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Healthcare, Knowldege and Knowledge Sharing

Healthcare, Knowldege and Knowledge Sharing

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Published by myolles
Healthcare organisations seem incapable of coordinating organisational knowledge. However, one aspect of knowledge management centres on the use of knowledge sharing. A pre-requirement is that the organisation knows what knowledge it has. This can be identified through knowledge management models.
Healthcare organisations seem incapable of coordinating organisational knowledge. However, one aspect of knowledge management centres on the use of knowledge sharing. A pre-requirement is that the organisation knows what knowledge it has. This can be identified through knowledge management models.

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Published by: myolles on Jun 02, 2009
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1
Healthcare, Knowledge, and Knowledge Sharing
In Bali, R. (Ed.), 2005 (Oct),
Clinical Knowledge Managemen
, Idea Group Inc,USA.Maurice Yolles, m.yolles@ljmu.ac.uk 
Abstract
: Healthcare organisations seem incapable of coordinating organisationalknowledge. However, one aspect of knowledge management centres on the use of knowledge sharing. A pre-requirement is that the organisation knows what knowledgeit has. This can be identified through knowledge management models.
Keywords
: Healthcare, knowledge management, knowledge sharing.1.
Introduction
Healthcare organisations have the same problem as any other organisation that is runby sentient, but mentally isolated beings. It is a problem that comes out of constructivist thinking, and relates to the ability of people, once they start tocommunicate, to share knowledge. The popular knowledge management paradigmargues the importance of knowledge to management processes and organisationalhealth. It may be said that it is likely that this paradigm will in due course give way tothe “intelligent organisation” paradigm that addresses how knowledge can be usedintelligently for the viability of the organisation. Part of the knowledge managementparadigm centres on the use of knowledge sharing. This takes the view that whileknowledge is necessary for people to do their jobs competently, there is also a need tohave the potential for easy access to the knowledge of others. The reason centres onthe capacity of organisations to know what knowledge they have, and to coordinatethis knowledge.The incapacity of healthcare organisations to coordinate such knowledge is typifiedby the old joke
1
about a hospital asking its consultant doctors to provide someguidance in coming to a decision about the construction of a new wing at the hospital.The allergists voted to scratch it; the dermatologists preferred no rash moves; thegastroenterologists had a gut feeling about it; the neurologists thought theadministration had a lot of nerve; the obstetricians stated they were labouring under amisconception; the ophthalmologists considered the idea short-sighted; theorthopedists issued a joint resolution; the pathologists yelled, “over my dead body”;the pediatricians said, “grow up”; the proctologists said, “we are in arrears”; thepsychiatrists thought it was madness; the surgeons decided to wash their hands of thewhole thing; the radiologists could see right through it; the internists thought it was ahard pill to swallow; the plastic surgeons said, “this puts a whole new face on thematter”, the podiatrists thought it was a big step forward; the urologists felt thescheme wouldn't hold water; the cardiologists didn't have the heart to say no. Themessage that this joke gives is that people working together in an organisation seethings from their own perspectives, these being formed by the knowledge that theyhave. The minimum requirement for an organisation to work as a single system is forperspectives to be coordinated, and this can only occur through knowledge sharing:one can only coordinate perspective when one knows what perspectives there are tocoordinate.
1
This joke is taken from http://www.med-psych.net/humor/joke0011.html
 
2Positivists normally see knowledge as a commodity that has value to individualswithin a social context. It can be identified, coded, transferred throughcommunications, decoded, and then used. The message that is provided in this chapteris that this commodity model is not only inadequate, but is actually dangerous fororganisations because it allows them to assume that no work has to be put into theprocess of knowledge sharing.
1. Healthcare and Information and Knowledge
Healthcare provision is a knowledge-intensive activity, and the consequences of anorganisation failing to make best use of the knowledge assets at its disposal can besevere (Lelic, 2002). Knowledge and knowledge processes (including sharing) inhealthcare have both an individual and an organisational dimension. Thesedimensions are defined as:1. Individual, involvinga. patient attributes for whose benefit healthcare establishments areestablished, where knowledge and information can assist patients toappreciate their condition and help them to maintain their treatments,b. staff members of a healthcare organisation that can only properly satisfyan employment role if they have relevant knowledge.2. Organisational, where healthcare is benefited from knowledge and knowledgeprocesses by enabling them to understand their own organisational capacity tomaintain and improve quality patient services, and to respond to the need tocoherently create new knowledge by becoming a learning organisation.In a constructivist world where subjective epistemology overshadows objectivism,part of the knowledge process in the UK National Health Service (NHS) centres on aneed to involve patients more in their own healthcare; and there are sound financialand medical arguments for this that satisfy the needs of both consultant practitionersand management. In traditional positivist culture that still operates in so manyhealthcare establishments, the patients are viewed as a commodity input to thehealthcare system represented as objectivated
2
“cases” rather than subjectivatedindividuals with their own learning needs. As a consequence, it is not unknown forpatients to become invisible as their “cases” are discussed with a third party in theirpresence. Baldwin et al (2002) note that there is a call for healthcare professionals toengage more fully with their patients, and to see them more as some kind of partner intheir healthcare rather than as a paternal authority. While Baldwin et al are primarilyinterested in information, without knowledge this has no value or significance to arecipient. It is knowledge that provides the capacity for patients to understand theirown conditions, recognise what constitutes relevant information, and contributes tothe decision making process both in regard to primary and secondary care.There is also a need in healthcare organisation to ensure that staff are provided notonly with the information and knowledge that enables them to effectively performtheir tasks, but that they are also included within the organisational processes thatenables them to become motivated and participate in organisational improvement.This human resource management approach is normal to techniques of OrganisationDevelopment (Yolles, 1999).
2
In the sense of Foucault (1982)
 
3In healthcare organisations the nature of the knowledge processes that are undertakencan be expressed in terms of organisational quality. Stahr (2001), in a study on qualityin UK healthcare establishments, uses the definition by Joss et al. (1994) to identifythree levels of quality:
technical
,
generic
and
systemic
. While the word technical isoften used to mean “control and predication”, for Joss et al it is taken to mean theemployment of specialist knowledge and expertise to solve a problem. The wordgeneric is expressed in terms of normative organisational healthcare standards. Theword systemic is concerned with making sure that the whole organisation works as anintegrated whole in order to ensure long term success. For Stahr (2001), if qualityapproaches are to be useful they need to affect the culture of an organisation, and todo this they need to be systemic. The systems approach to quality is more than just“joint up governance”
3
, intended to convey the impression of organisational cohesionthrough policy and processes of coherent group behaviour. Rather, it is characterisedby full integration of all aspects of its activities into focused action on continuousimprovement and patient needs (though Stahr does not consider whether these needsshould be considered from an objectivistic or subjectivistic perspective). Systemicapproaches are more likely to be successful, it is reasoned, than generic and technicalapproaches, because they impact on everything that managers and clinicians do. Stahralso suggests that systemic approaches become the culture of the organisation.However, they should instead be seen to be distinct but intimately connected with thatculture (Yolles and Guo, 2003).Each of these three levels of quality may be seen as archetypes (a term usedoriginally, for instance, by Carl Jung, 1936), and the search for quality should not beseen to be resident in one or other, but in a convergence of them all. Systemic qualitymust capitalise on technical and generic quality. Technical quality is knowledgecentred, and generic quality is paradigm centred and also involves knowledge andknowledge processes.While knowledge is important to healthcare organisations, there is also a currenttendency to explore it in terms of knowledge management (KM). Wickramasinghe(2003, p.295) offers what seems to amount to an information system (IS)conceptualisation of the nature of KM:“Knowledge management deals with the process of creating value from anorganization's intangible assets (Wigg, 1993). It is an amalgamation of concepts borrowed from the artificial intelligence/knowledge-based systems,software engineering, business process re-engineering (BPR), humanresources management, and organizational behaviour (Liebowitz, 1999). Inessence then, knowledge management not only involves the production of information, but also the capture of data at the source, the transmission andanalysis of this data, as well as the communication of information based on,or derived from, the data, to those who can act on it (Davenport and Prusak,1998)”.This provides little access to a proper understanding of the nature of KM, nor inparticular, or the distinction between knowledge processes and data/informationprocessing. The conceptualisation of knowledge in the IS view limits onesunderstanding of knowledge processes, and dilutes the understanding that KM is
3
The term joined up governance is reflected in various sources likehttp://news.bbc.co.uk/1/hi/special_report/1998/11/98/e-cyclopedia/211553.stm.

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