A Tool for Sharing Internal Best Practices > Background

Part I. Background

In Uganda, a simple newsletter enabled midwives and nurses who run private clinics in isolated rural areas to share good practices (Fischer, 2004; Prefontaine, 2004). Each issue of the Best Practices Bulletin described how a clinic had met a practical challenge, such as networking with community organizations or conducting successful outreach visits. Then a section on “What You Can Do” explained how providers could implement this best practice themselves.

Staff from the Commercial Market Strategies (CMS) Project collected the best practices from participating clinics during regular monitoring visits. Every two months, a staff member wrote up a practice, photocopied the bulletin, which was designed to fit onto a single sheet of paper, and mailed it out to hundreds of providers. By identifying and disseminating effective practices, the bulletin increased providers’ knowledge, contributed to success of the private clinics, and ultimately improved the health of the community.

Why share your best practices?

As this story illustrates, a good way to improve performance is to replicate successes in one place throughout an organization. Reproductive health organizations have an untapped wealth of knowledge, skills, and creative practices, all of which could have a tremendous impact on programs and services if more widely applied (O’Dell and Grayson, 2000).

Sharing internal best practices can be an important adjunct to other improvement approaches, many of which focus on identifying and solving problems. A single-minded focus on problems may be demoralizing because it characterizes people and activities by their failures. In contrast, initiatives promoting internal best practices focus on what people are doing right, raise morale by demonstrating faith the staff, and make achieving excellence seem possible (Gallup Organization, 2002). Bottom-up approaches to improvement, such as sharing internal best practices, also encourage more learning within the organization than do top-down approaches, such as setting standards (Gainer, 1998).

Many experts advise health care managers to look outside their own organization for global standards and best practices to improve the quality of care. Yet practices developed inside the organization are not only more readily accessible, but they are also more likely to suit the cultural and organizational setting and thus need the least adaptation (Vitasek and Manrodt, 2005).

This tool is designed to help health care program managers understand what a best practice is, identify best practices within their own organizations, and share them internally. Too often internal sharing is limited to the informal diffusion of common practices through personal connections. Much more can be accomplished if an organization develops systematic processes to identify and share the practices that work best for them.

What is a best practice?

Despite much discussion, there is no universally accepted definition of a best practice—and continuing debate over terminology and definitions can even create a roadblock to action. At a minimum a best practice must:

Demonstrate evidence of success,
Affect something important, that is, contribute to the organization’s mission or program goals, and
Have the potential to be replicated or adapted to other settings (Advance Africa, 2005; United Nations Population Fund, 2001).

Some international health and development organizations also believe a best practice must be innovative, sustainable, cost-effective, ethically sound, and/or superior to all other approaches (MOST Clearing House, 2005; UNAIDS, 2005; UN Inter-Agency Committee on Women and Gender Equality 1999).

Deciding what is “best” is not easy. Best practices can vary over time, as new evidence and new possibilities emerge, and from place to place, depending on available resources and infrastructure (Singleton, 2005). What is “best” also depends on what people want: for example, a family planning program manager might value practices that bring more clients to the clinic for services, while clients value the option of being visited at home (Skyrme, 2001). Given this shifting reality, some organizations prefer to talk about “good practices” or “promising practices” rather than “best practices” (Skryme, 2002). Other organizations prefer to look at lessons learned as well as success stories. They contend that an organization can learn as much as or more from its failures and near misses as from its successes (Gainer, 1998). No matter what term is used, everyone involved in identifying and disseminating internal best practices must first agree on a definition that fits the organization’s needs. (See the case study on the UNDP Regional Bureau for Asia and the Pacific for an example of how one organization set guidelines defining best practices.)

The best way to learn about a best practice is through a combination of reading, observing, and talking. A report can make you aware of a practice and provide enough information to decide if it is worth investigating further. Observing a practice can show you how it is done. If you want to put a practice into operation, however, you need to talk directly with the people who have already applied the practice, so that you can learn from their experience and know-how (Skryme, 2001). Therefore, best practice initiatives generally employ two complementary strategies to share knowledge:

Producing and disseminating written records, such as newsletters, reports, and databases; and
Arranging for person-to-person contacts through meetings, coaching, consulting, communities of practice and the like (NHS, 2001; Skryme, 2002).

What are the benefits of sharing best practices?

raise the overall quality of services;
improve operations at poorly performing units so that their performance more closely approaches that at the best units;
avoid duplication of effort or “reinventing the wheel”;
minimize the need to redo work because poor methods led to poor quality; and
save money through increased productivity and efficiency (NHS, 2001; Skryme, 2002).

Sharing internal best practices is especially useful when organizations include multiple units, divisions, or people that do similar work and thus can learn from one another (Vitasek and Manrodt, 2005). In reproductive health organizations, these might be service delivery points, such as hospitals, clinics, or individual community-based health agents; functional units, such as warehouses and training centers; or district, regional, and country offices. Sharing internal best practices also holds greater benefits for units in scattered locations that have little contact with one another (Skryme, 2002).

What organizational factors aid or hinder sharing?

Experience. Sharing internal best practices seems to work best in organizations that already focus on process or have some experience with sharing successes and failures. Many family planning and reproductive health organizations fit this description, because they are engaged in COPE (Client-Oriented, Provider-Efficient), Performance Improvement, or quality of care initiatives.
Size. Because the best practices approach offers a relatively informal way to improve work processes, it is well suited to small as well as large organizations (Gainer, 1998).
Structure. It is more difficult for people to gain a good understanding of how to adapt a practice and make it work in decentralized organizations, in which people in different units and divisions have little regular contact and no working relationships (O’Dell and Grayson, 2000). Building social networks and lines of communication that cross boundaries within the organization can help.
Organizational culture.Units that have developed a best practice will be less eager to share it with others if the organizational culture values the accumulation and hoarding of knowledge, fosters competitive relationships between units, or encourages “silo” thinking—that is, considering only the needs of your own unit rather than the organization as a whole (O’Dell and Grayson, 2000). Managers instead should foster a climate that values learning, encourages collaboration, and supports knowledge sharing.
Absorptive capacity. In order to internalize and apply new practices, units need positive staff attitudes towards learning and experimentation, the technical competence and resources to carry out a specific practice, and the managerial ability to oversee changes associated with a new practice (CFAR, 1999; Simard and Rice, 2001). Units that develop a practice also need additional resources to oversee its transfer to other units.
Motivation. Staff members will not make an effort to adopt internal best practices if they believe the only credible sources for best practices lie outside the organization, if they are not convinced that so-called “best” practices will really work better, or if they resent the implication that their own practices are inferior. Managers must foster local commitment to and ownership of a new practice, so that people feel motivated to adopt it and do not abandon it when they encounter problems (CFAR, 1999).

How can you get started?

Finding just one important best practice and promoting it to all who could benefit is a big achievement. The next section outlines a simple five-step process to help you do just that—by identifying, describing, promoting, adapting, and implementing effective practices within your own organization. For this process to succeed, you will need to create a supportive environment. Make sure that your organization has:

People to facilitate identification and sharing of internal best practices, for example, by training or hiring staff to serve on a best practices team or act as a best practices coordinator;
Processes and tools that are designed to share knowledge through reports, electronic discussions, and face-to-face meetings; and
A commitment to take the time needed to identify, document, and share best practices.

Identifying your organization's best practices helps your staff members learn from each other and reuse proven practices. Effective sharing of best practices can help an organization to: