Introduction
In the technological age and intense globalization, knowledge management has to be defined properly and accurately so that individual workers and organizations can respond to changes and innovations. Organizations and businesses have to adapt to changes and innovations which are a common occurrence in the workplace.
Health care professionals and hospital management are constantly facing innovations and applications, thus physicians, nurses and health care workers have to cope with constant changes. Managing change should be one of the priorities of a good organization because change is an opportunity for improvement.
Health workers have to adopt and continuously train and improve because of these changes. Adoption and improvement are significant here because knowledge management is a source of strength. Organizational learning is affected by these changes and innovations.
Study on Knowledge Management in a Romanian Clinic
This is a case study involving research of a Romanian clinic of a hospital where 20 physicians and 10 nurses were asked to act as respondents. They were provided questionnaires and their responses were analyzed and used as basis for the article “Culturally-Bound Innovation in Romanian Teaching and Research Hospitals” by Dan, Vasilache, and Dima (2011).
The Clinic’s Current Knowledge Management Status
Knowledge management is significant in the study of hospitals along with their physicians and health workers, especially when we deal with innovation and adoption. Knowledge is usually understood to mean theoretical knowledge, practical knowledge, experience, and skills. Knowledge and knowledge management are significant developments in the new globalizing environment.
In the present age of globalisation, competitive advantage is more pronounced with the knowledge people possessed, or what is termed, ‘people-embodied knowhow’ (Rodriguez and de Pablos, 2002, p. 174). Firms are focusing on what their people know, and invest much on intellectual capital. It is one of the objectives of organizational learning.
The current knowledge management status of the clinic in the study can be considered moderate but not too low although external and internal knowledge are not being seriously considered if we look at and analyse the table for physicians, one of the two types of respondents in the study of Romanian hospitals. Students and residents considered knowledge management important and view it as significant in their work.
They also consider learning as too important in their job. The patients in the clinic are not disregarded with respect to knowledge management but are not well informed about how the clinic deals and introduces treatment. Their status and the way they are being treated in the clinic are also significant. Archiving the patients’ cases for future use is well executed and monitored.
There is a question, however, in the case of the physicians who are too concerned with their careers than with the organization or the clinic where they work. However, both types of respondents respect and observe the values of the clinic. Nurses perceive that their organization is providing a supportive culture. They don’t feel that they are gaining internal experience. But nurses have adopted learning in the clinic.
KM Initiatives
Individual
Doctors are not so concerned with the norms of the clinic or hospital in which they work. They are more concerned with their individual roles as physicians and their careers than with how the hospital should deal with their employees.
This issue is a support statement in the study of Scott et al. (2003 cited in Dan, Vasilache, & Dima, 2011, p. 232) where both types of respondents were regarded as subcultures: doctors are more concerned with the culture of the medical profession than with those of the hospital. But nurses regarded themselves as partners in the treatment process.
Organization
The study focused on organizational learning rather than on individual variables. This provides an understanding of how the organization, in this case the clinic, provides knowledge and learning and how individuals attained the learning process.
Organizations, hospitals particularly, conduct knowledge sharing within the organization as part of enhancing the knowledge and competence of their workforce. But even then, there are barriers to this kind of HRM exercise. Szulanski (1996) termed this as the internal stickiness within the firm.
Organisations usually apply and transfer best practices among themselves, or within the firm, but the barriers impede this transfer of knowledge from people to people, from department to department, or from branch to branch.
Experiences of different organizations, like General Motors, IBM, etc, proved that it is not easy to transfer knowledge or best practice. Internal stickiness has been seen as a barrier or hindrance in the transfer of knowledge and thus should be an important topic of study.
Groups
The two types of respondents, doctors and nurses, have different perspectives on the culture of the organization. The physicians were concerned with their own organization as professionals, nationally and internationally, while the nurses were more concerned with the clinic and how they could facilitate treatment.
The nurses can contribute much to the improvement of the organizational culture than the physicians because the latter are focused to working for their respective careers.
The Nonaka and Takeuchi KM Model (Nicosord, 2011)
In applying the four quadrants of the Nonaka and Takeuchi model, we have to consider several factors to make knowledge management effective for the Romanian clinic. The first step is about socialization. The two groups of respondents have different views about their organization or the clinic where they worked.
According to Dan, Vasilache, and Dima (2011, p. 236), nurses did have a supportive culture but both groups were poor in their communication process. In other words, this part of the learning process needs to be improved.
Communication is very important in an organization. Socialization or peer interaction must be part of the process of learning in the clinic. When it comes to communication, there are two sectors separated by profession and belief. The physicians view themselves and their profession higher than the nurses. They look at themselves as the bosses. The nurses are concerned with the organization they work for.
These two sets of respondents are separated by belief and profession, and they are not united for a common cause. The organization and the patients suffer. The hospital must do something to have a live interaction and effective communication for the two groups of health workers.
The physicians should give in to suggestions and regard the nurses as equal partners in providing health care and treatment to the patients who in a way can be considered as customers, or if not, as bosses of both the physicians and the nurses.
The second quadrant in the Nonaka and Takeuchi knowledge management cycle is externalization. Individuals who are workers can express their knowledge into something explicit. In the clinic, the physicians and nurses should be creative in a sense in delivering healthcare and treatment to the patients. This should be a part of their training and development.
Training and development vary from organization to organization; meaning how the organization conducts training and shapes its own workforce is its own lookout and problem.
Generally, however, training and development is aimed at the personnel who are new; those who have been in the hospital for quite some time need continuous learning and other HRM functions like performance management, appraisal, and other special training needs.
The third step emphasizes combination. Organizational knowledge can be combined into the knowledge gained by physicians and nurses. Information systems should be applied to the clinic. This can be carried out by the administration personnel or an independent company that can provide expertise for the personnel and nurses who can be charged to handle administrative matters.
The fourth step is internalization. Internalization integrates learned knowledge and experience with the knowledge we already have. In this final step, new knowledge is formed out of the external and internal knowledge. This can be improved and applied to the environment.
In the clinic under study, the physicians and nurses can integrate the knowledge they already have from the years of academic study to the knowledge from their experiences inside the clinic and hospital.
What the Company Hopes to Achieve through KM
Knowledge management requires inputs from databases and knowledge repositories. Universities or schools of learning, including organizations like hospitals and government agencies that have the dual role of business and organisation, and global organisations, become sources of data, knowledge, information and expertise.
Explicit and implicit knowledge of individual persons or organisations become a part of their own repository or data base.
In the hospital and clinic under study, contents of their information and knowledge repositories can become a part of the individuals’ own databases. This is part and concept of the information revolution.
From the organizational profile plots of the two classes of respondents, the organization aims for a positive learning outcome for the people working there.
Both working respondents have almost similar profile plots which revealed characteristics on variables like integrating learning into strategy and policy, applying the learning, creating a supportive culture, etc. These variables are well described in the plot and they provide a picture of the strengths and weaknesses of the organization in which the respondents belong.
Key enablers of the organization include integrating learning into the organization’s success strategy and policy. An additional KM enabler is accessing external learning for the physicians and nurses. A strategy could be the hiring of experts or specialists doctors to lecture on certain topics that pertain to illnesses of patients and other matters pertaining to the nature of their job.
Another key enabler is the application of a web-enabled information system and installation of a website for the clinic and hospital, or by using an intranet for fast and effective communication within the hospital and clinic. By connecting online, physicians and nurses and other employees of the hospital can access the vast resources of knowledge. (Dalkir, 2005, p. 2)
A hindrance to KM success is the contrasting beliefs of the two types of respondents to the study, the physicians who believed they were bosses of the nurses and the latter who considered themselves as partners in providing health care to patients. One is selfish while the other has a noble profession.
Gap Analysis
Knowledge management in the context of the physical place at the clinic under study draws our attention to the philosophy of ba, a concept originally proposed by the Japanese philosopher Kitaro Nishida (cited in Nonaka and Konno, 2008, p. 40). In the context of knowledge management, ba is a shared space for emerging relationships, which can be thought of as a physical place (e.g., office, clinic or hospital).
Knowledge management and the creation of knowledge are phases or steps present in this study of the clinic. An organization’s knowledge assets also fall under the category of either tacit or explicit (Reynolds, 2010, p. 237).
In the factorial analyses being shown in Table 6, the respondents recognized the importance of teamwork (tmw =.223). But the variables PRS (each treatment is part of a process) and NEW (new therapies are experimented) registered negative. This means the respondents did not feel that treatment was part of a process and did not attempt to seek new ways of treatment.
The clinic view archiving and record management as too important for future use. But there are hindrances. The doctors are not too cooperative while the nurses wanted to cooperative but were hindered by the doctors’ attitude.
The nurses have a major role to play in delivering care and treatment, in fact they provide more time and efforts and are prone to stress and fatigue. The knowledge they possess is vital to the treatment that the clinic aims for the patients.
The contrasting attitudes of physicians and nurses can provide a scenario such as rivalry in delivering service and in acquiring resources from the clinic or organization. The organization, on the other hand, should provide a mechanism that will bridge this gap between the physicians and nurses.
We suggest that a continuous dialogue and discussion groups be provided by the clinic, at the same time, the hospital should facilitate acquiring resource persons and speakers to provide expert opinions and advices for patient care.
These recommendations are for long term solutions in that it can help the organization to succeed in knowledge management. The organization can effectively manage knowledge through an effective communication with the use of information systems. The clinic aimed for improvement.
This is shown in the various knowledge management programs. The organization values the importance of focusing on the doctors and nurses especially on what they know and how they care for their patients.
Information technology present in this clinic is the intranet which allows effective communication for the doctors, nurses, specialists, and all the stakeholders in the clinic under study. Technology has become a tool and a total part of the workers’ lives in the workplace. (Córdoba, 2007, p. 910)
Knowledge management is essential in the age of globalization and the Internet. Organizations use emails and the many features of the Internet. Managers must know what knowledge management is and how to handle it.
Knowledge management (KM) creates value for an organization, especially its intellectual assets, a product of intellectual capital and years of continuous innovation and improvement. KM codifies what everyone in the organization knows, shares these information within the organization and other organizations for best practices.
The respondents in the study have a major role to play in the clinic’s knowledge management. Not only do they need knowledge, they are a source of knowledge, they can pass on this knowledge to their peers, to the patients and to their successors. They become a part of the organizational knowledge of the clinic under study.
The doctors and nurses are a part of the organization and society. They cannot be separated although they have different views and varied perspectives of their jobs and philosophies of life (Hofkirchner, 2007, p. 477).
There is a theory in organizational knowledge which is known as the resource-based view. This theory examines ‘the manner in which organizational resources are applied and combined, the causes which determine the attainment of a sustainable competitive advantage, and the nature of rents generated by organizational resources’ (Rodriguez and de Pablos, 2000, p. 174).
The organization is seen as a repository of unique and multi-cultural resources and knowledge. The doctors and nurses are a source of the new database of information. The resource-based view assumes that each organization is a collection of unique resources and capabilities which form the basis for the firm’s strategy and its ability to earn above-average returns.
Information systems are the most valuable tool in this age of the information revolution. The clinic should be able to integrate these tools into their operations. Technology is a tool and an aid. The Internet can provide the necessary mechanism for the advancement and management of knowledge. (Mische, 2000, p. 3)
References
Córdoba, J. (2007). Developing inclusion and critical reflection in information systems planning. Organization 2007, 14(6), 909-927. DOI: 10.1177/1350508407082266
Dalkir, K. (2005). Knowledge management in theory and practice. Oxford, UK: Elsevier Butterworth-Heinemann.
Dan, M. C., Vasilache, S., & Dima, A. M. (2011). Chapter 14: culturally-bound innovation in Romanian teaching and research hospitals. IGI Global, doi: 10.4018/978-1-60566-701-0.ch014
Hofkirchner, W. (2007). The quest for a unified theory of information. The Netherlands: Gordon and Breach Publishers.
Mische, M. A. (2000). Chapter 1 Defining systems integration. In J. M. Myerson, Enterprise Systems Integration (Second Edition). Florida: CRC Press LLC. pp. 3-10.
Nicosord (2011). Nonaka and Takeuchi knowledge management cycle. Retrieved from: https://hubpages.com/education/Nonaka-and-Takeuchi-knowledge-management-cycle
Nonaka, I. & Konno, N. (2008). The concept of “ba”: building a foundation for knowledge creation. California Management Review, Vo. 40, No. 3, Spring 2008.
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Szulanski, G. (1996). Exploring Internal Stickiness: Impediments to the Transfer of Best Practice Within the Firm. Retrieved from: Strategic Management Journal, Vol. 17(Winter Special Issue), 27-43 1996.