A positive deviance perspective on hospital knowledge management: analysis of Baldrige Award recipients 2002-2008.

Knowledge management (KM) is emerging as an important aspect of achieving excellent organizational performance, but its use has not been widely explored for hospitals. Taking a positive deviance perspective, we analyzed the applications of nine healthcare organizations (HCOs) that received the Malcolm Baldrige National Quality Award from 2002 to 2008. Baldrige Award applications constitute a uniquely comprehensive, standardized, and audited record of HCOs achieving near-benchmark performance. Applications are organized around leadership, strategy, customers, information, workforce, and operations. We find that KM is frequently referenced in all sections, and about two thirds of each application addresses KM-related issues. Many specific KM activities, such as strategic and action plans, communications, and processes to capture internal and external knowledge, are addressed by all nine applications. We present examples illustrating these frequently appearing KM concepts. Baldrige Award-recipient HCOs apply continuous improvement to KM processes, as they do to their organizations as a whole. We conclude that these HCOs have developed sophisticated, comprehensive KM processes to align both culture and specific procedures throughout the organization. KM in these organizations is a deliberate effort to keep all relevant knowledge at the fingertips of every worker, characterized by frequent communication, careful maintenance of content accuracy, and redundant distribution. We also conclude that the extent and rigor of their KM practice distinguish them from other U.S. hospitals.

The use of cervical paravertebral block as the sole anesthetic for shoulder surgery in a morbid patient: a case report.

OBJECTIVES: The purpose of this case report is to describe the use of the cervical paravertebral block as the sole anesthetic for shoulder surgery in a patient unable to tolerate general anesthesia. Recent literature describes the continuous cervical paravertebral block as an effective alternative to the interscalene block for the management of postoperative pain after shoulder surgery. CASE REPORT: An 85-year-old man with severe respiratory and cardiac disease presented for major shoulder surgery. The patient's complex medical history required an anesthetic technique that would avoid general anesthesia and preserve phrenic nerve function. This case report describes, to our knowledge, the first successful use of the continuous cervical paravertebral block as the sole anesthetic for shoulder surgery. CONCLUSIONS: Continuous cervical paravertebral block provided excellent surgical conditions and postoperative pain relief for this patient and allowed gradual and intermittent dosing of the catheter and continuous assessment of the anesthetic impact on respiratory function.