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:
. 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”
, 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
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.