Social Networking “Enlightenment Found” in the U.S. Air Force Medical Service

Knowledge management projects are of limited value without a critical mass of content from end users. Content managers generally do a good job pushing information out to end users; it’s their job, after all. The great unwashed masses of end users, however, often feel a lesser need to communicate back. Most have something of value to contribute but are often unwilling to do so, particularly if there is a technical learning curve. This scenario can result in a mostly one-way conversation – even if hundreds of content managers are contributing quality content into a robust system indexed by an excellent search engine so that content is discoverable. Bottom line? A top-downonly information flow is not an effective knowledge management system.

This was precisely the dilemma faced by the Air Force Medical Service (AFMS) a couple of years ago. Our subject-matterexpert (SME) content managers – most of them operating in headquarters jobs far removed from hospitals and clinics – needed to stay in close touch with their “Tribe in the Trenches” (their “Community of Practice”) in order to stay at the top of their game. Conferences, phone calls, and emails were being used to maintain this line of communication, but Web 2.0 tools were the missing link.

The AFMS had already launched a Web content-management and documentmanagement intranet platform called the AFMS Knowledge Exchange (Kx) in 2003. Five years later the Kx had grown to over 400 microsite communities of practice and 20,000 registered users. Over 50,000 system documents were kept up-to-date by an automated expiration system that required content managers to renew documents, with users receiving email notification of new or updated content for communities they chose to subscribe to. This was innovative stuff five years ago – but in the Web 2.0 world of today? Not so much.

The problems
Any of the 20,000 registered Kx users could contribute documents; very few, however (besides the 400 content managers) ever did. Document check-in Web forms with required metadata fields – a necessary part of good document management – discouraged end users from “casual” content contribution. Bottom line: the Kx was a textbook case of a knowledge management platform that needed Enterprise 2.0 (E2.0) tools as a catalyst for end-user content contribution. What was needed was a user interface that was instantly self-explanatory and made the benefits of contribution immediately obvious to users.

While the Kx was in dire need of bottoms-up intelligence via end-user contributed content, it was also ideally suited as a launch pad for discussion forums, blogs, and rich user profiles. Much has been written by E2.0 experts about the need to coherently exploit Web 2.0 tools inside the enterprise, as opposed to letting every department deploy their own siloed toolsets ad-hoc. The whole point is to have one search interface that efficiently returns all content, and while search can always be federated, it is more practical to have all the content inside one enterprise platform.

One good way to do this is to bolt Web 2.0 tools on top of existing enterprise-wide communities of practice framework with established community members/subscribers – because a great question buried in a discussion forum that nobody sees benefits no one. But a great question posted on a discussion forum that is emailed out to 50 existing community subscribers is probably going to generate some thoughtful answers.

The solution
The AFMS and Evolvent Technologies (the Kx systems integrator) chose Jive Software’s Social Business Software suite for an E2.0 supplement to the Kx. Dubbed “Kx Communities,” the full-featured community platform was launched in April 2009 and since then has been used by numerous Kx communities of practice to enhance two-way communications and bottoms-up intelligence. A search query on the Kx now returns not only Web content and documents, but discussion threads, blog posts, rich user profiles, and wiki-like collaborative documents – all on the same search-results page.

A basic tenet of knowledge management is the concept that “knowledge sticks to practice,” and this is nowhere more true than in healthcare. Clinicians and administrators of any given healthcare specialty generally need to compare best and worst practices with their geographically separated “tribe members” more than they have a need to collaborate locally with coworkers in other specialties.

Because the AFMS has a lot of small clinics spread across the globe, many AFMS professionals are one-person shops in their area of expertise. They may see their fellow tribe members face-to-face but only once a year at a conference, for instance, so these E2.0 tools are critical. The accompanying graphic (see next page) shows a typical Kx Community discussion forum – a flight surgeon needs to know how flight surgeons at other Air Force hospitals and clinics are handling the administration of Army flying exams. He posts a discussion thread, designates it as a question, and receives nine replies.

The surgeon and other users in this real-life example later rated one answer as “correct” and one answer as “helpful,” so the system reflected that the question had been answered to a satisfactory degree. This functionality helps the SME/content manager for the community easily monitor the status of queries – an invaluable feature in larger communities.

Keys to success
This illustrates a key point. A big part of E2.0 success is owed to the Kx feature set:

• It’s not just a discussion forum, but a discussion forum that allows users to rate the quality of answers and shows the most popular discussion threads on the Kx Community home page;
• It’s not just a subscription platform, but a system that permits detailed management of email subscription options, so that users can tailor the amount of system-generated email in their inbox. End users can subscribe to all new content in a given community, or just to certain discussion threads, or just to certain SMEs;
• It’s not just a blog, but a blogging platform in which every post and every comment has a link to the author’s user profile so there is complete transparency into who is saying what. There is no anonymous comment on the Kx. Even if a user has not posted a photo and bio into the user profile, contact and demographic information is still available, as such data is required to get a Kx account; and
• It’s not just better Web content management, but a drag-and-drop, iGoogle-like widget interface, which enables content managers to easily create a rich user experience tailored to the needs of their community of practice.

In contrast, another government knowledge-management platform added E2.0 tools, but did so with custom code instead of using a best-of-breed platform. This resulted in a feature-poor user interface, and to date their discussion forums and other E2.0 tools have not enjoyed broad adoption even though the core functionality of the site continues to be very successful.

Saving real lives in Iraq and Afghanistan today: The “Self Ai d and Buddy Care” blog.
One cogent example of invaluable bottoms-up intelligence enabled by Kx Communities is the Self Aid and Buddy Care (SABC) blog. SABC is a program that trains every airman in the Air Force (not just medics) on battlefield first aid. With the military involved in two wars, it’s not difficult to see the life and death implications of this tool. If airmen are not effectively trained on the latest battlefield first-aid measures with the latest life-saving equipment, informed by the latest lessons learned from the fighting in Iraq and Afghanistan, then somebody’s son or daughter overseas is not going to make it home that otherwise would have.

The SABC program’s training manager blogs on SABC details, and she frequently solicits specific feedback from the field in order to improve the program. Two recent posts, one about revising SABC policy, and one about updating the SABC instructor kit, resulted in dozens of back and forth comments from all across the AFMS and clearly assisted the training manager in making the best management decisions.

One of our senior flight surgeons recently posted a question about the use of probiotics to reduce the incidence of traveler’s diarrhea in aircrews conducting missions in the third world. It was a complex question that was unlikely to have one correct answer, but it was likely that other flight surgeons in the AFMS would have had similar experiences and might be able to help solve his dilemma. The author ended his question with the phrase “awaiting enlightenment.” Kx Communities sent a systemgenerated email to the 200+ subscribers in the aerospace medicine community, and three helpful replies from fellow flight surgeons were posted back to the discussion thread that day.

It’s a pretty safe bet that knowledge workers across your enterprise are “awaiting enlightenment” on multiple knowledge questions they face. Are you giving them the E2.0 tools they need to locate SMEs, get help with their questions, easily share their expertise, and deliver bottoms-up intelligence across your enterprise?

Major William Sorrells (FACHE, CPHIMS, CHCIO) is tasked to the Office of the Surgeon General of the Air Force Medical Service. He can be reached at (703) 681-6523 or william.sorrells@pentagon.af.mil.

GEOFF HOWARD is the Chief Technology Officer at Evolvent Technologies, Inc. (www.evolvent.com). He can be reached at (703) 824-6004 or geoff.howard@evolvent.com.