Healthcare, Knowledge, and Knowledge Sharing

In Bali, R. (Ed.), 2005 (Oct), Clinical Knowledge Management, Idea Group Inc,
USA.
Maurice Yolles, m.yolles@ljmu.ac.uk
Abstract: 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.
Keywords: Healthcare, knowledge management, knowledge sharing.

1. Introduction
Healthcare organisations have the same problem as any other organisation that is run
by 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 to
communicate, to share knowledge. The popular knowledge management paradigm
argues the importance of knowledge to management processes and organisational
health. It may be said that it is likely that this paradigm will in due course give way to
the “intelligent organisation” paradigm that addresses how knowledge can be used
intelligently for the viability of the organisation. Part of the knowledge management
paradigm centres on the use of knowledge sharing. This takes the view that while
knowledge is necessary for people to do their jobs competently, there is also a need to
have the potential for easy access to the knowledge of others. The reason centres on
the capacity of organisations to know what knowledge they have, and to coordinate
this knowledge.
The incapacity of healthcare organisations to coordinate such knowledge is typified
by the old joke1 about a hospital asking its consultant doctors to provide some
guidance 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; the
gastroenterologists had a gut feeling about it; the neurologists thought the
administration had a lot of nerve; the obstetricians stated they were labouring under a
misconception; the ophthalmologists considered the idea short-sighted; the
orthopedists issued a joint resolution; the pathologists yelled, “over my dead body”;
the pediatricians said, “grow up”; the proctologists said, “we are in arrears”; the
psychiatrists thought it was madness; the surgeons decided to wash their hands of the
whole thing; the radiologists could see right through it; the internists thought it was a
hard pill to swallow; the plastic surgeons said, “this puts a whole new face on the
matter”, the podiatrists thought it was a big step forward; the urologists felt the
scheme wouldn't hold water; the cardiologists didn't have the heart to say no. The
message that this joke gives is that people working together in an organisation see
things from their own perspectives, these being formed by the knowledge that they
have. The minimum requirement for an organisation to work as a single system is for
perspectives to be coordinated, and this can only occur through knowledge sharing:
one can only coordinate perspective when one knows what perspectives there are to
coordinate.

1
This joke is taken from http://www.med-psych.net/humor/joke0011.html

1
Positivists normally see knowledge as a commodity that has value to individuals
within a social context. It can be identified, coded, transferred through
communications, decoded, and then used. The message that is provided in this chapter
is that this commodity model is not only inadequate, but is actually dangerous for
organisations because it allows them to assume that no work has to be put into the
process of knowledge sharing.
1. Healthcare and Information and Knowledge
Healthcare provision is a knowledge-intensive activity, and the consequences of an
organisation failing to make best use of the knowledge assets at its disposal can be
severe (Lelic, 2002). Knowledge and knowledge processes (including sharing) in
healthcare have both an individual and an organisational dimension. These
dimensions are defined as:
1. Individual, involving
a. patient attributes for whose benefit healthcare establishments are
established, where knowledge and information can assist patients to
appreciate their condition and help them to maintain their treatments,
b. staff members of a healthcare organisation that can only properly satisfy
an employment role if they have relevant knowledge.
2. Organisational, where healthcare is benefited from knowledge and knowledge
processes by enabling them to understand their own organisational capacity to
maintain and improve quality patient services, and to respond to the need to
coherently 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 a
need to involve patients more in their own healthcare; and there are sound financial
and medical arguments for this that satisfy the needs of both consultant practitioners
and management. In traditional positivist culture that still operates in so many
healthcare establishments, the patients are viewed as a commodity input to the
healthcare system represented as objectivated2 “cases” rather than subjectivated
individuals with their own learning needs. As a consequence, it is not unknown for
patients to become invisible as their “cases” are discussed with a third party in their
presence. Baldwin et al (2002) note that there is a call for healthcare professionals to
engage more fully with their patients, and to see them more as some kind of partner in
their healthcare rather than as a paternal authority. While Baldwin et al are primarily
interested in information, without knowledge this has no value or significance to a
recipient. It is knowledge that provides the capacity for patients to understand their
own conditions, recognise what constitutes relevant information, and contributes to
the 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 not
only with the information and knowledge that enables them to effectively perform
their tasks, but that they are also included within the organisational processes that
enables them to become motivated and participate in organisational improvement.
This human resource management approach is normal to techniques of Organisation
Development (Yolles, 1999).

2
In the sense of Foucault (1982)

2
In healthcare organisations the nature of the knowledge processes that are undertaken
can be expressed in terms of organisational quality. Stahr (2001), in a study on quality
in UK healthcare establishments, uses the definition by Joss et al. (1994) to identify
three levels of quality: technical, generic and systemic. While the word technical is
often used to mean “control and predication”, for Joss et al it is taken to mean the
employment of specialist knowledge and expertise to solve a problem. The word
generic is expressed in terms of normative organisational healthcare standards. The
word systemic is concerned with making sure that the whole organisation works as an
integrated whole in order to ensure long term success. For Stahr (2001), if quality
approaches are to be useful they need to affect the culture of an organisation, and to
do 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 cohesion
through policy and processes of coherent group behaviour. Rather, it is characterised
by full integration of all aspects of its activities into focused action on continuous
improvement and patient needs (though Stahr does not consider whether these needs
should be considered from an objectivistic or subjectivistic perspective). Systemic
approaches are more likely to be successful, it is reasoned, than generic and technical
approaches, because they impact on everything that managers and clinicians do. Stahr
also suggests that systemic approaches become the culture of the organisation.
However, they should instead be seen to be distinct but intimately connected with that
culture (Yolles and Guo, 2003).
Each of these three levels of quality may be seen as archetypes (a term used
originally, for instance, by Carl Jung, 1936), and the search for quality should not be
seen to be resident in one or other, but in a convergence of them all. Systemic quality
must capitalise on technical and generic quality. Technical quality is knowledge
centred, and generic quality is paradigm centred and also involves knowledge and
knowledge processes.
While knowledge is important to healthcare organisations, there is also a current
tendency 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 an
organization'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), human
resources management, and organizational behaviour (Liebowitz, 1999). In
essence then, knowledge management not only involves the production of
information, but also the capture of data at the source, the transmission and
analysis 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 in
particular, or the distinction between knowledge processes and data/information
processing. The conceptualisation of knowledge in the IS view limits ones
understanding of knowledge processes, and dilutes the understanding that KM is

3
The term joined up governance is reflected in various sources like
http://news.bbc.co.uk/1/hi/special_report/1998/11/98/e-cyclopedia/211553.stm.

3
about knowledge and human understanding rather than about information technology
(IT). Wickramasinghe (2003, p.295) further tells us that:
Since knowledge management addresses the generation, representation,
storage, transfer and transformation of knowledge (Hedlund, 1994), the
knowledge architecture is designed to capture knowledge and thereby enable
the knowledge management processes to take place. Underlying the
knowledge architecture is the recognition of the binary nature of knowledge;
namely its objective and subjective components. Knowledge can exist as an
object, in essentially two forms - explicit or factual knowledge - and tacit or
"know how" (Polyani, 1958, 1966). It is well established that while both
types of knowledge are important, tacit knowledge is more difficult to
identify and thus manage (Nonaka, 1994, 1991). Further, objective
knowledge can be located at various levels, e.g. the individual, group or
organization (Hedlund, 1994). Of equal importance, though perhaps less
well defined, knowledge also has a subjective component and can be viewed
as an ongoing phenomenon, being shaped by social practices of
communities (Boland and Tenkasi, 1995).”
It is clear that here the subjective dimension of KM is recognised, but the IS approach
tends to diminish the barriers to appreciating KM and its implementation. What is the
objective nature of knowledge referred to here, and how does it differ from subjective
knowledge? It is enough to distinguish between tacit and explicit knowledge? How
does the subjective component of knowledge differ from tacit knowledge? More
questions, it seems, are raised than responded to. Unsurprisingly, by exploring a
number of case studies Wickramasinghe (2003) found that knowledge based systems
did not support the subjective aspect of knowledge, and by not doing so, their function
is reduced to that of an explicated organisational memory.
There are broader views of KM than that provided by Wickramasinghe expressed by
Allee (1997), who poses the question of what constitutes KM. One approach is to
express it in strategic terms, where questions of ownership, control, and value, with an
emphasis on planning, are discussed. In an alternative view knowledge is more usually
seen as organic, and has a flow, a self-organising process, and patterns. This latter
approach explores how knowledge emerges, and how the patterns change, and thus
encompasses the notion of knowledge tracking. Also, in an organisational context, what
happens to an organisation’s knowledge if a knowledgeable and wise employee leaves,
and how can an organisation manage to capture that? It is here where KM begins to
link into concepts of organisational learning. Knowledge is increasingly recognised as
an important organisational asset (Iles, 1999). KM is the creation of knowledge and
its interpretation, dissemination and application, retention and refinement (De Jarnett,
1996). It is often now seen as a critical source of competitive advantage (Allee, 1997),
and it creates intellectual capital (Drucker, 1995). Knowledge creation is an important
consideration for organisations. However, knowledge renewal is an idea that also has
some importance. This is part of knowledge housekeeping that includes both
knowledge creation and evacuation. In the former, knowledge is seen to be important
for competitive advantage, and in the latter old knowledge is often seen to be of little
value in changing situations that can contribute to the nature of a problem. This implies
the need for self-reflection on knowledge and on the learning process.
We have said that KM links with organisational learning. This is an interest of
Grieves and Mathews (1997) for healthcare establishments. For them:

4
 “Learning is produced by organizational members themselves by actively
creating the conditions for individual and organizational development. If
organizational learning is viewed this way then it is both tacit/ informal and
explicit/ formal. Learning requires the assimilation of knowledge and skills
by individuals and groups who take responsibility for their own activity and
come to "own" what they learn. This type of learning is non-directive since
its purpose is not to transmit information through a trainer.
All human learning requires the ability to name, classify, construct
and communicate cognitive imagery conveying both spatial and temporal
characteristics (Bateson, 1979). Mental maps can be considered as tacit, in
the head methods, for making sense of and for performing tasks. Such
methods are acquired by individuals either through contextually-tied trial-
and-error techniques, or through imaginative thinking that is essentially
abstract and not tied to an immediate context. By contrast, it is possible to
argue that organizations create mental maps through methods that formally
articulate rules and procedures to guide the activities of their members.”
The term “organisational learning” is attributed to Argyris and Schon (1978) intended
to cover the notion that organisations, like organisms, adapt to a changing
environment. Learning in organisations can be said to require the development of both
systems and processes in order that changes in the external (and internal)
environments filter through to attitudes, procedures and practices in a way that
facilitates constant review of operating norms at a variety of levels throughout the
organisation. Interestingly, this implies a relationship to Stahr’s (2001) adopted
notions of systemic and generic quality. Since the concept of learning also relates
directly to the acquisition of knowledge, it entails a fundamental link to quality.
Having discussed some notions of information, quality and the learning organisation
in terms of knowledge and knowledge management, we are now in a position to
consider some knowledge conceptualisations that are appropriate to both individual
and organisations dimensions of healthcare.
3. The Theoretical Approach
The development of a cohesive approach to the coordination of perspectives through
knowledge sharing in healthcare organisation requires a clear frame of reference to be
provided. This section provides such a frame of reference.
3.1 Organisations and Complexity
Organisations are seen by many to exist in social environments that entertain rapid
changes, interdependence between different organisations, and complexity. When we
talk of complexity, we really mean a situation composed of structures (and their
associated processes) that have considerable variety in their microscopic distinction
(i.e., microstructures). When a variation in microstructure is perceived, then it may be
referred to as an event in time or space. Classes of space are physical or conceptual,
and related to the social, emotional or cultural context. Each of these can involve a
relatively large number of elements and associated relationships and processes. For
example, a situation may involve socially differentiable organisations. These have
conceptual forms that are represented physically through legal paper work and the
presence of individual workers. If there is seen to be considerable variety in the way
these organisations are differentiated, then the situation is complex; otherwise, it is
simple. We note that what is seen to be simple and complex is relative to the

5
knowledge and information of a given viewer. Another way of saying this is that the
situation is locally viewed to be simple or complex. In social situations, formal and
informal or perceived structural roles may exist, and both informally and formally
defined groups may exist as part of a structural differentiation. Together with their
interrelationships, these may be seen as an intricate fabric of social microstructures
relative to the whole organisation that represents a complex picture. Additionally,
individual emotions may be raised in the situation, and their intensity and direction
will make it more complex in respect of making decisions. Finally, considerable
variety in cultural differentiation may exist, that will be associated with many ways of
seeing or thinking. This very variety in seeing means that locally held knowledges
(that is, knowledge held local to any given viewholders) can be explored as cultural
microstructures in a complex situation.
Microstructural variety that occurs in time occurs when the relationships between
elements of spatial microstructures change over time. Another way of saying this is
that situations have dynamic events. Simple dynamic situations can be seen in terms
of their cause-effect relationships. In complex situations there may be many causes
that generate perceived effects, and they may not occur in simple relationships. There
is a view that complexity begets complexity, when people expect complex situations
to have complex causes. Cohen and Stewart (1994) refer to the principle of
“conservation of complexity”, when people adhere to a simple cause-effect rule that is
not often born out in practice. In certain circumstances systems act as amplifiers so
that simple causes can have fall-out consequences that are quite complex and lead to
chaos. There is also the idea of antichaos, proposed by Stuart Kauffman. Here,
complex causes produce simple effects indicating that complexity can diminish as
well as increase.
Within any complex situations we usually also find we have chaos. “Now that science
is looking, chaos seems to be everywhere” (Gleick, 1987, p5). In complex spatial
situations, chaos occurs when unexpected variety is seen that that has no logical or
relational basis for a viewer. In complex dynamic situations, chaos amplifies tiny
differences hidden in the detail of the complexity, and enables the unexpected to
become the predominant. Lack of expectation can be ameliorated if potential
information inherent in complex situations is realised.
The notion that complexity exists and can be dealt with takes us away from traditional
views about how our organisations function. The rise of the industrial revolution was
a period when we thought that we knew everything about the world in which we live.
It adopted what we now call mechanistic or simple thinking. Today, we realise that
things are more complex. We have been surprised by our accidental discoveries in
science, and the best-laid plans of our organisations tend to fall to ruin in the longer
term. The relatively new paradigm of complexity (proposed at the turn of the century)
is able to capture more of the interactive subtleties that appear to exist around us, and
this is captured in systems thinking. While machine age thinking adopts analysis
through reductionism, sees cause-affect relationships, and is deterministic, a systems
view seeks synthesis after analysis, and in doing so seeks to promote a broad picture
that is perspective sensitive. It allows for interactivity and unpredeterminable
variation, and distinct and changing views.
The paradigm supported in this paper is that of viable systems theory. It is sufficiently
rich to enable organisations to be modelled in such a way as to explore how they
might "successfully" operate in complex dynamic environments. The notion of

6
success may be seen as related to an organisation being viable in relation to what it
does, and today there is a view that this can be facilitated through the creation and use
of knowledge.
3.2 Viable Systems
A viable system is an active, purposeful, and adaptive organisation that can operate in
complex situations and survive. Since complex situations entail variety differentiation,
in surviving a viable system responds to changing situations by generating sufficient
variety through self-organisation to deal with the situational variety it encounters
(called requisite variety). It is often said in the cybernetic literature that variety is a
measure of complexity.
A viable organisation is able to support adaptability and change while maintaining
stability in its behaviour. In particular an organisation is viable if it can maintain stable
states of behaviour as it adapts to perturbations from its environment. Now, the
environment can be differentiated into a suprasystem of interacting organisations that
exists in its environment. Such organisations are normally considered to be
autonomous, in that they are taken to be analytically and empirically independent from
one another. What constitutes independence is a matter of practical requirement that
enables, for instance, measurements to be taken from a given organisation without
conceptually complicating them with data from other organisations. The question of
whether an organisation in a suprasystem of them is indeed autonomous, is one of
estimating its degree of interactivity with the other organisations. It is perspective
driven, and is ultimately axiomatic.
Viable organisations seek ways of improving their ability to survive in complex
situations. This is often coupled with the idea that they have fluid knowledge banks,
and organisational survival hinges upon an ability to create and manage knowledge.
Knowledge creation/recognition is therefore of prime importance to organisations.
The idea of knowledge creation is closely related to that of learning. A learner (who
may be seen as an individual or organisation), will undertake viable learning if there
is an ability to maintain stable learning behaviour. The caveat is that the learner is
able to adapt to changes in a given learning environment that alters the learning
situation. Whether a learner can adapt to the changes in the learning environment is a
function of that learner's plastic limit. In the systems literature, when perturbations
push it beyond this limit, the system either changes its form (incrementally through
morphogenesis, or dramatically through metamorphosis) or dies. As an example of
this, a learner studying on a university course who is struggling “dies” in this context
when s/he leaves the course prematurely (fails?) because new learning behaviours
cannot be established. If a viable organisation survives, then it is able to change its
form and thus its behavioural potential, to adapt.
Knowledge creation is associated with different worldviews. They are relative to the
institutions that one is attached to in a given society, and they change as the
institutional realities change (Berger and Luckman, 1966). Thus, worldview has a
view or perspective of the perceived behavioural world that is determined by cultural
and other attributes of the viewers. Through a process of socialisation, a view is
formed within the institutions one is attached to in a given society, and they change as
the institutional realities change. Worldviews may be shared by a group of people,
though when this occurs the individuals each retain their own realities while using
common models to share meaning. Further, worldviews have boundaries that are

7
generated within the belief system and cognitive space of their viewholders, and as a
result we can explore worldviews in terms of their knowledge attributes.
In developing on from and relating the work of Checkland and Scholes (1990) and
Kuhn (1970), two types of worldviews may be defined, informal (weltanschauung),
and formal (paradigm). By formal we are referring to the expression of ideas through
language. A formalisation enables a set of explicit statements (propositions and their
corollaries) to be made about the beliefs and other attributes that enable (more or less)
everything that must be expressed, to be expressed in a self-consistent way. Informal
worldviews are more or less composed of a set of undeclared assumptions and
propositions, while formal ones are more or less declared. Both are by their very
nature bounded, and thus constrain the way in which perceived situations can be
described. Now paradigms can change (Yolles, 1999; Kuhn, 1970), so that the nature
of the constraint is subject to a degree of change - however bounded it might be.
Consequently, the generation of knowledge is also constrained by the capacities and
belief systems of the worldviews.
The idea of a worldview (Yolles, 1999) is that it:
(a) is culture centred,
(b) has cognitive organisation (beliefs, values, and attitudes) are its attributes,
(c) has normative and cognitive control of behaviour or action that can be
differentiated from each other,
(d) it has a cognitive space of concepts, knowledge and meaning that is strongly
linked to culture.
Worldviews interact, and following the cybernetic tradition, this interaction can be
placed in a cognitive domain that drives the purposeful adaptive activity system. The
system has form, thus has structure, process and associated behaviour. It is assigned to
an energetic behavioural domain. The knowledge related cognitive domain is the
“cognitive consciousness” of the system that it drives. According to Yolles (1999), the
two domains are connected across a gap that we refer to as the transformational or
organising domain, and that may be subject to surprises. It is strategic in nature, and
operates through information (figure 1). The three existential/cognitive,
virtual/organising, and existential/behavioural domains are analytically and
empirically independent. This model can be applied to any purposeful adaptive
activity system by distinguishing between cognitive, strategic, and behavioural aspects
of a situation.
adjustment of Metasystem
Phenomenal/ Virtual/ organising Formal/informal
representation
Behavioural Organising group worldviews Existential/
Domain Domain Cognitive
Domain
System development/ group learning/
Behaviour Virtual personal consolidation
(structurally facilitated System learning explication (formal)
and constrained) Images
that
enable Informal
interaction formation
organising (often personal)
reflection/
worldviews
creation
Environment

interpretation
Figure 1: The Relationship between the Phenomenal, Virtual and Existential Domains
in a Viable System

8
This defines the basis of viable systems (as defined by Yolles) that, through
transformational self-organising processes, are able to support adaptability and change
while maintaining stability in their behaviour. In a plastic organisation the nature of
that behaviour may change, and in so doing a viable system will maintain behavioural
stability.
There are properties associated with each of these domains, perhaps most simply
expressed in terms of table 1. This derives from Yolles (1999), and the notion that is
associated with each of the three domains is a cognitive property that guides our
organisations in the way that they function and survive. Yolles (1999a), in his
exploration of the nature of cognitive influence, associates it with the process of
knowledge migration, that is the movement of knowledge between worldviews that is
subject to redefinition every time it migrates. It is not only knowledge that can be
associated with the cognitive domain. Data is associated with the behavioural domain,
and information with the organising domain. All three may also be identified as
analytically independent commodities that enable the properties to become
manifested.
3.3 The Cognitive Domain Commodities
Relationships exist between the cognitive domain commodities of table 1. These are
often poorly defined however (Roszak, 1986). For instance, systems analysts frequently
say that information is data, and information theorists that knowledge is information.
Our definition is as follows:
 Data are a set or string of symbols that can be associated with structures and
behaviours. They are meaningful only when related to a given context. They can
be stored, and if storage is to be meaningful or coherent, then within that context
storage will occur according to a set of criteria that are worldview derived. Data is
able to reflect variety differentiation in complexity. Stored data is also retrievable
according to the pattern of meaning created for it within the context (e.g., by
defining a set of entities that meaningfully relate to each other)
 Information is a sign or set of signs or signals that predisposes an actor (that is, a
person, or group of persons acting as a unit or organisation) to action. This appears
to be consistent with the notion of Luhmann (1995), who considers information to
be a set of coded events. It can also be defined as, that which enables a viewer to
perceive greater variety differentiation in a complex situation
 All knowledge is worldview local, and belief related. It can be defined as patterns of
meaning that can promote a theoretical or practical understanding that enables the
recognition of variety in complexity. These patterns are often developed through a
coalescing of information. If information is seen as a set of coded events, then
consistency with Nonaka and Takeuchi occurs when they say that explicit
knowledge is codified.

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 Sociality Properties
Cognitive Kinematics Orientation Possibilities/potential
Properties (through energetic (determining trajectory) (through variety
motion) development)
Cognitive Technical Practical Critical Deconstraining
interests
Work. This enables Interaction. This requires that Degree of emancipation. For
people to achieve people as individuals and organisational viability, the
Phenomenal goals and generate groups in a social system gain realising of individual
(conscious) material well-being. and develop the possibilities of potential is most effective
domain It involves technical an understanding of each when people: (i) liberate
ability to undertake others subjective views. It is themselves from the
Activities action in the consistent with a practical constraints imposed by
Energy environment, and the interest in mutual power structures (ii) learn
ability to make understanding that can address through precipitation in
prediction and disagreements, which can be a social and political processes
establish control. threat to the social form of life. to control their own
destinies.
Cognitive Cybernetical Rational/Appreciative Ideological/Moral
purposes
Intention. This is Formative organising. Enables Manner of thinking. An
through the creation missions, goals, and aims to be intellectual framework
and strategic pursuit defined and approached through which policy makers
Virtual or of goals and aims that through planning. It may observe and interpret reality.
organising may change over involve logical, and/or This has an aesthetical or
(subconscious) time, enables people relational abilities to organise politically correct ethical
domain through control and thought and action and thus to orientation. It provides an
communications define sets of possible image of the future that
Organising processes to redirect systematic, systemic and enables action through
Information their futures. behaviour possibilities. It can politically correct strategic
also involve the (appreciative) policy. It gives a politically
use of tacit standards by which correct view of stages of
experience can be ordered and historical development, in
valued, and may involve respect of interaction with
reflection. the external environment.
Cognitive Social Cultural Political
influences
Formation. Enables Belief. Influences occur from Freedom. Influences occur
individuals/groups to knowledge that derives from from knowledge that affect
Exustential or be influenced by the cognitive organisation (the our polity determined, in
cognitive knowledge that relate set of beliefs, attitudes, values) part, by how we think about
(unconscious) to our social of other worldviews. It the constraints on group and
domain environment. This ultimately determines how we individual freedoms, and in
Worldviews has a consequence for interact and influences our connection with this to
Knowledge our social structures understanding of formative organise and behave. It
and processes that organising. ultimately has impact on our
define our social ideology and morality, and
forms that are related our degree of organisational
to our intentions and emancipation.
behaviours.
Table 1: Relationship between human cognitive interests, purpose, and influences
The second part of the definition for information derives from Information Theory. It
supports the idea that if the entropy of a situation is increased, structures become less
differentiated. Entropy may usefully be thought of as a lack of information (Brillouin,

10
1967, p.160). In a well ordered situation there is a high probability of finding
differentiation. If this is expressed in terms of distinct microstructures (that is,
microscopically distinct structures), then they are differentiated through the
boundaries or frames of reference that distinguish them. If a viewer is to be able to
recognise that these boundaries or frames of reference are differentiable, then that
viewer must be able to adopt concepts (that is, characteristics of knowledge) that
enable differentiation.
When Brillouin considers entropy, he is more interested in the possibility of
microstructures arising in a process of negative entropy (or negentropy), that by its
very nature connects it to an information process. Our interest is not so much
concerned with the possibility of negentropy, but more with viewer perceived
negentropy, that is the perception of microstructures arising. In taking this route, we
shall not worry about whether the situation itself has a changing negentropy. Whether
or not it has is irrelevant for an explanatory process, because what is important is the
ability to perceive (and in quantitative terms to measure) any changes in negentropy.
Microstructure differentiation can be seen if a viewer knows what to look for. That is,
patterns of meaning operate to provide a perspective from which information is
sought. The perceived lack of information about a situation, with a given level of
complexity, introduces the possibility of seeing greater complexity (through
perceiving microstructure variety). However in practice, a viewer may not be able to
distinguish one microstructure from another. Since the perception of any one of these
different microstructures can actually always be realised, the lack of information
corresponds to a perception of disorder in the hidden variety. Taditional interest has
been in Shannon information as a form of negentropy (Brillouin, 1967), but more
recently other definitions of information have been highlighted, including that of
Fisher Information from the 1920s (Frieden, 1999). This derives from measurement
theory, and has interests in "imperfect" observation - where views of situations are
viewer based (i.e., local). Fundamentally, it is a measure of indeterminancy.
A view about the relationship between knowledge and information is based on
Bellinger (1996), that provides an interconnection between data, information, data
and wisdom derived through the relationship between contexts and understanding
(figure 2).

Independence
of context

Context defining Wisdom

Context forming Knowledge

Context bound Information

Context free Data Understanding

relations patterns principles

Figure 2: Connection between data, information and knowledge through the relationship
between understanding and context, based on Bellinger (1996)

11
According to this construction, data, as an unattached symbol or mark, is context free, and
with no reference to time any point in space and time. As such it is without a meaningful
relation to anything else. Meaning is attributed to data by associating it with other things,
i.e., defining a context.

Information is constituted through an understanding of the relations between classes of data.

Such relations, defined by the pattern of knowledge of a viewer, tend not to be dynamic in
their nature unless the patterns of knowledge that establish them are themselves dynamic.
Information is thus closely associated with a dependence on context that generates meaning,
and not predictive capability is implied. This, information is closely bound to context.
Patterns, according to Bellinger, embody both a consistency and completeness of relations
that create their own context. Pattern also serves as an Archetype with both an implied
repeatability and predictability. Patterns can also represent knowledge when they promote
implications by creating their own context (self-contextualisation). With understanding, a
pattern that is knowledge provides a high level of reliability or predictability as to its future
dynamic. We have consistently talked of patterns of knowledge, implying therefore, a level
of understanding about the knowledge that is held. Thus is, patterns of knowledge imply
some connection with metaknowledge that reflection.
Bellinger refers to wisdom as an understanding of the foundational principles responsible for
the patterns representing knowledge being what they are, and it creates its own context
totally. These foundational principles are completely context independent, and have been
referred to here as context determining because the context is bound into the wisdom.

A traditional view in finding information is to seek data, and this leads us to seek an
appreciation of the relationship between data and information, and indeed between
information and knowledge. Such a relationship is proposed in figure 3. Here, data can be
processed into information (called data information) through the application of patterns of
meaning that relate to organisational purpose. Data processing is also constrained by criteria
of what constitutes a processing need. Information also exists phenomenally, through the
very microstructural variety differentiation that exists in a structured situation. The
coalescing process that converts from information to knowledge through some form of
distillation is one that occurs through the renewal of patterns of meaning that constitutes
knowledge. The creation of explicit knowledge is often seen as a process of storing and
indexing information. However, these patterns can also occur mentally as tacit knowledge.
Knowledge also enables context to be defined in a richer way, and this affects both data
processing and the distillation of information into new knowledge by enriching existing
patterns.

The model given in figure 3 leads to questions about our understanding of knowledge
creation, and has consequences for the way in which we see knowledge development in
organisations. For instance, how and through what means are the patterns of meaning formed
that enable data to be processed, and information to be coalesced. Further exploration of
knowledge processes within organisations can be developed within the context of knowledge
management.

12
 Data Bank with patterns of meaning Bank of Knowledge Patterns

Data Processing Information Coalescing Knowledge

A collection Occurs through Set of symbols that Renewing patterns Patterns of
of symbols patterns of have meaning & relate of meaning through meaning that
that are meaning that relate to action, & enable relating new that connect to
devoid of to purpose & are variety differentiation information to patterns of belief
meaning criteria constrained within complexity existing patterns of
knowledge

Context and criteria

Feedback to worldview & redefinition of criteria and context

Figure 3: Relationship between data, information and knowledge

There is a perhaps better way that that of figure 3 to describe the relationship between
data, information and knowledge, that comes from an ontological model of viable
systems that originates from Schwarz (1997).
While data is not information, data classifications or classes can be described as entities that,
when woven into a relational pattern can become information when conditioned by
knowledge within an action setting.
Just as data is not information, information is not knowledge. However information can
contribute to the creation of knowledge. This occurs when information is analysed,
interconnected to other information within a thematic context, and compared to what is
already known.
A relationship between data, information, and knowledge cannot be considered
independently of an agent that is involved in creating that relationship. Our interest lies in
the generic relationship, rather than local detailed relationships between commodity
elements that will be different for each agent. The generic relationship is defined in figure 4.
It presupposes that the agent has a purpose for inquiry and is involved in the process of
either quantitative or qualitative measurement. Qualitative measurement involves conceptual
assessment brought together with some form of mapping agent that is capable of generating
a possibly complex scale of values that can be assessed as though they are quantitative
measurements. The measuration processes occurs through a process of self-organisation. It
is through inquiry that acquired data information derives through decisions about inquiry
process that enable measures to come about from the phenomenal microstructural variety
that differentiates the parts of a structure. This then becomes manifested in the virtual
domain as part of a set of relational images that are connected to some theme. The principle
relationship in any holon is between data and information, conditioned by knowledge
expressed in terms of contextual thematic principles. Relational information that plays a part
in decision processes is used to self-produce a network of processes that manifests inquiring
behaviour from which data is collected. This is fed back to the virtual system to create data
information that becomes integrated into the relational images that exist there. Failure in
information and knowledge relationships influences the patterns of knowledge that are used
to define thematic context.

13
 Autopoiesis and
Autogenesis and contextual manifestation of
thematic principles from constrained inquiring
knowledge behaviour

Existential domain Virtual domain Phenomenal domain

Patterns of Relational information Data from structure and
knowledge defining decision measuration
defining context processes

Autopoiesis and
Autogenesis and
regeneration of network
regeneration of evaluative
of decision processes
perceived experience
through data processing

Figure 4: The ontological relationship between data, information and knowledge

4. Knowledge Management
The management of knowledge is becoming an important area of interest. However, the
question of what constitutes knowledge management may be posed in different ways
(Allee, 1997). A traditional meaning approach discusses questions of ownership,
control, and value, with an emphasis on planning. Another view is that knowledge is
organic, and has a flow, a self-organising process, and patterns. This latter approach
explores how knowledge emerges, and how the patterns change. Also, in an
organisational context, what happens to an organisation’s knowledge if a
knowledgeable and wise employee leaves, and how can an organisation manage to
capture that. Knowledge is increasingly recognised as an important organisational
asset (Iles, 1999). Its creation, dissemination and application is often now seen as a
critical source of competitive advantage (Allee, 1997; Lester, 1996).
Knowledge creation is an important consideration for organisations. However,
knowledge renewal is a phrase that is also seen as important. This includes both
knowledge creation and evacuation. In the former, knowledge is seen to be important
for competitive advantage, and in the latter old knowledge is often seen to be of little
value in changing situations. This implies the need for self-reflection on knowledge and
on the learning process.
Following a tradition supported by Ravetz (1971), Nonaka and Takeuchi (1995, p.8)
distinguish between two types of knowledge: explicit and tacit (table 2). Tacit
knowledge includes cognitive and technical elements. Cognitive elements operate
through mental models that are working worldviews that develop through the creation
and manipulation of mental analogies. Mental models like schemata, paradigms,
perspectives, beliefs and viewpoints, according to Nonaka and Takeuchi, help
individuals perceive and define their world. The technical element of tacit knowledge
includes concrete know-how, crafts, and skills. However, explicit knowledge is about
past events or objects "there and then", and is seen to be created sequentially by
"digital" activity that is theory progressive.
Nonaka and Takeuchi (Ibid.) develop on this to create what has become perhaps the
most well known model for knowledge creation, referred to as the SECI model of
knowledge creation and illustrated in figure 5. It derives from their model of the
conversion process between tacit and explicit knowledge, and results in a cycle of
knowledge creation. The conversion process involves four processes: socialisation,
externalisation, combination, and internalisation, all of which convert between tacit

14
and/or explicit knowledge. Socialisation is the processes by which synthesised
knowledge is created through the sharing of experiences that people have as they
develop shared mental models and technical skills. Since it is fundamentally
experiential, it connects people through their tacit knowledges. Externalisation comes
next and occurs as tacit knowledge is made explicit. Here, the creation of conceptual
knowledge occurs through knowledge articulation, in a communication process that
uses language in dialogue and with collective reflection. The uses of expressions of
communication are often inadequate, inconsistent, and insufficient. They leave gaps
between images and expression while promoting reflection and interaction. It
therefore triggers dialogue. The next process is combination, when explicit knowledge
is transformed through its integration by adding, combining and categorising
knowledge. This integration of knowledge is also seen as a systemising process.
Finally, in the next process explicit knowledge is made tacit, by its internalisation.
This is a learning process, which occurs through the behavioural development of
operational knowledge. It uses explicit knowledge like manuals or verbal stories
where appropriate.

Expression of Explicit Knowledge Tacit Knowledge

knowledge type
Objective
Rationality (mind)
Sequential (there and then)
Nonaka and Drawn from theory (digital)
Takeuchi Codified, formally transmittable in
systematic language. Relates to
past
Formal and transferable, deriving
in part from context related
information established into
Alternative definable patterns. The context is
therefore part of the patterns.
Table 2: Typology of knowledge
Subjective
Experiential (body)
Simultaneous (here and now)
Practice related (analogue)
Personal, context specific, hard to formalise and
communicate. Cognitive (mental models),
technical (concrete know-how), vision of the
future, mobilisation process
Informal, determined through contextual
experience. It will be unique to the viewer
having the experience. Not transferable except
through recreating the experiences that
engendered the knowledge for others, and then
the knowledge gained will be different.

The different types of knowledge process are seen as phases in a knowledge creation
cycle. This is driven by intention, seen as an aspiration to a set of goals. Autonomy is
another requirement that enables the knowledge cycle to be driven. This increases the
possibility of motivation to create new knowledge. There are three other conditioning
factors. One is the need of fluctuation and creative chaos. This can generate signals of
ambiguity and redundancy that inhibits the "improvement" of knowledge. The sharing
of redundant information promotes a sharing of tacit knowledge when individuals
sense what others are trying to articulate. Finally, requisite variety is needed if an
actor is to deal with complexity. Thus, five factors condition the knowledge cycle
enabling it to maintain developmental motion.

15
 Tacit K nowledge Explicit K nowledge

Socialisation
Existential; face-to-face
Tacit Creates sympathised
K nowledge knowledge through sharing
experiences, and development
of mental models and
technical skills. Language
unnecessary
Externalisation
Reflective; peer-to-peer
Creates conceptual knowledge
through knowledge articulation
using language. Dialogue and
collective reflection needed

Internalisation
Collective: on-site
Creates operational
Explicit knowledge through learning
K nowledge by doing. Explicit knowledge
like manuals or verbal stories
helpful
Combination
Systemic; collaborative
Creates systemic knowledge
through the systemising of ideas.
May involve many media, and
can lead to new knowledge
through adding, combining &
categorising

Figure 5: The SECI cycle of knowledge creation (Nonaka and Takeuchi, 1995)
It is often the case that something that has associated with it behaviour has both
structure and process. Structure provides the framework for behaviour and defines its
limitations. What do we mean by this? Well, consider that the application of a
structured method of inquiry is to reduce a messy, complex and ill-understood
situation to a difficulty by reducing uncertainty and increasing information through
the use of a set of conceptual tools (Yolles, 1999). It is through method that the
inquiry takes a form (through structure and processes). Often, the processes are seen as
an ordered set of procedures, and these are applied according to some regime or
strategy. Thus, to fix a poorly running engine, the first two steps might be to examine
the engine electronically, then mechanically. If the method is adaptable, then its form
can change enabling its set of procedures to be applied in a changing order. This is due
in principle to the use of controls that confirm or adjust the progress of the inquiry as it
develops. An example of such a methodology is Soft Systems Methodology (Checkland
and Scholes, 1990).
Now, an inquiry method can also be seen as a cycle of creation. This is because the
application of its procedures results in the creation of something new. Normally, in the
application of systems methods to messy situations, it is information (rather than
knowledge) that is created. This proposition means that there is a relationship between
inquiry methods and knowledge creation cycles. Well chosen arguments about an
inquiry method can presumably also be applied to a knowledge creation cycle.
However, in discussing such epistemological considerations, there is a need to explore
ontological issues.
5. Philosophy and Knowledge
Understanding the potential for knowledge sharing and therefore the coordination of
perspectives in healthcare organisations requires that a reasonable appreciation of
some of the philosophical underpinnings is understood. This section intends to
provide this.
We can identify four types of paradigm that define the nature of an approach to
inquiry (Guba and Lincoln, 1994). They are positivism, postpositivism, critical

16
theory, and constructivism. Each has its axiomatic ontology and epistemology that
form the basis of its other propositions. Ontology concerns beliefs about the form and
nature of reality, and epistemology the nature of knowledge and the relationship
between those who know (the knowers) and knowing. How we inquire into, and see
organisations and the environments in which they exist depends upon our knowledge,
understanding, and epistemological frame of reference, and how we deal with what
we know is determined by both epistemology and ontology.
Positivism has an ontology that is naïvely realistic (there is a reality that may be
apprehended), an epistemology that adheres to the notion of objectivity, and the
possibility of finding universal truths. Those who hold positivistic views see reality to
exist autonomously from any observer, and inquirers can be objective and non-
participant observers to the events that they see. The events can be represented by
observer independent measurables called data that represent the “facts” of a single
objective “reality”. Thus for instance, a given investigation should always produce the
same result for any observer if the theory about it is true, and if it is undertaken
“scientifically” (according to a set of propositions that represents a positivist
epistemology). The truths set up as a pattern of propositions represents the
knowledge. Through deductive reasoning, the approach usually embeds an attempt to
test theory in order to improve both the understanding of a situation and the ability to
make predictions about it. Postivism has a long tradition. During the last few hundred
years within the period of the industrial revolution, there was a belief in the West that
science had conquered the unknown. Simple mechanistic thinking ruled, and extended
into what has been called behaviourism in psychology that is decried by systemic
thinkers (Koestler, 1967).
The age of complexity has led many away from the positivist perspective.
Postpositivism is linked to positivism. It supports the notion of an objective reality,
but this may only be apprehended imperfectly and probabilistically, and only an
approximate image of reality may be possible. It may be that an example of
postpositivist perspective is that of the engineering view (see Fivaz, 2000). In this,
observers can have their own perspective that can influence the way that they see
things. They are endowed with consciousness, which in extension to simple
behaviourism is seen to be a set of engineering processes that converts information
acquired as observation from “outside” into information implemented “outside”. A
corollary of this is that different people can be better or worse at these engineering
processes, and in all such perspectives, the possibility of at least fuzzy optimisation
becomes a relevant concept. Thus, mind is a biased machine, reality is actually out
there and may possibly be found, and knowledge is objective.
Critical theory is a blanket term that may be defined to include both postmodernism
and poststructuralism since their epistemology supports the notion that inquiry is
value determined (Guba and Lincoln, 1994). The ontology of critical theory holds that
reality is virtual, and shaped by social, political, economic, ethnic and other factors
that crystallise over time. Epistemologically it is subjectivist, so that findings are
value laden with respect to the world view of an inquirer. Finally, constructivism
departs from critical theory in that it abandons ontological realism for ontological
relativism, that is reality seen as a relative phenomenon. Epistemologically,
knowledge is created in interaction between inquirers in a situation and its
participants. It takes its name from the notion that there exist both local and
specifically constructed realities. Both critical theory and constructivism are related in
that both support subjectivist epistemology, but the latter relates to created findings.

17
The perspective adopted in this paper lies more within the critical than the positivist
tradition. Within it, there are no observers, there are only viewers, and their views like
their behaviours are worldview derived. Worldviews also interact with each other.
Following the work of Luhmann (1995), this interaction occurs through a semantic
communication process. From Habermas (1987), interaction occurs in a framework of
meaning called the lifeworld.
In critical theory there is no absolute real world that can be separated out, because
viewers create it within their frame of reference, and interact with their creation.
There is therefore no separation between the viewer and the behavioural world around
him. Since what constitutes reality is determined through worldviews, it changes as
worldviews change. In each worldview we build our view of what we perceive to be
the world through our mental models. We may believe that we share them with others,
but they will be incommensurable to some degree (Yolles, 1999). This is because the
models may involve different conceptual extensions, or the same conceptual
extension may take on meanings that are qualitatively different. We are never aware
whether these shared models are related, except by attempting to draw meaning from
others' explanations provided through language, or comparing what we expect from
the behaviour of people in a situation, with what we perceive that they are doing.
One often thinks of physics being positivist or postpositivist. However, the interest of
Frieden (1999) in physics is probably more related to critical theory than
postpositivism. In his exploration of positive physics he acknowledges that people
attempt to predict deterministically the future as a result of the past. Since reality is
objective and unique, full knowledge is possible and prediction is certain. Along with
this, it is usually held that "all statements other than those describing or predicting
observations are meaningless" (Ibid., p108). His view, however, is that the idea of
observation must be replaced by "creative observation", where observations are
themselves meaningless except in so far as they create local physics. More generally,
futures may be seen to be the result of changing patterns of perception that result from
new knowledge, experiences and beliefs of viewers. Frieden holds that prediction is
local, but it requires that people are prepared to constantly modify their view of the
world arround them, and consistently need to realise or release the information
potential inherent to the complex situations that they see around them. This does not
seem too far from our view in which there is no observer, but rather an other who is a
potential or actual viewer. In a social context, a viewer has a worldview that interacts
with the worldviews of others either directly or indirectly (through some of their
apparent constructions). A result of the interaction is the creation of viewholder-local
knowledge - that is, knowledge that is personal and therefore local to the viewer.
Since this knowledge tells us about reality, then reality is a local phenomenon. This is
also so if one considers only a situation involving a single worldview. In this case,
reality is created through the interaction between a viewer and the information around
him (Ibid.), again seeing reality to be locally made. However, this in turn leads us to
questions about what constitutes information, and what the role of the viewer is in
defining it.
5.2 Ontology, Epistemology, and the Knowledge Creation Cycle
We have already indicated that the ontological and epistemological aspects of inquiry
are important, and we shall relate this to the Nonaka and Takeuch knowledge creation
cycle which we shall argue offers a perhaps benign schizophrenia. To do this we shall
first revisit the dynamic relationship between tacit and explicit knowledge.

18
In any coherent social group situation, there is normally a dynamic between explicit and
tacit knowledge. Tacit knowledge is seen as informal and determined through
contextual experience, and will be unique to the viewer having the experience. It is
therefore not transferable except through recreating the experiences that engendered the
knowledge for others, and then the knowledge gained will be different. Tacit knowledge
is therefore the result of self-learning. Explicit knowledge may be identified as formal,
deriving in part from context related information established into definable patterns.
Context formally exists as part of these patterns. Formal knowledge is transferable if the
medium of transfer enables the transferral of meaning. Explicit knowledge can be a
consequence of self-learning tacit knowledge, or received as a transfer. Examples of
such transferable knowledge occur when it is provided in a book, or set out in a
knowledge base system as a pattern of meanings through a set of propositional rules or
through some other patterning process.
We are aware that the processes of knowledge creation in the Nonaka and Takeuchi
SECI model are socialisation, externalisation, combination, and internalisation. The
cycle is constructivist (Meehan, 1999), and we shall argue that it also has a positivist
structure. To see its positivistic elements, we begin by noting that a primary
distinction between explicit and tacit knowledge given by Nonaka and Takeuchi is that
the former is objective, while the latter is subjective. Since they do not seem to provide
any indication that their view of objectivity is not positivist, one can therefore suppose
that it is. In our view, the objective elements can at best be described as an "objective
potential" to the group that may not be, and are unlikely to be realised. The reason is
that frequently explicit material may be "misinterpreted" by members of a group. This
is because each individual will find meaning in the explicit knowledge through their
own tacit knowledge, and this can result in meaning variance within the social group of
participants. There is usually not enough semantic communication for this to be
appreciated by the members of the group.
The obverse positivist notions of objectivity and subjectivity provide a definition for
the context within which the knowledge creation structure operates, and suggest
positivist ontology. There is nothing to indicate that the cycle is not continuous
sequential in its passage through its phases, uninterrupted, and non-adaptable. The
process nature of each phase in knowledge creation is determined through its
conditioning. However its sequence of phase activation is predetermined by the prior
phase, and there appears to be no facility by which one phase can be spontaneously
enabled out of sequence. This is consistent with a positivist epistemology. The idea
that it has a constructivist process and positivist structure leads to a perhaps benign
epistemological schizophrenia (adopting the base rather than the clinical meaning - of
two minds).
As an example of the structural problem with the SECI knowledge cycle, we can ask
if conceptual knowledge is assigned to the externalisation phase only after the
development of socialisation, or can it develop independently without socialisation
and be externalised. Perhaps, though, this might be a process of socialising with
oneself? Our mental models centre on our conceptualisations, and they are often not
made explicit. When we are unable to explain things that we believe, we create
concepts that enable us to help us explain situations. This is a process that Cohen and
Stewart (1994) call collapsing chaos, which reduces complexity. It would also seem to
be the case that the process of externalisation that leads to new theories and
generalisations offers a sound rational positivist logic. However, we are aware that
such rational approaches tend to be unrepresentative of the way that patterns of belief

19
can change the nature or relevance of knowledge. Returning to the socialisation
process commented on before, Nonaka and Takeuchi acknowledge that knowledge is
belief based. However, it may be argued that beliefs may develop into knowledge
without the benefit of the socialisation process.
Ideally, we require a metaprocess that enables us to show under what conditions
combination (say) may follow socialisation. As in the case of Soft Systems
Methodology as shown by Yolles (1999), this metaprocess occurs through the
creation of a set of control loops that explain how changes can occur in a cycle of
creation.
6. A Viable Approach to Knowledge Creation
The structured spiral of knowledge creation offered by Nonaka and Takeuchi adopts a
positivist perspective. An alternative critical approach is possible that links closely
with the viable system model of figure 1. In addressing this, we note that each of the
three domains have associated with them its own knowledge process, one connected
with cognition, one with organising, and one with behaviour. This notion is consistent
with Marshall (1995), whose interest lies in knowledge schema. Schema have four
catagories: (1) They are the mental organisation of individual’s knowledge and
experience that allows him/her to recognise experiences that are similar. (2) They
access a generic framework that contains the essential elements of all these similar
experiences. (3) They use of this framework to plan solutions. (4) They have the
ability to utilise skills and procedures to execute the solution. For this purpose,
Marshall identifies three types of knowledge:
 Identification knowledge – the facts and concepts making up the knowledge
domain
 Elaboration knowledge – the relationships between the individual knowledge
components and the way they are organised
 Execution knowledge – the conceptual skills and procedures required to execute
an activity
Marshall does not attempt to address knowledge creation, though we shall do so
through our own model. We consider that in social group situations, knowledge
creation occurs through a process of knowledge migration from one worldview to
another. It is an identification knowledge process. The basic knowledge management
model is as given in figure 6. It links to table 1, and depicts the three fundamental
phases of the knowledge process: migration, appreciation, and action. Migration is
associated with the cognitive domain, appreciation with the organising domain, and
action with the behavioural domain. The way that migration occurs is conditioned by
cognitive influence, appreciation though cognitive purpose, and action through
cognitive intention. Each phase process has an input and an output. A feedback
control process is able to condition each phase process directly, or through its input.
The way that each phase process is conditioned by the feedback control is represented
symbolically in figure 6 by a loop around the process bubble, and we shall return to
this in a moment.

20
 Re-migration of
knowledge(recursive)

influence

Knowledge contagion
migration

interconnection
re-interconnection purpose
(recursive) Knowledge
appreciation
Knowledgable
action
intention
application

re-appreciation (reursive)

Figure 6: The Knowledge Cycle

The structured spiral of knowledge creation offered by Nonaka and Takeuchi adopts a
positivist perspective. An alternative critical approach is possible that links closely
with the 3-domain model of figure 7. In addressing this, we note that each of the three
domains have associated with them its own knowledge process, one connected with
cognition, one with organising, and one with behaviour. This notion is consistent with
that of Marshall (1995) in connection with knowledge schema.

Autogenesis and principles Autopoiesis and self-

of contagion that guide the production logical network
development of common of knowledge action
shared knowledge processes involving tactics

Existential
domain

Pattern of Phenomenal domain

knowledge of Virtual domain Knowledgeable action
actor A1 Knowledge supported by
accommodation through facilitating structures
Structural
shared models
coupling
enabling
knowledge Pattern of
migration knowledge of
through actor A2 Autopoiesis and regeneration of
lifeworld logical networks of knowledge
interconnection action processes
to develop
shared patterns Autogenesis and regeneration
of knowledge principles of contagion through
reformation of shared knowledge

Figure 7: Ontological expression for knowledge migration cycle.

Marshall applies her ideas on knowledge schema to decision-making by people rather

than by social groups. However, a link can be made between them by applying the
typology of knowledge to the viable knowledge cycle of figure 7. We consider that in
social group situations, knowledge creation occurs through a process of knowledge
migration from one worldview to another, and it is an identification knowledge

21
process. The basic knowledge management model depicts the three fundamental
phases of the knowledge process: migration, accommodation, and action. Migration is
associated with the existential domain, accommodation with the virtual domain, and
action with the behavioural domain. The way that migration occurs is conditioned by
cognitive influence, accommodation though cognitive purpose, and action through
cognitive interest. Each phase process has an input and an output. A feedback control
process is able to condition each phase process directly, or through its input. The way
that each phase process is conditioned by the feedback control is represented
symbolically by a simple loop around the process bubble.

Returning now to the control process we referred to earlier, we show the explicit
meaning of each return loop in figure 8.

Input evaluation output

filter Process monitor
reference
criteria monitoring
criteria
world
views control feedback
measures

empirical criteria concepts defining

Figure 8: Basic form of the Control Model

Control processes not only condition phase processes. They can also be responsible
for re-scheduling them in the overall knowledge cycle. Within perspectives of
traditional positivism, it is normal to consider controls in simple terms; but they may
also be susceptible to complexity and chaos as illustrated in table 3 (Yolles, 1999).
This has implication for the development of a chaotic activation of a phase that is not
sequentially ordered, and that can occur when complexity is affective.

Simple Terms of Control Complex Terms of Control

Likely to be linear and have a
steady state behaviour with
clear relationships between the
inputs and outputs of a process.
Indications of instability will
probably be predeterminable
and boundable. The actuator
that can take action to regulate
the process will be deterministic
or involve rational expectation.
Table 3: Distinguishing between Simple and Complex Feedback Control Loops.
Likely to be non-linear and far from a steady state behaviour.
Instability may appear without prior indication. The relationships
between inputs and outputs will in general not be strictly causal,
but unclear. The effects of the actuator will be uncertain. It is not
always the case that standards, norms, and objectives that drive a
control process will be well defined. It is not uncommon for them
to be fuzzy whether or not it is believed that they are well defined,
and it may be that such a belief can only be validated
retrospectively. Even if they are well defined, it may be that their
definition entails some level of unrealised flexibility. Measures of
performance may be inadequate to indicate the nature of the
output.

22
Control processes, while often considered in terms of positivist or postpositivist
paradigms, may also be seen from a critical theory perspective. To do this we invoke
the propositions that:
a) knowledge that enables the nature of a control process to be understood is local
and worldview dependent
b) empirical and reference control criteria are worldview dependent, value laden, and
will be susceptible to ideology and ethics
c) conditioning control processes are implemented in a local inquirer-relative way.

These propositions have implications for the way in which the social group, subject to
the phase process conditioning: (i) responds to the control situations, and (ii)
appreciates the need of semantic communications that make it broadly meaningful.
The conditioning processes of the knowledge cycle are illustrated in the figures 9-11.
In figure 6, we consider the control process involved with knowledge migration. This
occurs through the development of (lifeworld) interconnections between the
worldviews of the actors in a given suprasystem, and is the result of semantic
communication. As part of the process of knowledge migration, new knowledge is
locally generated for an actor. While this may be seen as part of a socialisation
process, it may also be seen as an actor local spontaneous thing when the process of
knowledge migration operates as knowledge creation trigger.

Local actor contagion of

Worldview interconnection
Between actors through
Semantic communication
cognitive
influences Knowledge of actor
cultural & social
influences
knowledge ask questions knowledge to
creation and count relevant others
Knowledge migration (adaptational
basis through:
innovation &
polity knowledge filter deep learning)
Who has knowledge
been passed to, & who
has retained in what
way for future use
empirical criteria defining concepts

Figure 9: control model for knowledge migration

Newly migrated knowledge may be shared and re-shared within the suprasystem,
because the new knowledge created by one actor will have a local definition that will
be different for others. As a result, the originally migrated knowledge will have to be
re-migrated in a feedback loop. This is fundamentally consistent with the notion of
paradigm incommensurability, since every worldview will have its own distinct
pattern of meaning that will be different from every other one. This does not stop the
knowledge from being “contagious” to relevant others within a given suprasystem
through the continuous semantic communication process that they participate in, that
involves recursive migration (that is re-migration and re-remigration) of knowledge.
Each recursive knowledge migration has the potential of new knowledge creation for
each actor in the suprasystem. As knowledge is migrated, it is likely to pass through a

23
morphogenic process, and sometimes a metamorphic one that makes it new to the
group.
Polity, a core aspect of politics, acts as a filter on knowledge migration. It is
concerned with an organised condition of social (or civil) order. Polity is connected to
politics through the latter’s interest in the causal relationships relating to behaviour,
that enables what may be referred to as social engineering. Within the context of
knowledge about the creation of order, we can talk of polity knowledge. It would
seem to be connected to what Marshall (1995) refers to as elaboration knowledge
(relating to the relationships between the individual knowledge components and the
way they are organised within a schema). Polity knowledge can be seen to relate to
the relationships between individual knowledge components as perceived by an actor
to be possessed by the other actors, and the relative way that they are organised. It
would thus seem to be an active recogniser of identification knowledge (Ibid.) – i.e.,
the concepts and patterns of meaning that make up knowledge. When polity
knowledge is applied to other actors, it enables us to decide about them. Sometimes,
such decisions involve “false” assumptions that are not representative of the
indentification knowledge of other actors. This can inhibit the process of knowledge
migration, since recognition of knowledge differences is needed before knowledge
migration can occur. When no such recognition occurs, then one reason may be that
the worldview of the viewer may be closed (Yolles, 1999).
Measures can be attempted. Contagion can be evaluated by examining to whom
knowledge has been passed, and whether it has been retained for use. Cultural and
social influences can be evaluated by examining beliefs, values and attitudes
(cognitive organisation). One way of doing this is to examining resistance to the
adoption of new patterns of cognitive organisation. Social influences represent
knowledges about the way in which social processes operate. This dimension can be
measured in terms of not social meaning, but the reticence that actors have to the
introduction of new social meaning.
The process of knowledge appreciation (figure 10) can follow knowledge migration.
An appreciation of how migrated knowledge can be of use to a relevant other is
essential if they are to be able to harness it within a behavioural world. Knowledge
appreciation by relevant others is dependent upon knowledge contagion to these
others. However, this is filtered through knowledge that activates weltanschauung
derived ideology and ethics. In addition, the evaluation reference criteria derive from
knowledge about intention and logico-relational cognitive purposes. Interestingly, this
connects with the Marshall (1995) idea of planning knowledge - the knowledge of
which pathways to select in order to achieve a solution.

24
 Local actor application of
Contagion of knowledge information search knowledge that
to relevant others creation environment affects super-
Knowledge appreciation structure and
substructure
(e.g., technology
ideological & ethical knowledge filter issues,…)
cogntive Knowledge of actor
purpose intention, logic & relations measures of
planning & organising,
test of ethics, & vision
of past/future
empirical criteria defining concepts

Figure 10: control for knowledge appreciation

A consequence of the process of knowledge appreciation is its intelligent application.
We say intelligent, because its obverse, rote application may not require knowledge
appreciation or even migration. Knowledge application can occur behaviourally
within a superstructure and a substructure. Superstructure identifies the
institutionalised political and cultural aspects of a situation, and is also issue related.
Substructure is task orientated, and relates to the mode and means of production (e.g.,
technology) and the social relations (e.g., roles and their relationships) that
accompany them.
Measurements for this control process are qualitative, requiring an inquirer to search
the local environment for ways in which knowledge has been applied (directly or
indirectly) to varieties of situation.
The process of knowledgeable action (figure 11) is dependent upon the application of
knowledge. Knowledgeable action is action that occurs with awareness of what is
being done within a behavioural world. Knowledgeable action in a situation is
dependent upon knowledge application to the tasks that are perceived to require to be
addressed within the situation. This is filtered through knowledge that activates
weltanschauung derived emancipative capabilities that enable knowledgeable action
to occur. The evaluation reference criteria derive from knowledge about actor
interests through work and interaction. It relates to the Marshall (1995) idea of
execution knowledge, that is seen as the computational skills and procedures required
to execute a behaviour.
A consequence of the process of knowledgeable action that derives from knowledge
migration is the creation of new definition of relationships between identifiable actors.
It gives meaning to work related activities, and particularly with respect to those that
involve interaction.
Measures within this control loop with respect to knowledgeable action can occur by
examining the environment in which that action has occurred. Work and interaction
knowledge that conditions knowledgeable action can be explored by examining how
work and interaction processes change with the introduction of new knowledge.
Knowledge about emancipation can be determined through in-depth questioning of
relevant others.
When the above control loops operate to make process changes, morphogenic changes
occur in the knowledge phases of our knowledge cycle. When the control processes are
complex and control action fails, knowledge process metamorphosis can occur (Yolles,

25
1999). As an example of a metamorphic change, a new concept may be born during
the process of knowledge migration.

New definitions of
Local actor relationships
Knowledge data classify between actors
application creation environment (develops:
Knowledgeable action teamworking &
customer relations;
enables worldview
knowledge about degree of emancipation filter interconnection)
cognitive Knowledge of actor
interest work & interaction communications channels,
feeling of being included,
requests, blocks, support,

empirical criteria defining concepts

Figure 11: control model for knowledgeable action

7. Conclusion
This is a good point to return to the hospital wing joke that we introduced this chapter
with. We have argued that for healthcare perspectives to be coordinated there is a
need to share knowledge, and we have explored the knowledge sharing possibilities
for healthcare staff. However, the capability for organisations to share knowledge
requires that healthcare organisations need to develop a capacity to recognise and use
knowledge for patients and staff as well as organisationally. Organisational knowledge
exists by virtue of the individuals associated with it, and there is a need to recognise that
knowledge creation and sharing involves processes of knowledge migration, where
knowledge transmitted in a communication from one individual to another may not also
be the knowledge that is assembled.
There is a difference in the way knowledge creation is structured, whether one adopts a
positivist or another epistemology. The ideas of Nonaka and Takeuchi would appear
quite influential in the development of a theory of knowledge creation. While they are
constructivist in their perception of each phase process, they are overall structurally
positivist. It is not uncommon to have this type of usually benign methodological
schizophrenia, though it may well be more aesthetic not to. An alternative approach that
is fundamentally critical (even though it entertains the notion of control) and that does
not suffer from the above problem derives from viable systems theory. This does not see
knowledge creation as a set of sequential steps, but rather as a set of phases that are
constantly tested and examined through possibly complex feedback. Shifts from one
phase to another may occur according to the control phenomena that drive particular
perspectives.
There are parallels between our proposed knowledge cycle (figure 4) and that of
Nonaka and Takeuchi (figure 3). In the former knowledge can be created
spontaneously within a migration process, and any socialisation process that occurs is
through communication that may be seen to act as a trigger for new knowledge.
Unlike that of Nonaka and Takeuchi, our cycle is not required to be sequential
continuous relative to a conditioning process. Rather, the process of continuity is

26
transferred to the communication process, and knowledge creation is cybernetic,
passing through feedback processes that can change the very nature of the patterns of
meanings that were initiated through the semantic communications.
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