Strzelecka A. (WZ PCz, c. Czestochowa, Poland)


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This paper presents an approach that allows both for effective decisions making to reduce the risk in the provision of medical services and to improve organization of the health care centres.


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Keywords: knowledge management, risk management, system approach



A particular stress has been put on the quality improvement of performed services in healthcare in recent years. Various management models have appeared in the healthcare organizations and the number of patients taking advantage of health services has increased. Moreover, the consumption of health services has risen which is the result of the change in the approach of society members to the protection of their own health. The innovations introduced both in science as well as in the medical technology have shown the need to apply new management models in medicine, in particular while preparing new system solutions which could reveal mistakes made in medical practice and which put a significant emphasis on the process of acquiring knowledge and permanent improvement of healthcare employees.

Taking the above into consideration, international healthcare organizations i.e. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and World Health Organization (WHO) prepared and accepted the concept of clinical management the purpose of which is to provide the patients with care of the highest quality. This type of management comprises monitoring and improvement of services, risk management, audit and testing the efficiency of clinical programmes, personnel management, health education and the use of information in order to provide healthcare at sufficiently high level..

Therefore, this article presents the matters of knowledge and its management in healthcare organizations. Furthermore, the aspect of outsourcing and the necessity to consider the risk appearing in the treatment process in the healthcare are discussed in it.


Knowledge management and outsourcing in health care institution

The role of healthcare organizations is to initiate open and hidden knowledge of healthcare employees in the services offered to patients, better understanding of the organization objectives by the entire staff, decrease in the resistance against the introduction of organizational changes, increase in the quality of patients service.

Thus, it is very important that all employees, regardless of their age, education or taken position, should acquire new abilities, acquire and make the knowledge public. It has particular meaning in satisfying community needs, which is performed by healthcare organizations when they provide health services at the level of high quality and in a way which ensures the efficiency of a given organization. These objectives can be gained thanks to knowledge management (KM) which in healthcare consists in:

1.     Gathering data for healthcare provider,

2.     Data processing (reports, indexes),

3.     Creating knowledge being the entire gather information,

4.     Taking advantage of knowledge in order to obtain benefits.

KM helps to facilitate the activity of a given unit and, thanks to it, to improve the quality of community lifestyle and the results of healthcare organizations and to decrease the risk connected with taking decisions inappropriate from economic point of view (Figure 1.).



Figure 1- The functional aspect of knowledge management

Source: Own analysis


Taking into consideration the specification of the healthcare sector, it is possible to understand the knowledge management as the combination of people, processes, data and technology in order to optimize information, cooperation, competences and experience in order to affect the results and organization development [Cagliano A. C., Grimaldi S., Rafele C, 2011].

Therefore, using Information and
Communications Technology
(ICT) in healthcare seems to be very important as it makes it possible to increase internal efficiency of the managerial functions, to improve the health service quality, to create the rules of working and controlling the decisions, to monitor and to compare organization results and communication with the surroundings. The technology is a powerful tool to increase safety in the health processes but the improper way of introducing IT or its functioning in the medical organization may complicate the work of the staff in the healthcare organization. Taking advantage of e.g. Electronic Data Interchange (EDI) may contribute to the control of healthcare organization costs and to increase in the quality of the care over the patient. Moreover, modern information and communication technologies make it possible to manage the healthcare system in a rational way and in particular to control the costs and to increase the quality of health services.

Cost reduction is very important from the point of view of healthcare providers as it affects the level of provided services. Outsourcing, which makes it possible to transfer the auxiliary services connected with the process of patients service to the external suppliers, is of significant meaning in this area.

This management concept in the healthcare organizations is constrained by e.g. legal regulations, increasing costs of providing services, no possibilities of insourcing, in many cases, which was transferred in outsourcing of services due to complete liquidation of previous background [Strzelecka A., 2011, pp. 222-223].

This situation may be solved when some healthcare organizations create so called groups of recipients who taking advantage of the services of the same supplier, can generate the economies of scale for this supplier and at the same time lower prices e.g. by exchange of possessed knowledge (Figure 2.).


Figure 2- The project of providing medical services in the group of recipients

Source: Own analysis


Such a solution makes it possible to decrease the costs of healthcare organizations working and simultaneously provides the market for health service providers.

In such case the cost reduction is connected with the probability that the risk occurs while performing the core activity by an entity.


Risk management in health care

Healthcare is often connected with the lack of control over the performance of particular processes which is conductive to the occurrence of undesired events the consequences of which the patient suffers and which (similarly to mistakes while treatment) are difficult to be eliminated in the healthcare entities. However, it is possible to control them by permanent improvement of management processes including risk management. According to Project Management Institute risk management includes: actions connected with planning the place of risk occurrence, its identification, analysis, monitoring and control, whereas the purpose of such management is to increase the probability and the consequences that the positive events occur and in the same time to decrease the probability that the undesired events occur and their consequences [Project Management Institute, 2004].. Thus, these actions are necessary in case of among other following risks existing in the healthcare [Lewandowska H., 2011, pp.277-282]:

-     Risk connected with core and auxiliary activity it refers to the appropriate choice of medical services, it refers to the ability to take advantage of intellectual potential of white medical staff by the managers of the organization and is most often connected with outsourcing.

-     Logistics risk occurs at the level of internal organization processes and is connected with wrong assessment of suppliers and recipients.

-     Technology risk refers to factors which affect the shape of organizational structure and management concept and means the optimal use of technical infrastructure leading to the realization of a particular objective.

-     Market risk is connected with the number of services in the spatial and quality approach and the demand forecast.

-     Strategic risk refers to the results of changes performed in the organization.

-     Operational risk refers to the healthcare organization objectives and priorities.

Regarding the risk arising from direct (medical) and indirect (healthcare system functioning, providing security for patients, remuneration for medical staff, outsourcing, environment protection) activity affecting the patients, it is possible to say that testing medical mistakes and knowing the reasons for occurrence of these mistakes is very important. It makes it possible to understand the essence of undesired events and their connections with other non-medical factors better.

In order to find the reasons for damage the Reasons theory of hidden damage is appropriate [Reason J., 2002, pp. 40-44]. Undesired effects are rarely the result of one mistake, they are usually the consequence of the set of mistakes and events which are affected by both human and technological factors. Thus, it is possible to say that a given accident (event) is a result of actions happening at different levels of decision taking.

In the Reason model an undesired event is defined as the unexpected energy release (impulse) which can be prevented by constructing barriers between the source of energy (inappropriate action) and the person or protected object. The figure 3 presents the Reason model in reference to the accidents at work in the healthcare. Obviously, it is possible to use it in respect to undesired events occurring in the healthcare organizations (specific companies).


Figure 3- Undesired events in healthcare and protection against them according to the Reasons model of accident

Source: Own analysis on the basis of Pietrzak L., 2002, p. 4.


Figure 3 analysis leads to the statement that improper decisions taken by the managers of hospitals or its wards are very often the first reasons for the occurrence of undesired events. Moreover, the following may be treated as indicators of undesired actions: incompleteness of procedures, too big emphasis on producing medical goods and services, the lack of medical equipment maintenance or postponing it in time, too little number of proper activities, flow of different, frequently contradictory, information, failure to determine entities responsible for activity and responsibility transfer on different people, inappropriate (insufficient) trainings or wrong technical conditions.

In the model the barrier may be understood as wide range of preventive measures and using the protective measures e.g. the safety systems, protective devices, procedures, trainings, supervision and emergency plans. [Harms-Ringdahl L., 2009, pp. 353-363].

Thus, the existence of direct or indirect reasons for disadvantageous events in any social or technological system implicates the need of systemic approach to the risk which is necessary to obtain complex picture of mutual relationships between technical, human and organization factors which could cause or prevent the negative events. The need for such approach is much more visible in case of clinical risk as the healthcare systems are created for people and by people, whereas the final purpose of these models is to provide medical service in such a way which is the safest for a patient.

Engaging the entities taking part in the examined process, delivering information needed at all phases of risk management makes individual prospect possible. Thus, using the information and knowledge being possessed by the healthcare staff is important. Its appropriate use guarantees proper course of treatment processes (Figure 4.).


Figure 4- Information use in providing health services

Source: Own analysis


Systematic approach to risk management is focused on a specific healthcare process and on identification, assessment and control of risk connected with providing health services.

Taking advantage of Human Reliability Assessment (HRA), the modern techniques are used, among others the computer ones to increase the reliability and safety in the healthcare sector.

Except for such HRA stages as:

1.  Data collection,

2.  Task description,

3.  Task simulation,

4.  Human mistake identification,

5.  Performed analysis,

it is possible to distinguish:

6.  Context analysis - determining and getting acquainted with examined process, in this stage the first (general) knowledge about existing processes and quantitative data flows, clinical and organizational information is gathered.

7.  Process mapping using risk management tools in order to obtain detailed information concerning the process and identification of entities responsible for it.

8.  Risk identification and assessment specification of risk sources and its analysis. The main area enabling to identify internal risk sources comprise:

- human resources medical staff, its tasks, knowledge and professional abilities of particular persons,

- physical and technological background modern technologies and materials used to perform particular activities,

- communication / information basis of the relations between material and human resources and between them and technological background,

- physical structure all tools necessary to support the management of processes, technologies and clinical treatment while providing healthcare.

9.  Failure modes and waste analysis (FMEAWaste analysis) - technique used in order to pay attention to action ineffectiveness, inefficiency and inability of considered health system and examining the reasons for damage.

The discussed systemic approach makes it possible to consider the analyzed issue in entirety. Considering the risk management Joint Commission on Accreditation of Healthcare Organizations approved FMEA as a tool serving to risk reduction for patients [Brown A., Eatock J., Dixon D., Meenan B.J., Anderson J., 2008, pp. 541-555; Ookalkar A.D., Joshi A.G., Ookalkar D.S., 2009, pp. 817-830].


Final remarks

Processes of providing services in healthcare enable the patients to take advantage of the work of different providers offering special services. A patient has the possibility to obtain the best complex healthcare provided there is a cooperation between service providers.

Initiation of logistic solutions in non-profit organizations in healthcare contributes to the increase in efficiency and effectiveness of provided services, cost reduction, rationalization of resources flow in these organizations, improvement of the patients service quality as appropriate management of medical data and supporting the decision making process is one of the key tasks in the management of healthcare organizations.

Moreover, appropriate knowledge management in healthcare system is an incredibly significant issue. It can be done by implementing technological solutions, reduction of service costs, limitation risk in decision making.

Thus, it is possible to say that the information and knowledge are one of the most valuable resources, the possession and proper use of which more and more often decides about the organization position and meaning as modern technologies and market globalization change the economy forcing the use of modern information technologies and knowledge resources in management.

The complexity of healthcare requires the management approach considering different point of views. It makes it possible to use the system approach in the examination of clinical risk which considers an important role performed by a man in healthcare systems.


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