Knowledge Transfer to Improve Clinical Practices in Saudi Arabia
In the healthcare system, it has become imperative to facilitate the transfer of research evidence into medical practice aimed at improving the hospital enterprises. However, occupational healthcare staffs have encountered challenges while delivering evidence-based practice, due to the need for accountability in the system. For healthcare organizations to deal with the challenges that may occur in the process of facilitating research based-evidence, knowledge transfer or translation (KT) is being used as a significant concept to link research with the healthcare services (Pentland et al., 2011). AlBuhairan and Olsson (2014) argue that KT is a crucial concept that healthcare personnel can use to address the gap between knowledge acquired from research and its application within the clinical system. For instance, in Saudi Arabia, the health services have been given priority by the Saudi administration, which makes the sector to improve in terms of quantity and quality (Almalki, FitzGerald, and Clark 2011). However, more needs to done in the Saudi medical system, in particular regarding the course of transferring knowledge acquired through medical researchers. Thus, the purpose of this paper is to present a proposed plan that can be used to disseminate evidence-based knowledge in the Saudi Arabian healthcare system. The plan is to implement computerized decision support system to improve medical care practices in a local clinical facility in Saudi.
Objective
The use of computerized decision support system (CDSS) in the healthcare setting has numerous advantages to both the clinicians and patients receiving the care services. The CDSS system is an information technology based software that provides doctors and nurses with guidelines for illness diagnosis, management of various diseases, and treatment (Moja et al., 2016). In most cases, the system is integrated with evidence-based knowledge and patient electronic healthcare record system (EHRs). Thus, for a detailed analysis of the system and its significant to a local hospital in Saudi Arabia, this proposal will be based on the following objectives.
- To explore the use of computerized decision support system (CDSS) in minimizing medical errors.
- To outline the way CDSS can be implemented for improving the quality of care and enhance that the hospital achieves patient satisfaction.
- To establish the way CDSS system can help leaders in the hospital facilitate managerial processes within the healthcare institution.
Summary of the Context
The KT plan is going to be implemented at a local hospital located in Saudi Arabia. Currently, in Saudi Arabia, the government operates most of the public health care institutions. Due to improvement in the education system and more accessible learning program in the country, the clinical system has improved intensively (Almalki, FitzGerald, and Clark 2011). Despite the effort by the government in Saudi to make local hospitals among the best in the Middle East region, computerization in the sector is yet to become effective (Altuwaijri, Bahanshal, and Almehaid 2011). Therefore, from the list of the objective mentioned above, it is clear that the new knowledge is meant to increase across the hospital, enhance the quality of the medical care, and makes the healthcare personnel familiarity with advanced technology in the healthcare unit.
Audience
The obvious audience for CDSS system will be the nursing staff and doctors working at the hospital, as the system will have a direct impact on the hospital’s personnel. Theoretically, computerized decision support system influences hospital practitioners positively; therefore the proposal considers the staffs in the hospital as the primary audience. In a report compiled by Fossum (2012), it is quoted that 92% of the people who were involved in the research felt that physician are the primary users of CDSS system. Kroth et al., (2006) agree with this argument by saying that CDSS is useful for nursing and physician personnel, as the system assists the medical workforce to improve the accuracy of the care services. Therefore, the local hospital staffs will apply the proposed plan to comply with the recommended care practice, reduce the cost of operation, and sustain the quality of patient care.
Stakeholders
When designing the plan, it will be essential for the researcher to consider the healthcare interested parties and other types of decision makers who will benefit when the plan if implemented. For the plan to attain its objectives, the researcher will consider the hospital’s design and organization structure in terms of decision-making procedures, the strategic planning that the healthcare applies, and governance structure. Abdullah, Albeladi, and AlCattan (2014) assert that in the application of research-based KT plans, it is vital for one to understand the organizational structure as having the structural idea relevant for the system’s effectiveness. As CDSS is a software that will support both internal and external individuals, the primary stakeholders who will use this system are clinician-administrators, leaders, patients, and other stakeholders involved in clinical decision-making process. Rajalakshmi, Mohan, and Babu (2011) cite that CDSS is an act of providing medical stakeholders, patients, and other participants with pertinent knowledge or accurate information intelligently that will enhance them to provide better care services.
Barriers and Facilitators
In Saudi Arabia, technology is changing the shape of healthcare organizations, which is strengthening the growth of the healthcare firms in the country, as well as the quality of services offered. On the other hand, the Saudi Arabia government has focused on implementing health information systems so that hospitals can provide the patients with standard and well-versed care services (Alsadan 2015). However, as the Saudi government continues to work on ensuring that all hospitals in the state have a computerized system, scholarly evidence shows that several barriers hold healthcare organizations in Saudi back from adopting technology in the system. Consequently, these obstacles have made hospitals in Saudi lag behind and work with staffs who do not have the necessary knowledge for improvement and healthcare development.
The CDSS barriers are the factors that may lead to the failure of the system and unreliability of the decisions implemented through computerized decision support system. For the plan intended to be developed in the local hospital, the following are the primary barriers that will influence the effectiveness of CDSS system.
Inadequate Resources
With no doubt, CDSS system will be implemented appropriately where planning and resources are used in the best way possible. Hasanain, Vallmuur, and Clark (2014) suggest that during the application of the technological system in the hospitals, lack of resources can be a major problem and it can lead to the failure of the system. For example, for the case of CDSS system, the key resources barriers include human resources, skilled computer and technology personnel, as well the availability of other technological devices such as printers, ink, conventional computers, among others (Alsadan 2015). In essence, due to the shortage of these resources, the use of CDSS in the hospital will not be fruitful for healthcare practices. On the cases of lack of skilled staff, this means that many people working at the hospital do not have the knowledge of using CDSS system, which is a major challenge when it comes to the success of the system. For the nurse leader to solve the human resource problem, it is proposed that the staff working in the hospital need to be trained about CDSS system, as this will improve their knowledge on the use the system in different levels of medical decisions.
Financial Barriers
This problem is associated with money and funding that is employed to support the implementation of the computerized decision support system in the hospital. Based on available literature, many hospitals in the Middle East region do not have enough fund to spend on healthcare technological system (Alsadan et al., 2015). As a result, this makes it difficult to implement the systems and train professionals on the usage of the same. Khalifa (2013) proposes that this problem can be dealt with by allocating proper funding and investments, on the CDSS project, as this will assist the hospital to overcome the cost of implementation and training the staff on how to apply the system during the decision-making process.
Complexity of Clinical Workflow
In the Saudi Arabian healthcare organization, the clinical workflow is complex, and the implementation of CDSS will not make the routine work of the medical professionals easy. The system is expected to bring the unexpected event that requires nurses to respond to them in a correct and efficient manner. The aspect of workflow is considered as one of the biggest barriers to the implementation CDSS, as it can influence nursing staffs to make errors in the management of tasks and implementation of decisions. Khalifa (2013) expresses that for the technological system in hospitals to be applied effectively, the leaders in the hospitals should ensure that the workflow matches the system. This can be achieved if managers redesign work, in a way that the medical tasks are set in a particular manner that will require the workforce to integrate the system implemented with their day-to-day work activity.
The Transference of the New Knowledge
Knowledge transfer is part of knowledge management, and the person who is better suited to transfer knowledge is an individual working within the organization. In the healthcare organizations, knowledge is power and in this study, an experienced person will transfer the information contained in the plan. Thus, the nursing preceptor will be requested to transfer the KT information, as it is part of his or her role in the hospital. Flynn and Stack (2006) posit that in hospitals, it is the role of preceptors to ensure that nurses have excellent skills, the nurses work as a team, and staffs in the nursing organizations are proficient at all time. Since the preceptor is a teacher in the hospital, he/she will be taken as a knowledge transfer expert, hence, taking the role of conveying the CDDS information to the experienced and novice nurses.
Strategies to Transfer the Knowledge
Before the procedures to transfer the new knowledge are selected, efforts should be made to overcome barriers that would influence the aspect of KT plan. To understand the best ways that can be applied to overcome the KT barriers, the researcher may research information on knowledge transfer through face-to-face contacts with the nursing expert or give suggestion on the way nursing leaders can change the behavior of the nursing staffs who do not have the skills concerning the CDSS system.
Training
For this proposal, training will be the most prominent strategy to use when transferring the new information to the nursing staffs. Since all the nurses in the hospital have an idea or knowhow to use computers, the preceptor will focus on training them on how to integrate the computers with the hospitals EHRs with the CDSS system. The guide that will be inform of a training program will focus on three major areas. First, the preceptor will highlight to the nurses how to apply CDSS in the each unit, second the perceived facilitator, and finally, barriers and experiences that may be gained by when using CDSS system. White (2005) suggests that training nurses about the technological system that are implemented in the hospitals help nurses become more accurate and learn how to link diverse sources of client’s information to make the decision that will allow them to offer effective care services. At the same time, Fossum (2012) affirms that training on the use CDSS and any other system is a supporting strategy for the systems and their implementation.
Mentoring
Mentoring is another strategy that this proposal considers in the process of transferring the new knowledge. The rationale of taking mentoring as part of this plan is that it will help the preceptor establish a relationship with nurses and ensures that the knowledge becomes part of the hospital’s culture (Malloch and Porter-O’grady 2016). This implies that when the preceptor mentors nurses about the new knowledge, this will give them an opportunity for development, become mutually committed to the new system, and keep the employees engaged with the new knowledge for decision-making.
Effectiveness of the Knowledge Transfer Plan
The first method that will be used to test whether the KT system’s effective is verification or static method. In this context, the nursing expert will review the CDDS knowledge base manually or automatically in which programs that search for systematic errors in the aspect of knowledge base will be used (Jean-Baptiste et al., 2010). In this method, verification of the effectiveness of the KT plan will be done through checking, where the preceptor will take the responsibility of inspecting whether there are errors when CDSS is implemented, or mistakes are occurring when the decision support system is not implemented.
Moreover an iterative approach will also allow the nurse leader at the hospital to determine the benefits and unanticipated problems relating to the new decision-making model. The iterative approach is a computation method that can tell the nurses the benefit of CDSS system from multiple stages and the types of testing that will be required at all point of CDSS development cycle. According to Sim et al., (2001), CDSS evaluation in actual practice should incorporate computation, as this could aid the nurse leader to improve the process, understand the strength, and weaknesses of the new system aimed at enhancing patient care practices.
Conclusion
This paper proposes a KT plan that will change a local hospital in Saudi Arabia if the concept is applied by considering all factors that will influence it positively and negatively. In essence, CDSS has been presented as a program that healthcare enterprises can use to facilitate the practice of evidence-based for sustainability and improving the hospital. Although CDSS is viewed as a promising model for the hospital, substantial factors such as barriers and the person to transfer the knowledge need to be considered. With this understanding, this proposal identifies that the nursing preceptor is the rightful person who should take the responsibility of delivering the new insights using training and mentoring methods. When the two techniques are used, it is apparent that the hospital will realize the advantages of CDDS and use the program continuously for the benefit of the patients and nursing staffs.
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