Improving patient safety: Closing the knowledge-practice gap at the frontlines

The knowledge-practice gap. Technology is fueling the exponential growth of healthcare knowledge, while the capacity of the human brain to master tasks remains static. There is a rapidly expanding gap between what institutions know, and what frontline caregivers (nurses, docs, and staff) actually do. We must close this gap.

The knowledge-practice gap results in inconsistencies in care and inefficiencies in workflows. Caregivers are frustrated with their inability to meet the growing demands of the system, and institutions have too often responded with increasing bureaucracy. Caregivers feel too much blame and not enough gratitude. We have a healthcare system that could be on a path for self-destruction.

  • Medical errors: #3 cause of death (BMJ, 2016).
  • Inefficiencies and Waste: $200B annually, US. (Health Affairs, 2012)
  • Burnout: >50% of physicians (nurses are not far behind). (Becker’s Hospital Review, 2017)

Healthcare is about the delivery of care—care delivered by people, not technology. To elevate care, we must first empower our frontlines with knowledge and engage them as true teams. We must break down professional silos, promote the transparency and accessibility of knowledge, and create a culture of inter-professional respect. Healthcare organizations should frame quality and safety as a team endeavor. Bring consistency to practices, beginning with the organization’s most urgent pain points.

Hospital-Acquired Infections (HAI) are such pain points. HAIs cost US healthcare $10B annually (JAMA, 2013). HAI-reduction is incentivized by hundreds of millions of dollars of penalties and incentives from Medicare, and HAI rates are key components of hospital ratings.

Hospitals have general knowledge of best practices for prevention, but have struggled in attempts to implement these practices at scale. At this week’s American College of Medical Quality national meeting, we present a scalable pathway to succeed. Through an approach based upon just-in-time micro-learning and self-assessment checklists, we cut central line infections (a type of HAI) in half, saving over $1M. It’s all about engagement. Give frontline staff technology comparable to what they have in their personal lives; help them work smarter, not harder. Bring the learning to the bedside, in bite-sized portions consumable right at the point-of-care. Just-in-time reinforcement of best practices—what you need, when you need it. Close the loop with real-time gratitude. Let our caregivers know that what they do every day really does make a difference.


  • Old way: Healthcare systems still use didactic/classroom teaching, where learning is disconnected from doing, and retention is poor.
  • Old way: Best practices are generally text-based and are distributed in a myriad of channels (emails, websites, intranet, share points, electronic health records, paper binders), which are impractical to access when needed. User engagement /content consumption cannot be measured.
  • New way: Deliver point of care micro-learning, including concise how-to video, to teach/reinforce best practice when actually doing the practice.

Quality Improvement (QI):

  • Old way: Observation & Education. Healthcare systems rely on costly independent audits of performance, often collecting data on paper. Data is painfully collated and analyzed. Weeks or months later, educational classes are held, with variable attendance and poor retention. Cycle is then repeated.
  • New way: Tracks user engagement at the point-of-care, and provide just-in-time education tied with the actual practice. The quality improvement cycle is reduced to minutes.

Leverage mobile and cloud technologies to give frontline staff what they need when they need it—closing the knowledge-practice gap right at the point of care. Simplify quality & safety practices, and accelerate lateral spread throughout the institution. This saves money, and saves lives. As the costs of healthcare continue to rise, value is king. The digital transformation of quality is not optional, it is essential.