Defining and measuring Knowledge Capital in Health Care

1. Defining and measuring Knowledge Capital in Health Care Presenter:Sumathi Sundram University Of East Anglia - Health Economics Group / Norwich Business School Co – Author: Dr Pinar Guven- Uslu University of East Anglia – Norwich Business School Sumathi Sundram - UEA

2. Knowledge Capital in Health Care • Context • Purpose of Research • Concept ;Theoretical Frameworks • Methods • Some Results • Conclusion Sumathi Sundram - UEA

3. UK context of Health Care Primary Care Trusts - HMOs Policy - Centralised, national Funding - Top down to PCTs Care Providers - Public Sector, mainly Private Sector, limited Sumathi Sundram - UEA

4. Purpose of Research Maximise Investment in Health Define and measure Knowledge Capital in health care organisation • Stock of embedded knowledge generating capacity • Method to define and measure knowledge capital in monetary and non monetary terms Sumathi Sundram - UEA

5. Knowledge Capital Edvinsson & Sullivan define : “Intellectual/ Knowledge Capital as the knowledge that is constantly being developed in organisations together with its’ ability to convert these assets into revenue” Sumathi Sundram - UEA

6. Theoretical Frameworks • Theory of Knowledge creating organisations • Meritum Project categorisation Sumathi Sundram - UEA

7. Research/ Knowledge Creation in Health • “Public Good” certain outputs non- rival, non excludable • Research & Development key driver for Health Improvement • Economic potential of public sector research establishments • Research key resource in healthcare services Sumathi Sundram - UEA

8. Why Knowledge Capital in Health • Theoretical basis for management of knowledge creation or research in health • Difficulty in agreeing resource allocation basis • Lack explicit recognition of phenomena • R&D capacity part of knowledge capital base • Optimal path of investment in health to maximise all benefits (inc) knowledge generation/ research capacity Sumathi Sundram - UEA

9. Methodology • Literature Review • Mixed Methods - Bottom up costing & Qualitative methods • Semi Structured Interviews- 2 Stages • Operational and Financial reports analysis Sumathi Sundram - UEA

10. Knowledge Creation Cycle – Health socialisation Primary Knowledge Explicit Knowledge Experiential Knowledge Tacit Knowledge Conceptual Knowledge Interacting & Capturing Organising & Formalising Practical Knowledge Internalisation Research & Health and Social Care delivery Externalisation Secondary Knowledge Routine Knowledge Systemic Knowledge Selecting & Adapting Explicit Knowledge Tacit Knowledge Identifying & Sharing Application Knowledge Combination Adapted from Nonaka, Nomura and Kametsu , & Umemoto (1999) Sumathi Sundram - UEA

11. Emerging Condition Pulmonary Hypertension • Cusp of Research – Clinical Care • Provision in care pathway, specialist tertiary/ specialist community services support • Defined as a National Specialist service Sumathi Sundram - UEA

12. Case Study Hospital • Specialist Cardio Thoracic Hospital • One of 5 National Centres for1 Pulmonary Hypertension (PH) Heart & Lung Transplant, Sleep Studies • International & National Center for Pulmonary Thromboendartecomy (PTE) • Patients from England, Wales and Scotland 1.Department of Health National specialist commissioning group “Service specification for the national pulmonary hypertension services (NPHS) January 2003 http://www.dh.gov.uk/assetRoot/04/13/08/99/04130899.pdf Sumathi Sundram - UEA

13. Purpose – Bottom Up Costing • Patient pathways –Pulmonary Hypertension services • Identify and cost resources - services & research • Cost the resources for Pulmonary Hypertension • Cost vs reimbursement per NHS (HRGs) Sumathi Sundram - UEA

14. Pulmonary Hypertension Activity Profile: 2005/06 Assessments: FCEs ( Finished consultant Episodes) Thoracic Day ward 62 Inpatient 66 Total Assessments 127 Follow–ups: FCEs & Attendances Inpatient FCEs 186 Thoracic Day ward attendances 291 Outpatient attendances 303 Sumathi Sundram - UEA

15. Pulmonary Hypertension – Multi- Disciplinary Team Sumathi Sundram - UEA

16. Pulmonary HypertensionResource Profile Assessments Inpatient or Day ward • Establish PH cause and stabilise • Establish severity • Between 3 to 5 days stay • Suitability for surgical intervention • Emergency inpatient Transfer • Patient Education Follow ups Outpatient , Day ward or Inpatient • Monitor progression of symptoms • Monitor and adjust drugs • up to 7 day stay if inpatient • Emergency inpatient Transfer • Readiness for surgical intervention • Patient Education Sumathi Sundram - UEA

17. Pulmonary Hypertension - Tariff Payment by Result Tariff – Reimbursement HRGs D06 - minor thoracic conditions requiring <2days stay), D07 – Fibre optic Bronchoscopy (requiring <2 days stay) E14 – Cardiac Cath and angiography without complications and co-morbities) E37- other Cardiac Diagnoses (ranging from viral carditis to haemorrhage, not elsewhere captured) E38 – Electrophysiology and other Percutaneous Cardiac Procedures>18 E39 – Electrophysiology and other Percutaneous Cardiac Procedures>19 E40 – Other Cardiothoracic or Circulatory procedures >18 E41 – Other Cardiothoracic or Circulatory procedures >19 E99 – Complex Elderly with a Cardiac Primary Diagnosis P25 – Cardiac Conditions (includes Aortic Stenosis, multiple valve disease, Primary Pulmonary Hypertension etc) Q12 – Therapeutic Endovascular Procedures Q19 – Vascular access for renal replacement therapy Sumathi Sundram - UEA

18. Costed Profile vs Reimbursed Sumathi Sundram - UEA

19. Other Funding Generated PH Team 7 years Annualised Donations & Interest £103.7k £14.8k Research £544.1k £77.7k Total £647.7k £92.5k Sumathi Sundram - UEA

20. Staff time, specialist training posts, research staff National protocols, leadership of professional body, national patient pool, specialist training materials, Patient education and material, Patient Support groups Human Resources Capital Equipment, databases, computers, Specialist Medical equipment National Capacity in Health Knowledge Capital Tangible Capital Relational Capital & Public Goods in Health Capital External research funding, Patient Donors, National, Global Leadership in field Dimensions of Knowledge Capital Meritum project Adapted from Meritum project Sumathi Sundram - UEA

21. Challenges (1)- National Policy • Healthcare service • Funding not reflective of resources used • Targets not accommodating complexity • Additional outputs not recognised • Culturally seen as lower status Sumathi Sundram - UEA

22. Challenges (2)- National Policy • Knowledge creation • Lack of Commissioner understanding • Interdependency not explicitly recognised • Research outputs not part of main performance management • NHS Funding not for joint outputs Sumathi Sundram - UEA

23. Conclusion • Knowledge Creation & healthcare delivery interdependent • Policy and management needs to be integrated • Bottom up costing process useful for resource recognition • Services funding not enough for knowledge generation • Tool for planning better utilisation of knowledge capital Sumathi Sundram - UEA

24. Knowledge Capital Defining and Measuring Thank You For Defining and measuring Knowledge Capital bottom up costing useful tool Sumathi Sundram - UEA