Knowledge-Centered Service Can Help Enhance Efficiency and Improve Outcomes

Among our goals at Journal of AHIMA is to document best practices in health information management and to capture, in real time, emerging ideas and processes impacting the accuracy, timeliness, privacy, and security of patient health information. One strategy to improve operational efficiency—which, ideally, also improves patient outcomes—is the Knowledge-Centered Service (KCS) methodology.

KCS stood for Knowledge-Centered Support until 2016, when the acronym definition was changed to better reflect the scope of the program’s goals. Consortium for Service Innovation, a nonprofit alliance, was responsible for creating KCS in 1992; the aim was to “design tools with specific features” to help large organizations better “capture and reuse knowledge” that arose as a “byproduct of work performed.”

Many of you have worked in organizations where busy service teams are bottlenecked by repetitive requests and necessary research. Often, the answer given by a single service desk employee isn’t documented anywhere, because the volume of requests demands that they move on to the next issue. Documenting, managing, and disseminating that knowledge to support consistent, quick, and correct responses across an organization is where KCS comes in.

While the KCS mission was (and is) critical—manage knowledge more effectively to improve service delivery and levels, productivity, and cost savings—the consortium also quickly realized what health information management professionals already know: “No matter how good the tools, knowledge management success rests with people and their behaviors.” Simply building the knowledge base isn’t enough. Organizations and employees must be able to access and leverage it easily.

To that end, KCS has clearly stated principles for knowledge sharing:

• Create abundance (share and learn more)
• Evolve and collective experience (fine-tune the work tasks and increase the knowledge base)
• Demand-driven and reuse (knowledge is a by-product of interaction and double-loop feedback)
• Resolve (engage all task holders and empower the smart), and
• Improve and reward learning (to motivate all comers).

According to Sultan et al, in an article about the “fifth revolution” (digital tools) in cardiovascular treatments, “Early benefits of KCS are improved resolution times and first call resolution, reduced escalations, improved employee skills, job satisfaction, and confidence. These benefits translate into less stress and potentially better retention rates, dramatic improvement in self-service success, and reduced training time.”

While KCS itself isn’t new, some large healthcare systems are implementing it for the first time as part of their electronic health record platforms. Standford Health Care (SHC) is an example, and we recently spoke with Carol Bishop-Castro, MBA, about early experiences and results from that project. She is Manager of Informatics Education (Knowledge Management, Marketing & Communications, & Epic Education Support) at SHC.

Carol, can you tell us a bit about the history of KCS at SHC? When and why did you decide to implement it? Did the decision originate with a certain department, or with an overall cohort?

When I joined Stanford Health Care (SHC) in 2019, I could see that our knowledge was scattered in silos – different departments each had their own repositories. I’d used KCS in previous roles and knew it could unify our approach, saving time and improving consistency. I pitched the idea to our director, highlighting how KCS could reduce call times, minimize repetitive Q&A, and speed up Epic issue resolutions. She was immediately on board, so we started with the Informatics Education team, tested the waters, and then rolled it out more broadly as we built momentum.

Before implementation, were there specific outcomes SHC considered “top tier” in terms of assessing KCS success?

Yes, we focused on four main goals:

1. User Accessibility: Making it fast and easy for both clinical and non-clinical staff to find the information they need.
2. Knowledge Readability and Consistency: Introducing style guidelines and templates in ServiceNow to ensure articles were concise and user-friendly.
3. Reduced Time to Solution: Centralizing  decrease call times and repetitive inquiries.
4. Continuous Review and Improvement: Regularly auditing to keep content accurate, current, and trustworthy.

We also used KCS metrics like Process Adherence Review (PAR) as we matured, which helped measure how often our service desk staff actually searched for, reused, and improved knowledge articles.

Who led the charge in getting trained in KCS, and what type of training did staff undergo?

Initially, the Informatics Education team blazed the trail. I introduced them to the KCS methodology – covering everything from content standard checklists to article templates and the importance of “search early, search often.” After that, we phased in training for our Epic Education service desk. Our team learned how to create, reuse, and refine articles using:

• Hands-on coaching and Article Quality Index (AQI) scoring
• Monthly tips and tricks (quick, fun reminders on how to maintain quality and consistency)
• Process Adherence Review (PAR), which measures things like link rate and link accuracy

Over time, we raised our PAR link rate from 45.14 percent (when we introduced PAR in 2021) to 98 percent, and our link accuracy from 68 percent to 99 percent. That level of consistency has been a big deal in ensuring staff can trust the knowledge base.

When you initially mentioned this idea to us as something you wanted to share with your HI colleagues, you noted that the creation of an Employee Service Center was one of KCS’s most impactful effects at SHC. Can you describe how that came about? Was it early in the KCS implementation, or did it stem from something discovered after you started?

It was a little of both. Right from 2019, it was obvious we needed a single “source of truth” for staff to avoid hopping between different repositories. Our first stab at that was “AskSHC v1,” when Informatics Education partnered up with SHC’s Technology & Digital Solutions (TDS) team. But the real game-changer arrived in December 2023 with the Employee Service Center (ESC). That’s when we fully unified TDS, HR, Finance, Supply Chain, and others under one portal. Having the ESC in place not only simplified the user experience but also put a spotlight on the KCS framework, because we suddenly had one platform to demonstrate just how valuable a well-managed knowledge base could be.

Who are the stakeholders in the Employee Service Center? Which departments are involved?

It’s a cross-organizational effort:

• Informatics Education (where KCS took root)
• SHC’s ServiceNow development team (the tech drivers)
• Technology & Digital Solutions (TDS)
• HR, Finance, Supply Chain, Facilities
• Nursing Informatics and the Revenue Cycle Academy

Our CMIO, Dr. Topher Sharp, has been a major champion. He was a supporter from the beginning, understanding firsthand as a provider that knowledge needs to be accurate, centralized, and immediately accessible. His backing helps legitimize the program and keeps “work smarter, not harder” at the forefront of SHC’s culture.

You mentioned that the ESC “unifies previously fragmented knowledge repositories into a centralized hub” and that staff can “access critical information with ease.” Can you describe how it works? Is it a searchable database? Is it solely a “pull” effort (employees can take information from it), or does it also have a “push” aspect (where you’re delivering what you think is relevant content to employees by role or department)? I’m specifically wondering how this might work at point of care, as you mentioned something about EHR synchronization.

The ESC is a mix of “push” and “pull.” On the pull side, staff can quickly search for knowledge articles – Epic workflows, HR policies, finance requests – and submit issues and service requests – all in one place. We spent a lot of time making sure the UI/UX was intuitive. On the push side, we proactively share high-value updates (like a big Epic EHR change) so teams know what’s changing without having to hunt it down.

The next step is integrating AskSHC directly into Epic, so clinicians and staff can access relevant articles at the point of care. That means no more juggling multiple systems – knowledge will be right there when they need it most.

One other aspect you mentioned is that it has sped up onboarding for new staff. How?

In the past, new hires might have called the service desk for every question. Now, we point them to AskSHC from day one. We’ve also integrated Amplifire (our adaptive learning platform) with ServiceNow, making it easy for new staff to find exactly what they need – whether it’s an Epic workflow or a quick policy overview. We’ve created landing pages grouped by topic, so they’re not combing through a giant repository. This accelerates their ramp-up time and cuts down on basic “how-do-I” calls.

What statistics are you able to share across SHC in terms of outcomes improvements?

We have several that show real impact:

• 60 percent increase in knowledge content searches: People are using the portal more because they trust it and don’t have to jump between systems.
• 40 percent increase in click-through rate: Users aren’t abandoning self-service to call for help. Instead, they’re clicking through to relevant articles.
• 56 percent increase in average click rank: The search algorithm is doing a better job surfacing the most relevant knowledge articles and service catalog items at the top.
• 29 percent decrease in call abandonment rate among the Epic Education service desk because support specialists have the knowledge they need at their fingertips to quickly assist callers.
• 9 percent decrease in opportunity cost, likely tied to fewer abandoned calls and more efficient call handling.
• 98 percent PAR link rate; 99 precent PAR link accuracy, a testament to how consistently our Epic Education service desk specialists are following KCS best practices.

All of these point to a more efficient, user-friendly experience – and ultimately better patient care because staff can resolve issues faster.

What resources would you recommend for colleagues or systems just starting a KSC journey, or wondering if it’s right for them?

I always suggest the official KCS documentation from the Consortium for Service Innovation. It walks you through everything from setting up content standards to measuring success. It’s also helpful to talk to others who’ve been there - real-world anecdotes can be just as valuable as the official guidelines. And, of course, make sure your leadership team is aligned around the value of knowledge sharing. A supportive CMIO or CIO can really help smooth the path for broader adoption.

What is one piece of advice you could give your HI colleagues about implementation challenges or pitfalls?

Take it slow and steady. Don’t try to do everything at once – start with a smaller group, prove the value, and then expand. Also, don’t neglect the human side of KCS: it’s not just about technology. You need a culture of knowledge sharing, meaningful incentives, and ongoing coaching. Implementing something like PAR (Process Adherence Review) is a great way to reinforce good habits – like capturing knowledge during calls and linking the right articles to each case – because it gives you tangible data on how well people are following the process. And be open to learning from others and adjusting as needed.

Anything else you’d like to share?

Just that KCS isn’t a “service desk only” methodology. It’s truly an organizational mindset. At SHC, it’s not only streamlined our internal processes and improved staff satisfaction, but it’s also directly benefited patient care by getting clinicians the information they need, right when they need it. The success we’ve seen – from our improved call abandonment rates to the uptick in self-service utilization – really underscores how knowledge can be a unifying force. I’m always happy to connect with others who are on a similar journey and invite readers to reach out to me!