Best Practice of Development of Nursing Knowledge Management

System at Universitas Airlangga Hospital Indonesia

Purwaningsih

, Nasronudin

, Nyoman Anita Damayanti

Faculty of Nursing Universitas Airlangga-Universitas Airlangga Hospital, Surabaya, Indonesia.

Universitas Airlangga Hospital, Surabaya, Indonesia

Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.

Keywords: Nursing Knowledge Management System, Knowledge Management Cycle.

Abstract: Increased knowledge of human resources in hospitals is needed in an effort to improve the quality of services.

These activities require a very high cost so that required a knowledge management in order to be useful for

the institution. Universitas Airlangga Hospital is a new operational hospital so it does not have knowledge

management system yet. Objective of this study is to develop knowledge management system in nursing

services by using knowledge management cycle. The methods that we used in this research was a qualitative

study with data collected from semi-structured interviews with strategic management team, nurses and then

give intervention to the nurses. The results from the first identification that more than 73% of employees said

that they do not understand about knowledge management because it has not been applied at Universitas

Airlangga Hospital. After intervention to the nurses there is an increase in internal and external stakeholder

satisfaction. From this research we can conclude that implementation of knowledge management system

should be extended to all employees at Universitas Airlangga Hospital.

1 BACKGROUND

Knowledge is very important to increase productivity

so it must be considered and managed well (Drucker,

1998). In reality, however, most of the existing

knowledge in the organization has not been properly

managed. The high level of employee turnover,

creating individualized knowledge, will come out

along with the individual of each employee

(knowledge walkout). The new employee turnover

should be provided with additional training so that the

time and cost of the training also impact on the

slowing performance of the organization. If the

knowledge possessed by employees is not developed,

then no knowledge is shared to be utilized by the

organization. Knowledge that has been well managed

and accessible will be very useful for organizations to

avoid the same mistakes. Knowledge must be well

maintained, so it can be developed, updated and used

continuously. That way, an organization can find out

how to take appropriate steps to address problems and

explore organizational performance by promoting the

use of structured information.

According to Groff and Jones (2003), there are

two main types of knowledge. The first and most

common type is tacit knowledge. The second type is

explicit knowledge. Tacit knowledge refers to

personal knowledge inherent in individual experience

and involves factors such as beliefs, perspectives and

personal values. Tacit knowledge is difficult to move.

Explicit knowledge refers to the tacit knowledge that

has been documented. Explicit knowledge is usually

in the form of a formal language and is more easily

transferred between individuals. In tacit knowledge

shows that the largest portion of knowledge (42%) is

faith in the human brain only. While explicit

knowledge in the form of paper documents (26%),

electronic documents (20%) and knowledge-based

electronic objects (12%). According to Tobing

(2007), the main components of knowledge

management are people, process and technology.

Each of these components will be interconnected with

each other and integrated into each other to form a

solid foundation for knowledge management.

According Tobing (2007), to organize and manage

the knowledge contained in the organization can be

started by grouping and categorizing problems

encountered within the organization. This is done to

identify activities that are considered as core

Purwaningsih, ., Nasronudin, . and Damayanti, N.

Best Practice of Development of Nursing Knowledge Management System at Universitas Airlangga Hospital Indonesia.

DOI: 10.5220/0008330406530656

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 653-656

ISBN: 978-989-758-336-0

 2018 by SCITEPRESS – Science and Technology Publications, Lda. All r ights reserved

653

knowledge management processes that are related to

each other.

The data on the number of nurses who were

trained and attended the seminar at Airlangga

University Hospital in 2016 was 21.3%. The low

number of nurses who were trained due to financial

factors in institutions is still small because it is still

prioritized for the use of repair and development of

facilities and infrastructure. Besides, the training and

seminars are done by sending the nurses to other

institutions so it needs a high cost. Based on that, at

the beginning of 2017 a knowledge-sharing program

from nurses who have participated in training to

representatives of nurses who did not attend the

training. The results of these activities have little

impact on improving knowledge and quality in

providing services to patients. Because not all nurses

are exposed to the same knowledge and unstructured

implementation. Evaluation result of this activity is

still 26, 6% nurse who have gain knowledge to

support in effort to improve service quality. Based on

the above experience, we want to develop a structured

KM system to have a positive impact on the quality

of services provided by the nurses.

2 METHODS

Implementation of Knowledge Management at

Airlangga University Hospital was conducted in two

stages, the first was to design the application of

Knowledge Management using Wiig’s KM cycle.

Wiig’s KM cycle addresses how knowledge is built

and used as individuals or as organizations. There are

four major steps in this cycle, such as building

knowledge, holding knowledge, pooling knowledge

and applying knowledge. The methods that we used

in this research was a qualitative study with data

collected from semi-structured interviews with

strategic management team and nurses and than give

intervention to the 263 nurses.

3 RESULTS

Before starting the KM system, We start from the

entire head of nurse to set the strategy to be used. We

set the KM day of the nursing field is on the day of

every Wednesday afternoon. We set a Wednesday

afternoon due to the fact that the number of patient

visits in Wednesday is less than the other day so as

not to interfere with patient care. On the first

Wednesday trained were the head of nurses to

become trainer for the nurses. The number of nurses

at the Airlangga University Hospital is 263 nurses and

there are 19 head of nurse, so the total nurse is 244

nurses. Each meeting can be attended by 30 nurses,

so in one topic we need 8 meetings.

At the stage of building knowledge, we determine

the source of information can be obtained with formal

and informal education. In upgrading nurses’

capacity, we send nurses for further study to nursing

faculty at a qualified university, that is for

undergraduate and master's degree in nursing. By

2017 we can send five nurses for further study in the

master's degree education in nursing. For informal

education, we set by using the KM system with

selected topics are customer services, nursing care in

patients with respiratory and respiratory failure, ECG

training, intravenous infusion, and ICU nurse

training. Setting topics, we use the PDCA approach

and the concept of Kaizen. Example of PDCA cycle

implementation, When there is patient with

respiratory failure requiring referral to higher level

hospital, We have problem to contact by phone so that

the risk of impairment in the handling patient. P:

Increase nurse knowledge about nursing care in

patient of breath and respiratory failure. D: Provide

training to all nurses. C: Evaluate of nurse’s ability to

provide treatment to the patient. A: Make standard,

make job description specification each member of

code blue team (ABC and CPR management team).

All activities are conducted at Airlangga University

Hospital with an experienced internal resource person

and experienced in the field. At the holding stage of

knowledge we create a list of training that must be

followed by each nurse in the competence book that

is distributed to all nurses based on career path that

has been set. This will be able to monitor and evaluate

the development of knowledge in each nurse. The

first meeting will attended by all head of nurse with

trainer from expertise. At the next meeting, the

participants were 30 nurses and head of nurse as

trainer. At the pooling knowledge stage we do by

using role play and bedside teaching training methods

that adjust to real conditions in the field. Participants

are given the opportunity to try to demonstrate and try

the skills they need when giving services. Training

materials are provided in ppt format so as to facilitate

the participants to understand and can be saved and

where needed at any time can be accessed again. At

the applying knowledge stage, all nurses must apply

what has been obtained in the training and if required

standard operational procedures, it must be made

SOP it.

The results of the implementation of this KM

system can be seen from the results of patient

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

654

satisfaction survey has increased above the minimum

standard of service set by the Ministry of Health of

the Republic of Indonesia, which is more than 90%.

Nurses who received training and knowledge

upgrading have reached 100%. to try to demonstrate

and try the skills they need when giving services.

Training materials are provided in ppt format so as to

facilitate the participants to understand and can be

saved and where needed at any time can be accessed

again. At the applying knowledge stage, all nurses

must apply what has been obtained in the training and

if required standard operational procedures, it must be

made SOP it.

4 DISCUSSION

Based on the above results, the development of a

structured KM system is very important to be applied

in the field of nursing because it is able to improve

the knowledge and ability of the nurses in an effort to

improve the quality. This is in accordance with the

concept of Becerra at all, 2004, that knowledge is

information that has value and can be used for

decision making with a specific purpose. For example

in the provision of customer services material on all

nurses, there is an increase in good hospitality

behaviour of the nurses in contact with colleagues,

doctors, patients and families and the community who

visit the hospital. The KM system that has been

designed in Airlangga University Hospital has taken

note of the things that can foster a knowledge sharing

culture in the nursing environment in order to

improve the quality of service. Some of the things you

can do to developing a culture of knowledge sharing

were: 1) Creating know-how, where every nurse has

the opportunity to innovate by providing

opportunities to synergize knowledge into service

delivery at the hospital; 2) Capturing and identifying

knowledge that is considered to be valuable and

represented in a logical way; 3) Managing knowledge

to ensure the current information to be reviewed for

relevance and accuracy; 4) Monitor and evaluate the

level of nursing knowledge and skills in stages.

In the implementation of KM in the nursing area

of Universitas Airlangga hospital also aims to build

mutual information or knowledge sharing among

nurse colleagues so that all information or knowledge

is not keep itself by individual but can be utilized by

all nurses in Universitas Airlangga hospital. In this

case shows that the area of Nursing Hospital of

Airlangga University has conducted the process of

tacit and explicit knowledge. Tacit knowledge is the

knowledge that remains in the mind of the individual

who possesses that knowledge. Filemon in 2008

suggests that explicit knowledge is related to the

document or something that has been implemented

from human thinking and also related to facilities,

products, processes, services and systems.

The results of KM activities have a positive

impact on quality improvement efforts at Universitas

Airlangga Hospital because there are increasing

knowledge, skills and behaviour of nurses who

provide direct services to patients. The KM approach

followed by the competent people and the right time

will create value. KM is also closely related to human

resources, documents and expertise so as to avoid

waste of time, waste of money and its impact is the

achievement of goals.

5 CONCLUSIONS

Knowledge that has been well managed and

accessible will be very useful for organizations to

avoid the same mistakes. Knowledge must be well

maintained, so it can be developed, updated and used

continuously. That way, an organization can find out

how to take appropriate steps to address problems and

explore organizational performance by promoting the

use of structured information. The development of

unstructured knowledge sharing has no impact on

improving the quality of service so that a structured

KM system should be implemented. This is evident

in what has been done by the Nursing Departement of

Airlangga University Hospital.

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