The Value of Institutional Knowledge in EMS

Emergency Medical Service (EMS) providers continue to face significant challenges within their organization especially as it pertains to recruitment and retention, preparing for the possibility of a recession, inflation outpacing salaries, supply chain issues, and the ongoing demands of daily activities required to ensure EMS service delivery continues to meet and exceed customer/patient expectations. As a result of the constant challenges, EMS officers and other organizational leaders must adjust to ensure they are prepared to face these obstacles. Having institutional knowledge readily available can help overcome these challenges.

Currently, many EMS agencies are experiencing increased hospital “wall times,” a delay in transferring patients from EMS crew members to emergency department staff. While this delay isn’t new, it continues to challenge many hospitals. There is no doubt that increased hospital “wall times” may be the result of different circumstances, but proposed solutions from the past may offer some insight to current EMS officers and other organizational leaders looking to address this challenge. In addition, when administrative or operational activities are not going as expected, EMS officers must take this time to look back and see what worked in the past and what changes, if any, were made that have now led the organization in a different direction. Furthermore, new employees coming into an organization will be unfamiliar with the organization’s culture. Both of these are examples of why having a system that supports institutional knowledge will prove to be invaluable to the organization’s employees and leadership team. A new or senior EMS officer must not ignore the value of institutional knowledge and must ensure the organization is well-poised to support a knowledge management system.

Institutional Knowledge 

Institutional knowledge consists of business activities, projects, mergers, and overall experiences during the life of the organization. It is a valuable resource for EMS officers and other organizational leaders because it allows the evaluation of historical and current organizational activities which may help organizational leaders be better prepared when planning for new initiatives, managing current challenges that are directly impacting the organization, and assisting during the decision-making process. Newly promoted officers or individuals in leadership roles may not take advantage of institutional knowledge. It is not common for many assuming leadership roles to implement new initiatives or work diligently to adjust the organization’s culture without seeking the organization’s operational and administrative history. An institutional knowledge system will ensure that it will not be lost with time and is available even after employees leave the organization. Institutional knowledge can be shared by using three different types of knowledge: explicit, implicit, and tacit.

Implicit (Intangible) Knowledge 

This type of knowledge is gathered by experience and then shared with others throughout the organization. These experiences may consist of senior employees sharing best practices, specific activities, and even step-by-step processes that have been acquired through time of employment with the organization. Implicit knowledge is employee dependent and requires those employees with historical experiences to share such information. With that said a major concern for organizational leaders is what to do when those employees have left the organization.

This continues to be a major concern for organizational leaders, especially post-pandemic where many employees are choosing not to return to work, seeking employment elsewhere, or simply retiring. Employees that have been with an organization for a significant period and have acquired the implicit form of institutional knowledge are referred to as legacy employees. Legacy employees play a critical role and can serve as a tremendous resource for organizational leaders and employees by sharing what has worked and what has not worked in the past. Legacy employees as well as organizational leaders must be encouraged to use a “knowledge cascade” approach where information is either shared with small or large groups to have these members share the information with others throughout the organization.

Explicit (Tangible) Knowledge 

There is no doubt that numerous organizations lost a significant amount of institutional knowledge as employees chose to be part of what is known as the “Great Resignation.” The following departures left a void as pertains to sharing of information, and implicit knowledge, as experienced and knowledgeable personnel left the organization. On the other hand, Explicit institutional knowledge is achieved by ensuring documents, paper or electronic, are stored and available for reference at any given time.  Explicit institutional knowledge is not employee dependent in the sense of having someone available to covey the historical information. Although this form of institutional knowledge is not dependent on employees, it still requires organizational leaders to identify key information that is worth preserving and then have someone responsible for accumulating and storing the information. 

Tacit Knowledge 

The sharing of Tacit knowledge is a bit difficult since the knowledge is gained from personal experience and therefore difficult to put into paper form or share with others. However, Tacit knowledge is closely related to implicit knowledge, but will take time for junior employees to fully understand since the knowledge being shared is acquired through different individual experiences; for example, understanding body language or, as it pertains to EMS service delivery, getting a sense when to move EMS units for coverage before it is necessary. With that being said and being aware of the different types of knowledge to secure institutional knowledge, organizational leaders must then focus on developing a knowledge management system. 

Knowledge Management System   

This is a system designed to maintain and share employee experience and knowledge within an organization continuously. EMS Officers and other organizational leaders must ensure that a focus as it pertains to maintaining and sharing institutional knowledge must be part of every organization’s strategic plan.  Knowledge management is about sharing information and not being dependent on a few individuals to be the sole source of historical information. Moreover, the knowledge management process can be divided into three areas:  

• Accumulating Knowledge
• Storing Knowledge
• Sharing Knowledge  

As discussed above, as legacy employees leave the organization either seeking better employment opportunities or choosing to retire, EMS officers and other organizational leaders must find ways to minimize the knowledge gaps between legacy employees and new hires to avoid service delivery disruptions. Ensuring that your organization has a system in place that accumulates, stores and shares knowledge will eventually lead to positive outcomes, for example: 

• As information is accumulated, processes are reviewed, and potential issues can be identified before they begin to negatively impact the organization 
• Since information is being shared with employees regularly it will improve communication and reduce mistakes
• A positive working culture is created because of the information and skills shared between members of the organization.  This will lead to collaboration and ensures that institutional knowledge is shared amongst many rather than just a few.
• The knowledge management system also promotes the importance of a mentoring program.  As legacy employees plan to exit the organization, there is no rush to ensure institutional knowledge is shared because the sharing of information is done continuously by mentors; thereby avoiding a disruption during the transition of job roles.
• The sharing of information may also lead to improved employee retention and reduced onboarding costs. Sharing knowledge with internal customers and preparing them for future open positions is less expensive than onboarding someone to fill a position.  Furthermore, if employees feel there are growth opportunities there is less of a chance of them seeking employment with another organization. 

 As employees continue to exit organizations, regardless of the reason, organizations will continue to face challenges in preserving institutional knowledge that should be readily available for current and future leaders. Having a knowledge management system in place that focuses on accumulating, storing, and sharing institutional knowledge will prove to go a long way in supporting the viability of the organization. As Winston Churchill once said, “The farther backward you can look, the farther forward you can see.”