. Having a quick scan of the documents there are loops for learning but I wonder if it might benefit from the rapid feedback that an AAR would bring?

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LtF Chapter 7 - Learning from your peers

Half distance in the book and another chapter of practical advice around a technique - in this instance "Peer Assists".

Compared to the benchmarking exercises described in the previous chapter I found this technique harder to grasp. Perhaps because the scale of investment in time and people seems that much greater.

The Peer Assist is a means to share experience and knowledge around a topic. It is convened by those undertaking the work and is very much a request for help. It should happen early in a project to allow for maximum gain in terms of applying any lessons learnt. It is suggested that they may well take between one and two days to complete. There is a balancing act in terms of the people in attendance to get diverse enough views that fruitful learning can take place and assumptions be challenged, without things being so diverse that it is hard to know where to start. You also need people at the right level.

12 steps are laid down for planning a Peer Assist and these are explained in some detail. They seem a reasonable framework. Ideally it is suggested that you attend a Peer Assist as a participant before you organise one. So a case of asking around for someone who has participated or of getting in someone externally to run a trial?

Rolling peer assists are described as a means of dealing with larger groups or shorter time frames. Here people rotate in small groups with sharing of background / the issue repeated for each group. I was actually involved in something like this as part of the evidence gathering work for the CILIP Public Health Policy Statement. We used a rotation around four boards to gather views around a number of questions related to how librarians and libraries can / could contribute to Public Health. A scribe in each corner noted peoples comments providing something for people to build on. Unfortunately this was on a very short time frame as we were in a fringe meeting slot at Umbrella so the groups rotated roughly every ten minutes (indicated by me shouting "Bong" at the top of my lungs hence the image on this post!). From experience I can definitely say that a more structured version of this with a little more time available could be excellent.

I wonder if these quick hit type peer assists might be more manageable as a starter within our library networks. The peers could be from outside our network area but it might well be interesting to bring in those from other sectors (public libraries etc) or indeed people from outside the profession. Locally I suspect that the service redesign team will already have skills in these techniques (all be it perhaps under another name).

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LtF Chapter 6 - Connecting sharers with learners

First of the tools chapters - the focus is on the use of self assessment as a means to identify potential knowledge sharing opportunities.

It is suggested that a common language be established through benchmarking. The NHS is full of acronyms, NHS speak and the professional jargons of all the groups that work within it. A way to break through this sounds good.

As mentioned in my last post I spent the afternoon today at an event to launch a toolkit designed to share examples of where NHS Knowledge & Library Services are contributing to NHS goals and objectives. This is very much about making our case in a language that is clearer to other NHS staff. There were some great examples of how getting the right information can change lives and save money. I am not sure if the case studies include any of benchmarking but this might well be an area worth investigation.

In terms of developing a self assessment framework one option would be a stripped out version of the National Service Framework . I suspect we could probably thrash out a smaller subset of things we felt really matter. Based on this framework we would then have a chance to do a lot of the kind of work then described in this chapter. The techniques and methods of illustration are practical. The river diagram is particularly appealing. It is similar to the kind of diagrams generated by the LIBQUAL+ process which uses a circular variant to illustrate the gap between user ratings of a service and the service level they desire.

Trying this all out on health library services would be a great way to learn more about how the process works in practice. This could then be applied elsewhere in the organisation.

The chapter concludes with various examples of the process in action. All in all a very positive read with clear applications.

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LtF Chapter 5 - Getting started - just do it!

Back from leave and taking the plunge straight into Chapter 5 which looks nice and short.


First suggestion - start where the business is. I have this very much in mind as I am speaking at the launch of the Alignment Toolkit tomorrow afternoon. This is an initiative aimed at demonstrating how knowledge services align with, and impact on, NHS priorities. I am looking forward to hearing about examples of being 'where the business is' and am sure there will be some great ideas to follow up.

First reflection point - What do you need to learn? I am struggling to know where to start with this. I can think of many things I could do with learning. Off the top of my head - why do some people use our services a lot and others in similar roles not at all? I have to run a workshop for my Directorate on organisational learning early next year and this would certainly make a good question for debate.

Slightly frustrating to find the book again looking ahead a few chapters discussing a tool we are yet to learn much about (After Action Reviews).

Next reflection point - what is the best environment in your organisation for Knowledge Sharing? I am fairly sure that technology is not going to be the solution on this one. We have a number of technological means of knowledge sharing already in place and these definitely don't reach all parts. The idea of a physical, visual presence is appealing. It would definitely have to be addressed through teams. A case by case approach would be required. The book suggests Knowledge Managers need to be communicators and I would heartily agree with that.

This ends the first section of the book and we move into tools and techniques with Chapter 6.

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LtF Chapter 4 Getting the environment right

Last chapter for this week and we move on to managing the environment in which KM will take place.

First on the list is tackling barriers to sharing. One of these that will immediately ring bells for health folk is that of technology. This is a barrier to a variable extent in the NHS. My organisation has a good
setup technology wise in terms of the base position though our knowledge sharing tools could do with some work (more on this later). However, in common with most workplaces, there is some work still to do on equipping everyone with the skills to make the most of this. Things definitely get more difficult technically speaking when we move to collaboration with colleagues in other organisations in our patch. Another barrier identified in the text is that of a culture of not asking for help - not sure how much this applies in health. Certainly health librarians have a culture of seeking help from peers.

The discussion in the book of systems for sharing at BP sounds like a major set up. However most of use operate in a Microsoft world due to the national agreement. In terms of the Reflection Point the big problem I see in my organisation is the profusion of places that people can share information. By my count we have no less than three organisation wide points where people can share documents. There will then be a multitude of other departmental and team based systems. Resolving these into an effective system with good information retrieval will take some doing but would undoubtedly address issues around information sharing.

The book then turns to processes and specifically working with peers - either to peer review, peer assist or in sharing groups. Some of these remain to be defined. Within the reflection point an example I can think of is work in my organisation to training a group of people to act as catalysts for service efficiency improvement. This is can be a case of fresh eyes / perspectives and sharing knowledge which fits with these ideas.

Considering behaviours we need to think about how people can be encouraged both to seek and offer help. This is something I plan to take up within my directorate structure as there are a number of functions involved in the kinds of roles where we will be more effective if people ask for our assistance. An example of a positive feedback for those seeking help would be to ensure that the quality of evidence in support of a clinical policy was noted when it was submitted for approval. Other behaviours discussed are active listening (helpful) and challenging assumptions (harder).

Leadership is another part of the environment for consideration. The questions set by the Centrica directors are good ones. I would be happy to see these in action consistently. Supporting new starters in the organisation with more than just corporate induction seems like another excellent idea. This could be applied within health library networks (perhaps growing from the London Health Libraries induction) and might be a means to address some of the knowledge gaps created by staff turnover.

A number of examples are then discussed: a school, change at BNFL and the UN AIDS programme. I found the school example the most powerful in terms of the examples cited and the impact that sprang from them.

The chapter closes with a recap of the main seven threads to consider when preparing an environment for knowledge sharing / management. I find it interesting that in contrast to the chapter that treats technology first this is relegated to the final point on the list.

I am out of the office for a couple of days either side of the weekend so expect a later posting date for next weeks two chapters.

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LtF Chapter 3: The holistic model

Freakishly quiet on the bus this morning. This was a good thing as the glorious weekend weather saw me do none of the reading I needed to for today. I did get to try out my new garden waste incinerator which I can heartily recommend. Moving swiftly on to the text...

The chapter looks to build a model that can then be modified to fit other situations. The model described is focused on learning throughout the progression from business objectives to results. Previously captured Knowledge is applied during the doing phase and renewed through and after it.

This seems fairly self evident to me but encouraging people to think in this way would be constructive. Research before actually launching into something is easily missed. Lessons learnt afterwards are far from regularly captured and shared. The how will be interesting. Perhaps a format for structured reflection that is then searchable and shared? I agree that success stories can lead to a positive cycle of sharing.

I think the key would be how you sustain these behaviours. I can see lots of opportunity for good intentions and interesting projects that then falter in the face of other pressures. Staff turnover would also be an issue leaving behind orphaned "knowledge assets" and an induction burden.

A closing quote "When we define where we want to be, all our actions turn out to be congruent with that place" reminds me of Irrationality by Stuart Sutherland. Well worth a read (if rather repetitious) Sutherland would rephrase this as "When we define where we want to be, we tend to ignore the evidence that does not fit with our view".

This chapter still often points ahead rather than including much detail. At least the points to skip ahead to are clear but I am left wanting more.

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LtF Chapter 2: What is Knowledge Management?

A chapter with a big agenda.

The authors emphasise the cultural aspects of knowledge sharing and present a continuum (devised by Larry Prusak) ranging from Capture (codification of knowledge - documenting) throught to Connectivity (softer cultural and collaboration aspects).

1st Reflection point - where is the largest prize for my organization and where should we invest our effort?

I think it may be that the big reward will come from improving the connectivity type aspects. An enormous amount of capture and documentation is generated both within my organization and in the wider NHS / research settings. Often people do not know where to start with all this, how to cope with the flows of information or locate things they are dimly aware of. I definitely think there would be a benefit to the organisation of my team working to map and make more visible a lot of this stuff. Part of this would have to be about developing peoples skills in coping with information flows.

A definition of tacit versus explicit knowledge follows. Placed in the context of the Wilson article (I think I may refer to this regularly) this seems broadly OK. Explicit Knowledge can be written down (Information). Tacit cannot - it is what we have in our heads.

The importance of maintaining up to date information through the application and testing of knowledge is held up and that a network is a good way to do this (possibly a facilitated one). This is interesting as it points to a potential role for us - for example we can help seed a review of a local policy by supplying relevant new evidence to the relevant person. It might also tie into how we might use the Team Knowledge Officers proposed by the Hill Review?

I think we could safely put librarianship in the People AND Process AND Technology diagram but then you could put most modern work in that overlap. I am not sure how multimedia and videoconferencing would make tacit knowledge more widely available however since the whole problem is that this cannot be readily expressed.

The next section touches on the variety of KM 'solutions' on the market place. A holistic view is suggested with what looks like the Learning by Doing cycle I spend my life handing to student nurses (5 minutes later someone asks for that very book - spooky). The suggestion is that any documentation of this learning should be very brief - sounds reasonable. The learning also needs to be easy to reapply if it is to be used.

More discussion around defining knowledge which perhaps falls foul of Wilson - the example uses some information from frequent flyers - it is hardly knowledge. A barrage of definitions follows Know-how, Know-why, Know-what, Know-who, Know-where and Know when. I am not entirely sure about what to make of this - I guess it provides a set of categories to work with.

Four conditions are suggested as being required to create an environment where KM can flourish (given that the authors acknowledge Knowledge cannot be Managed!). They seem like quite a big agenda from where I am sitting.

The final major chunk relates to how we move from unconscious incompetence to unconscious competence. This is quite a widely circulated model and is suggested as a means to embed KM. Later in the book we should meet some tools to help with this.

That will do for today - maybe some fresh thoughts tomorrow. Comments welcome.

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LtF - Chapter 1 Setting the context

A nice short and summary packed chapter to kick off.

The chapter opens by discussing how we go about building knowledge in everyday life and highlights starting with simple questions.

The first exercise is to consider the process around your last car purchase. Hard for me to comment as I have never bought one - I know not a whole lot about them and care little. But the answer to the underlying question - how much effort do you put into getting a big purchase right versus making a decision at work - is more straightforward. I tend to put quiet a lot of effort into researching my options before making decisions. I suspect this is a fairly common trait amongst librarians - we like to look around an issue before taking the plunge.

The rest of the chapter is a summary of what lies ahead. I am not going to rehash it here!

The chapter closes with another exercise - three questions that occur to me.

1. How are they going to define knowledge?

2. How many of the practical ideas are going to be heavily IT based?

3. Why can't school children just sit quietly on the bus?

I suspect that only one of these will be answered in the next chapter...

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Learning to Fly - getting started

Back from leave and ready to start reading Learning to Fly. I got back lateish yesterday and therefore only managed a quick spin through the first chapter on the bus this morning. Rather than wade straight in I plan to run my eye over it (and chapter 2) again on the way home tonight / on the bus tomorrow morning).

I will probably post my reflections on the exercises denoted by a bird along with other commentary.

Final thought for today - I suspect from the introductory sections that the definition of Knowledge is going to be a bit vulnerable to the criticisms discussed previously.

Happy reading...

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