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

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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).

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In the sense of Foucault (1982)

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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
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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.

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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 trialand-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.
Phenomenal/ Behavioural Domain System Behaviour (structurally facilitated and constrained) interaction Environment formation Virtual/ representation Organising Domain adjustment of organising Metasystem Formal/informal group worldviews Existential/ Cognitive Domain development/ personal learning group learning/ consolidation explication (formal)

Virtual System Images that enable organising

reflection/ creation interpretation

Informal (often personal) worldviews

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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Cognitive Properties Cognitive interests

Kinematics (through energetic motion) Technical Work. This enables people to achieve goals and generate material well-being. It involves technical ability to undertake action in the environment, and the ability to make prediction and establish control. Cybernetical Intention. This is through the creation and strategic pursuit of goals and aims that may change over time, enables people through control and communications processes to redirect their futures.

Sociality Properties Orientation (determining trajectory) Practical Interaction. This requires that people as individuals and groups in a social system gain and develop the possibilities of an understanding of each others subjective views. It is consistent with a practical interest in mutual understanding that can address disagreements, which can be a threat to the social form of life. Rational/Appreciative Formative organising. Enables missions, goals, and aims to be defined and approached through planning. It may involve logical, and/or relational abilities to organise thought and action and thus to define sets of possible systematic, systemic and behaviour possibilities. It can also involve the (appreciative) use of tacit standards by which experience can be ordered and valued, and may involve reflection. Cultural

Possibilities/potential (through variety development) Critical Deconstraining Degree of emancipation. For organisational viability, the realising of individual potential is most effective when people: (i) liberate themselves from the constraints imposed by power structures (ii) learn through precipitation in social and political processes to control their own destinies. Ideological/Moral Manner of thinking. An intellectual framework through which policy makers observe and interpret reality. This has an aesthetical or politically correct ethical orientation. It provides an image of the future that enables action through politically correct strategic policy. It gives a politically correct view of stages of historical development, in respect of interaction with the external environment. Political

Phenomenal (conscious) domain Activities Energy

Cognitive purposes

Virtual or organising (subconscious) domain Organising Information

Cognitive influences

Social

Formation. Enables Belief. Influences occur from Freedom. Influences occur individuals/groups to knowledge that derives from from knowledge that affect be influenced by the cognitive organisation (the our polity determined, in Exustential or knowledge that relate set of beliefs, attitudes, values) part, by how we think about cognitive to our social of other worldviews. It the constraints on group and (unconscious) environment. This ultimately determines how we individual freedoms, and in domain 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 relations patterns principles

Understanding

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

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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.

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Data Bank with patterns of meaning

Bank of Knowledge Patterns

Data
A collection of symbols that are devoid of meaning

Processing
Occurs through patterns of meaning that relate to purpose & are criteria constrained

Information
Set of symbols that have meaning & relate to action, & enable variety differentiation within complexity

Coalescing
Renewing patterns of meaning through relating new information to existing patterns of knowledge

Knowledge
Patterns of meaning that that connect to patterns of belief

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.

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Autogenesis and contextual thematic principles from knowledge

Autopoiesis and manifestation of constrained inquiring behaviour

Existential domain Patterns of knowledge defining context

Virtual domain Relational information defining decision processes

Phenomenal domain Data from structure and measuration

Autogenesis and regeneration of evaluative perceived experience

Autopoiesis and regeneration of network of decision processes 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 knowledge type Explicit Knowledge Objective Rationality (mind) Sequential (there and then) Drawn from theory (digital) Codified, formally transmittable in systematic language. Relates to past Formal and transferable, deriving in part from context related information established into definable patterns. The context is therefore part of the patterns. Tacit 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.

Nonaka and Takeuchi

Alternative

Table 2: Typology of knowledge 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.

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Tacit K nowledge Socialisation Existential; face-to-face Creates sympathised knowledge through sharing experiences, and development of mental models and technical skills. Language unnecessary Internalisation Collective: on-site Creates operational knowledge through learning by doing. Explicit knowledge like manuals or verbal stories helpful

Explicit K nowledge Externalisation Reflective; peer-to-peer Creates conceptual knowledge through knowledge articulation using language. Dialogue and collective reflection needed

Tacit K nowledge

Explicit K nowledge

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 nonparticipant 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.

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Re-migration of knowledge(recursive) influence Knowledge migration contagion

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

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 of contagion that guide the development of common shared knowledge Existential domain
Pattern of knowledge of actor A1

Autopoiesis and selfproduction logical network of knowledge action processes involving tactics

Structural coupling enabling knowledge migration through lifeworld interconnection to develop shared patterns of knowledge

Virtual domain Knowledge accommodation through shared models

Phenomenal domain Knowledgeable action supported by facilitating structures

Pattern of knowledge of actor A2

Autopoiesis and regeneration of logical networks of knowledge action processes

Autogenesis and regeneration 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 reference criteria world views

evaluation filter

output

Process

monitor monitoring criteria

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 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. Complex Terms of Control 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.

Table 3: Distinguishing between Simple and Complex Feedback Control Loops.

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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 knowledge ask questions creation and count Knowledge migration contagion of knowledge to relevant others (adaptational basis through: innovation & deep learning)
Who has knowledge been passed to, & who has retained in what way for future use

Worldview interconnection Between actors through Semantic communication

cognitive influences

polity knowledge filter Knowledge of actor cultural & social influences

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

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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.

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Contagion of knowledge to relevant others

Local actor information search creation environment Knowledge appreciation

ideological & ethical knowledge filter cogntive purpose Knowledge of actor intention, logic & relations

application of knowledge that affects superstructure and substructure (e.g., technology issues,…) 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,

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1999). As an example of a metamorphic change, a new concept may be born during the process of knowledge migration.
New definitions of relationships between actors (develops: teamworking & customer relations; enables worldview interconnection)

Knowledge application Knowledgeable action

Local actor data creation

classify environment

knowledge about degree of emancipation filter cognitive interest Knowledge of actor 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

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