A knowledge management model: Implications for enhancing quality in health care

Project management in healthcare: An examination of organizational competence

This research aims to identify the factors that influence the organizational competence (OC) of hospitals in effectively managing projects. It follows a quantitative approach, analyzing data collected from three Portuguese hospitals (51 respondents) using R software. An organizational competence score (OCS) was calculated based on standardized values across five different competence areas. The results indicate significant associations between the competence areas and project categories, organizational alignment, governance, management, people's competence, and resources. Furthermore, the study explores the relationships between the competence areas and quantitative variables such as the number of project team members and former experience in projects. The OCS is also examined regarding project categories, region, experience in projects, and number of project members. The findings provide insights into the features that impact the OC of hospitals in PM, highlight the importance of organizational alignment, effective governance, competent management, skilled personnel, and adequate resources in enhancing PM capabilities. However, the wide confidence interval for the Odds Ratio indicates a high degree of uncertainty in the effect size estimates, suggesting the need for larger sample sizes and more robust models in future research to obtain more precise estimates.

Nurse leaders' perceptions of competence-based management of culturally and linguistically diverse nurses: A descriptive qualitative study

AIM(S)

To describe nurse leaders' perceptions of culturally and linguistically diverse (CALD) nurses' competence-based management.

DESIGN

A descriptive qualitative study of the competence-based management of CALD nurses, from the perspectives of nurse leaders in three primary and specialised medical care organisations. This study followed the COREQ guidelines.

METHODS

Qualitative semi-structured individual interviews were conducted with 13 nurse leaders. Eligible interviewees were required to have management experience, and experience of working with or recruiting CALD nurses. Data were collected during November 2021-March 2022. The data were analysed using inductive content analysis.

RESULTS

Competence-based management was explored in terms of competence identification and assessment of CALD nurses, aspects which constrain and enable competence sharing with them, and aspects which support their continuous competence development. Competencies are identified during the recruitment process, and assessment is based primarily on feedback. Organisations' openness to external collaboration and work rotation supports competence sharing, as does mentoring. Nurse leaders have a key role in continuous competence development as they organise tailored induction and training, and can indirectly reinforce nurses' work commitment and wellbeing.

CONCLUSION(S)

Strategic competence-based management would enable all organisational competencies potential to be utilised more productively. Competence sharing is a key process for the successful integration of CALD nurses.

RELEVANCE TO CLINICAL PRACTICE

The results of this study can be utilised to develop and standardise competence-based management in healthcare organisations. For nursing management, it is important to recognise and value nurses' competence.

IMPACT

The role of CALD nurses in the healthcare workforce is growing, and there is little research into the competence-based management of such nurses.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Impact of knowledge management on job satisfaction and organizational performance among healthcare employees: A structural equation modeling approach

Background and Aims

Organizational knowledge management (KM) involves creating, preserving, and sharing employees' knowledge. This approach can enhance efficiency, improve performance, and boost job satisfaction (JS) throughout all aspects of the organization. This research aimed to investigate the effect of three variables of KM, JS, and organizational performance (OP) on the employees of the Health and Treatment Network in Haji Abad City.

Methods

A study was conducted with 211 employees, such as physicians, nurses, and technicians. These employees worked in various sections, such as hospitals, health centers, rural centers, and emergency centers within the Health and Treatment Network of Haji Abad City. Newman and Kenard's KM, Hersey and Goldsmith's OP, and Smith, Kendall & Hulin's Job Satisfaction Questionnaires were used. The statistical software LISREL 8.8 was used to conduct structural equation modeling (SEM).

Results

The results indicate that the structural equation models had a good fit. Significant positive relationships exist between KM processes (creation, retention, and application) and JS. No significant relationship was found between knowledge transfer and JS. The coefficient obtained from SEM between knowledge retention and OP was 0.74, indicating a strong and direct correlation between the two variables. The standardized coefficients for the relationship between knowledge creation and retention and JS were 0.45 and 0.33, respectively. This indicates a positive and direct effect of knowledge creation and retention on JS. All KM processes positively predict OP.

Conclusion

The research model had a good fit, and the KM processes had a positive effect on performance and JS. However, no significant relationship was found between knowledge transfer and JS among employees in the Health and Treatment Network. More research is needed to identify mediating variables and factors influencing this phenomenon in healthcare centers.

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes

OBJECTIVE

The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering.

DESIGN

Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence.

PARTICIPANTS

Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States.

MAIN OUTCOME MEASURES

Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings.

RESULTS

In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education.

CONCLUSIONS

While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.

Understanding how and why quality circles improve standards of practice, enhance professional development and increase psychological well-being of general practitioners: a realist synthesis

OBJECTIVES

To understand how and why participation in quality circles (QCs) improves general practitioners' (GPs) psychological well-being and the quality of their clinical practice. To provide evidence-informed and practical guidance to maintain QCs at local and policy levels.

DESIGN

A theory-driven mixed method.

SETTING

Primary healthcare.

METHOD

We collected data in four stages to develop and refine the programme theory of QCs: (1) coinquiry with Swiss and European expert stakeholders to develop a preliminary programme theory; (2) realist review with systematic searches in MEDLINE, Embase, PsycINFO and CINHAL (1980-2020) to inform the preliminary programme theory; (3) programme refinement through interviews with participants, facilitators, tutors and managers of QCs and (4) consolidation of theory through interviews with QC experts across Europe and examining existing theories.

SOURCES OF DATA

The coinquiry comprised 4 interviews and 3 focus groups with 50 European experts. From the literature search, we included 108 papers to develop the literature-based programme theory. In stage 3, we used data from 40 participants gathered in 6 interviews and 2 focus groups to refine the programme theory. In stage 4, five interviewees from different healthcare systems consolidated our programme theory.

RESULT

Requirements for successful QCs are governmental trust in GPs' abilities to deliver quality improvement, training, access to educational material and performance data, protected time and financial resources. Group dynamics strongly influence success; facilitators should ensure participants exchange knowledge and generate new concepts in a safe environment. Peer interaction promotes professional development and psychological well-being. With repetition, participants gain confidence to put their new concepts into practice.

CONCLUSION

With expert facilitation, clinical review and practice opportunities, QCs can improve the quality of standard practice, enhance professional development and increase psychological well-being in the context of adequate professional and administrative support.

PROSPERO REGISTRATION NUMBER

CRD42013004826.

Healthcare managers’ competence in knowledge management: a scoping review

Aim

Background

Evaluation

Key issues

Conclusion

Implications for Nursing Management

A Health Care Value Framework for Physical Therapy Primary Health Care Organizations

BACKGROUND AND OBJECTIVE

To develop a health care value framework for physical therapy primary health care organizations including a definition.

METHOD

A scoping review was performed. First, relevant studies were identified in 4 databases (n = 74). Independent reviewers selected eligible studies. Numerical and thematic analyses were performed to draft a preliminary framework including a definition. Next, the feasibility of the framework and definition was explored by physical therapy primary health care organization experts.

RESULTS

Numerical and thematic data on health care quality and context-specific performance resulted in a health care value framework for physical therapy primary health care organizations-including a definition of health care value, namely "to continuously attain physical therapy primary health care organization-centered outcomes in coherence with patient- and stakeholder-centered outcomes, leveraged by an organization's capacity for change."

CONCLUSION

Prior literature mainly discussed health care quality and context-specific performance for primary health care organizations separately. The current study met the need for a value-based framework, feasible for physical therapy primary health care organizations, which are for a large part micro or small. It also solves the omissions of incoherent literature and existing frameworks on continuous health care quality and context-specific performance. Future research is recommended on longitudinal exploration of the HV (health care value) framework.

Systematization of absorptive capacity microprocesses for knowledge identification in project management

Purpose

This study aims to systematize the acquisition phase of absorptive capacity microprocesses that contribute to project management (PM) knowledge identification.

Design/methodology/approach

An exploratory and descriptive qualitative research was adopted. The first stage consisted of building the conceptual framework based on four systematic-literature-reviews. The data collection process in the second phase involved in-depth interviews, which are adequate to understand the interviewee’s reality. The sample composition consisted of 15 respondents who are PM professionals with an average of 15 years of experience. Each interviewee was chosen based on their expertise and ability to transmit the entire management process of several projects. The data were analyzed using the Atlas. Tecnology information software following the grounded theory technique with three coding cycles: open, axial and selective.

Findings

Based on the results, the authors organized the microprocesses into three groups: events, social interaction and the use of tools and techniques.

Research limitations/implications

The primary limitation of the study was the number of respondents. Future studies will be able to identify other microprocesses and evaluate their role in the knowledge identification process.

Practical implications

This study presents a systematization of microprocesses in knowledge identification, as it occurs in the context of PM. Based on the results of this study, organizations will be able to choose the microprocesses that best fit their operations and activities according to the complexity, innovation and/or criticality of their projects.

Originality/value

The systematic literature review revealed a gap in the knowledge identification phase of knowledge management as it pertains to PM. Thus, this study presents a systematization of how knowledge identification occurs in the context of PM.

Knowledge creation and interaction in an R&D project: the case of the energy weather forecast

Purpose

The purpose of this paper is to examine knowledge-creating interaction in developing an innovation in a multidisciplinary research community with hermeneutic phenomenology, to understand how previous experiences and future prospects shape the process and to examine the circumstances, which support or limit knowledge creation.

Design/methodology/approach

The approach of this study is phenomenological and the empirical case study has been conducted using ethnography. The data consist of field notes, videos, interviews and documents of a BCDC energy consortium, developing energy weather forecast (EWF) in a new type of research environment.

Findings

The results indicate that the role of actual interactive events was crucial in the development of EWF. Hermeneutic approach illustrated that the roots of that event were in the past experiences of the participants and the circumstances, which promoted the development of the innovation, but the acknowledgment of the future prospects was crucial in finalizing the process. The role of a leader organizing the interaction and collaborative work was also substantial.

Practical implications

The results of this study could be used to plan and organize knowledge creation processes in organizations, especially in universities and research communities, striving to create multidisciplinary research environments and practices.

Originality/value

This study proposes a new approach based on hermeneutic phenomenology to examine it in a unified way, by focusing on the key aspects of elements affecting knowledge-creating interaction.

Modeling the Pathways of Knowledge Management Towards Social and Economic Outcomes of Health Organizations

Despite the increasing emphasis placed on knowledge management (KM) by the business sector and the common belief that creating, acquiring, sharing, and the use of knowledge enable individuals, teams, and communities to achieve superior performance, within the healthcare context, there is still room from improvements from both the theoretical and empirical perspectives. The purpose of this paper is to outline the contribution of KM process to the social- and economic-related outcomes in the context of health organizations. Given the theoretical approach on the considered concepts and their relationships, a conceptual model and seven research hypotheses were proposed. The empirical data were provided by a cross-sectional investigation including 459 medical and nonmedical employees of Romanian heath organizations, selected by a mixed method sampling procedure. A partial least squares structural equation modeling (PLS-SEM) approach was selected to provide information on the relevance and significance of the first- and second-order constructs, test the hypotheses, and conduct an importance performance matrix analysis. The PLS-SEM estimation showed positive and significant relationships between KM process and quality of healthcare, and organizational-level social and economic outcomes. Moreover, the research results provided evidences for the complex complementary mediation of the quality of healthcare and social-related outcomes on the relationships between KM process and social and economic outcomes. The theoretical and managerial implications are discussed and suggestions for future research are provided at the end of the paper.

Factors affecting Web 2.0 adoption: exploring the knowledge sharing and knowledge seeking aspects in health care professionals

Purpose

This research aims to explore the factors that affect the adoption of Web 2.0 among knowledge workers. The research specifically investigated the role of factors related to both knowledge seeking and knowledge sharing, in the context of Web 2.0 use by health care professionals.

Design/methodology/approach

For this research, a cross-sectional survey design was adopted. The data were analyzed using the partial least square-structural equation modeling.

Findings

The results confirmed that the intention to adopt Web 2.0 depends upon both the knowledge-seeking and the knowledge-sharing attitudes. However, between the two, it is knowledge-sharing factors that are more important. Health care professionals tend to share knowledge driven by intrinsic motivators rather than by extrinsic motivators. On the other hand, knowledge-seeking attitude was determined by usefulness of knowledge and was not affected by the effort involved.

Research limitations/implications

All the respondents were health care professionals from India, and convenience sampling was used to reach them. This may limit the generalizability of the findings.

Practical implications

This research provides useful insights on implementing Web 2.0-based knowledge management systems, specifically for health care professionals. Particularly, it emphasizes the need to focus on reinforcing intrinsic motivators like self-efficacy and the joy of sharing.

Originality/value

It is perhaps the first study that integrates the factors related to knowledge sharing and seeking in a single theoretical model, thereby presents and tests a more realistic model of knowledge management.

Information and knowledge processes as a knowledge management framework in health care

Purpose

Effective knowledge management (KM) enables the health care organisations to reach their goals. In modern health care the empowered patients are active partners, whose preferences, needs and values should be taken into account. Shared decision making (SDM) aims at involving the patient and the health professionals as equal partners in care. The purpose of this paper is to present a new model of health care information and knowledge processes (IKPs) as a KM framework. The aim is to scrutinise what types of knowing can be identified the IKPs and how do the knowledge processes support SDM. The role of patients in the IKPs is discussed.

Design/methodology/approach

The qualitative case study was conducted in two Finnish university hospital districts in integrated care pathways of childhood obesity. In total, 30 professionals and three mothers and children were interviewed 2009-2011 and the findings were supported with a survey (n=13) and document material.

Findings

The findings indicate that the patients and families involvement in the IKPs is modest. This implies that SDM is not completely fulfilled which may affect the families commitment to positive lifestyle changes.

Research limitations/implications

The data of the patients and families were limited due to the challenges with recruitment.

Practical implications

The detailed IKP model enables the health organisations to scrutinise their own IKPs and to identify the shortages in order to change practices.

Originality/value

This paper presents a new model of health care KM which recognises the patients as active partners.

A systematic review of factors influencing knowledge management and the nurse leaders' role

AIM

To describe factors facilitating or inhibiting the development of registered nurses' competency and nurse leader's role in knowledge management.

BACKGROUND

Nurses' competency directly influences patient safety and the quality and effectiveness of patient care. Challenges of nurse leaders in knowledge management include acquiring, assessing and utilising current knowledge and assessing and enhancing competency.

EVALUATION

A systematic search was conducted in PubMed, CINAHL, SCOPUS and ERIC databases in April 2015. The search identified 18 relevant research articles published between 2009 and 2015. The quality of the studies was appraised in accordance with study designs.

KEY ISSUE

Knowledge management is facilitated by an organisation culture that supports learning, sharing of information and learning together. Leader commitment and competency were factors related to leadership facilitating knowledge management.

CONCLUSION

Nurse leaders need evidence-based interventions to support shared learning and to create infrastructures that facilitate competence development. Future research is especially needed to evaluate connections between knowledge management and patient outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP

The results of this review can be utilised in enhancing factors to facilitate knowledge management in clinical practice and identifying nurse leaders' role in strengthening nurses' competency.

Encoding and verification of a computer-interpretable guideline: a case study of pressure-ulcer management

This study examined ways to improve the accuracy of translating clinical practice guidelines (CPGs) into a computer-interpretable guideline (CIG) for pressure-ulcer management using the Shareable Active Guideline Environment (SAGE) guideline model, and aimed to verify the accuracy of the obtained CIG. The study was conducted using the following procedures: selecting CPGs, extracting rules from the selected CPGs, developing a CIG using the SAGE guideline model, and verifying the obtained CIG with test cases using an execution engine. The CIG for pressure-ulcer management was developed based on 38 rules and three algorithms at the semiformal representation level using MS Excel and MS Visio. The CIG was encoded by two Activity Graphs consisting of 115 instances representing algorithms and rules as knowledge elements in the SAGE guideline model. Two errors were found and corrected. Results of the study demonstrated that a CIG representing knowledge on pressure-ulcer management can be effectively developed using commonly available programs and the SAGE guideline model, and that the obtained CIG can be verified with a locally developed execution engine. The CIG developed in the study could contribute to health information management once it is implemented successfully in a clinical decision support system.

Big data text analytics: an enabler of knowledge management

Purpose

The purpose of this paper is to examine the role of big data text analytics as an enabler of knowledge management (KM). The paper argues that big data text analytics represents an important means to visualise and analyse data, especially unstructured data, which have the potential to improve KM within organisations.

Design/methodology/approach

The study uses text analytics to review 196 articles published in two of the leading KM journals – Journal of Knowledge Management and Journal of Knowledge Management Research & Practice – in 2013 and 2014. The text analytics approach is used to process, extract and analyse the 196 papers to identify trends in terms of keywords, topics and keyword/topic clusters to show the utility of big data text analytics.

Findings

The findings show how big data text analytics can have a key enabler role in KM. Drawing on the 196 articles analysed, the paper shows the power of big data-oriented text analytics tools in supporting KM through the visualisation of data. In this way, the authors highlight the nature and quality of the knowledge generated through this method for efficient KM in developing a competitive advantage.

Research limitations/implications

The research has important implications concerning the role of big data text analytics in KM, and specifically the nature and quality of knowledge produced using text analytics. The authors use text analytics to exemplify the value of big data in the context of KM and highlight how future studies could develop and extend these findings in different contexts.

Practical implications

Results contribute to understanding the role of big data text analytics as a means to enhance the effectiveness of KM. The paper provides important insights that can be applied to different business functions, from supply chain management to marketing management to support KM, through the use of big data text analytics.

Originality/value

The study demonstrates the practical application of the big data tools for data visualisation, and, with it, improving KM.

Towards a framework for strategic knowledge management practice

Purpose

This paper aims to address the limitations of current knowledge management (KM) models by presenting a strategic knowledge management (SKM) framework based on a unique configuration of literature concerned with optimising learning and knowledge creation at the interface between human (soft) and information and communication technology (hard) networks.

Design/methodology/approach

This paper revisits the key tenets and most frequently cited models in the existing literature, summarises their common elements, clarifies the interrelationships between the hard and soft KM processes and practices and systemically incorporates these previously separate and independent elements into a new integrated conceptual framework. Then, it identifies key organisational factors which could facilitate this integration and leverage the value generated from different systems embedded in this model.

Findings

The paper highlights the key elements and applications of a new SKM conceptual model for actively and purposefully integrating explicit and tacit knowledge embedded within organisation systems and broader social and business intelligence networks.

Practical implications

The application of the thinking, organising principles and management practices derived from the SKM framework with its unique characteristics that are hard to substitute or imitate may support improvement and/or innovation of processes, products, services and brands contributing to sustainable competitive advantage of the firm.

Originality/value

While both hard and soft KM systems have been individually identified by previous studies as integral to KM, the research is amongst the first attempts to explore how to integrate both systems within a strategic KM framework with supporting organisational design principles for creating firm competitive advantage.

Mental health knowledge management: critical success factors and strategy of implementation

Purpose

This paper aims to recommend implementation of the knowledge management (KM) strategy for a mental health organisation, an area that has, to date, limited attention in literature based on the factors that influence KM success.

Design/methodology/approach

A mixed-methods research was conducted to identify the organisational culture, resources, enablers and the influential factors of mental health knowledge management (MHKM). The data were collected in five referral mental hospitals and were analysed using quantitative, qualitative and triangulation methods.

Findings

The organisational culture has become a great barrier. Forty-three influential factors were identified. Otherwise, based on culture, resources, enablers and strengthen, weakness, opportunities and threaten (SWOT) analysed were adopted to propose ten of the critical success factors and were recommended into an implementation strategy.

Research limitations/implications

The paper has proven that KM is a new and emerging discipline in Indonesia, especially on mental health care. This will contribute to the governmental policy of KM implementation and enforce the quality of services.

Practical implications

This result has the potential to leverage interdisciplinary KM research. It supports a mental health organisation in applying KM.

Originality/value

This study is probably the first to analyse factors that are of influence in an MHKM initiative programme.

An empirically based model for knowledge management in health care organizations

BACKGROUND

Knowledge management (KM) encompasses strategies, processes, and practices that allow an organization to capture, share, store, access, and use knowledge. Ideal KM combines different sources of knowledge to support innovation and improve performance.

PURPOSES

Despite the importance of KM in health care organizations (HCOs), there has been very little empirical research to describe KM in this context. This study explores KM in HCOs, focusing on the status of current intraorganizational KM. The intention is to provide insight for future studies and model development for effective KM implementation in HCOs.

METHODOLOGY/APPROACH

A qualitative methods approach was used to create an empirically based model of KM in HCOs. Methods included (a) qualitative interviews (n = 24) with senior leadership to identify types of knowledge important in these roles plus current information-seeking behaviors/needs and (b) in-depth case study with leaders in new executive positions (n = 2). The data were collected from 10 HCOs. Our empirically based model for KM was assessed for face and content validity.

FINDINGS

The findings highlight the paucity of formal KM in our sample HCOs. Organizational culture, leadership, and resources are instrumental in supporting KM processes. An executive's knowledge needs are extensive, but knowledge assets are often limited or difficult to acquire as much of the available information is not in a usable format. We propose an empirically based model for KM to highlight the importance of context (internal and external), and knowledge seeking, synthesis, sharing, and organization. Participants who reviewed the model supported its basic components and processes, and potential for incorporating KM into organizational processes.

DISCUSSION

Our results articulate ways to improve KM, increase organizational learning, and support evidence-informed decision-making.

PRACTICE IMPLICATIONS

This research has implications for how to better integrate evidence and knowledge into organizations while considering context and the role of organizational processes.

How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review

Background

Prevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines.

Objectives

This study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice.

Methods

An integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used.

Results

Overall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n=4). Evaluation using related theories of “planned behavior” and the “technology acceptance model” (n=3) suggests that social media use is mediated by an individual’s positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions.

Conclusions

There is emerging evidence that health care professionals use social media to develop virtual communities to share domain knowledge. These virtual communities, however, currently reflect tribal behaviors of clinicians that may continue to limit knowledge sharing. Further research is required to evaluate the effects of social media on knowledge distribution in clinical practice and importantly whether patient outcomes are significantly improved.

Can Knowledge Management Be Implemented in the Teaching of Medical Sciences?

Universities play a vital role in social progress. Knowledge management (KM) is a kind of process which transforms data into knowledge and knowledge into capital. The aim of this paper is to investigate the use of KM in the field of education of medical sciences in order to help educators and students benefit from the knowledge present in the field of health sciences in a more meaningful and informed way.

To achieve the aim of this narrative review, the related Persian and English literature sources were carefully examined; first, the Internet and other data bases were searched for articles containing one or more of the following key words: knowledge, knowledge management, medical science and higher education. Then, the related articles were quickly scanned and useful information was extracted. The selected parts of the text were carefully studied and summarized by two researchers. After gaining a thorough comprehension of the subject, its different dimensions and aspects were described and compared.

As a process, the goal of KM in the field of medical sciences is to motivate the creation, sharing, storing and utilization of knowledge. Knowledge creation occurs by continually transforming tacit knowledge into explicit knowledge and vice versa. KM can be implemented in different areas of medical science including clinical practice. Knowledge managements system (KMS) plans are used to provide high quality, high value cost-effective care in medical science. Critical factors that influence the success of the implementation of KM in the field of medical education include culture, leadership and appropriate substructure. KM can be implemented for the development of medical education. KM is a tool which makes education and its practice intellectual, high quality and affordable. Implementation of KM is recommended in the field of medical education for effective health care delivery.

Knowledge creation and play – a phenomenological approach

Purpose

– The purpose of this paper is to examine the experiential nature of knowledge creating interaction and to introduce a framework to explore it theoretically coherently with hermeneutic phenomenology and Hans-Georg Gadamer’s concept of play.

Design/methodology/approach

– This paper presents a literature-based conceptual analysis of the concept of play. Gadamerian conception is related with the descriptions of knowledge creating interaction in the research of knowledge management and with the uses of the concept of play in the field of Library and Information Science (LIS). Theoretical analysis is applied in this study to structure the argumentation.

Findings

– This study illustrates how the preconceptions of experiences and different modes of being in interaction are implicitly present in the research of knowledge creation (KC) in the descriptions of interaction and human factors enhancing KC. A framework for examining KC in organizational circumstances is developed based on the hermeneutic phenomenology and Gadamer’s concept of play, which provide a basis for understanding KC as being together in interaction.

Research limitations/implications

– This theoretical study develops a framework for examining the process of KC also empirically. In this study the examination of hermeneutic phenomenology is limited to the conceptions of play, authenticity and everydayness; phenomenology offers means for further explication of human being and experience.

Originality/value

– This study provides a new view on KC based on hermeneutic phenomenology and play, and contributes to the examination of interactive knowledge processes in the field of LIS.

A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

Background

Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people.

Objectives

Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs.

Design

We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups.

Setting

NHS East and NHS West Midlands.

Participants

One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK.

Main outcome measures

Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care?

Results

Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement.

Conclusions

Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs are central. Intervention needs to mediate interprofessional and intraprofessional hierarchy, which, combined with compliance pressures, engender a ‘broken’ chain for applying PSK for service improvement, rather than a ‘brokering’ chain. Lower-status H-MLMs need to have their legitimacy and disposition enhanced to broker knowledge for service improvement. More informal ‘social mechanisms’ are required to complement clinical governance for development of a brokering chain. More research is needed to (1) examine why some H-MLMs are more disposed and able than others to broker PSK for service improvement, and (2) understand how knowledge brokering might be enhanced so that exogenous and endogenous knowledge is better fused for service improvement.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The Use of Knowledge Management in Healthcare: The Implementation of Shared Care Plans in Electronic Medical Record Systems at One Primary Care Practice

A transformation in the way in which primary care is delivered is underway in the US. Across the country primary care practices are grappling with how to change from the traditional physician-directed model to a more patient-centred collaborative style as part of the effort to curb the rise of chronic disease. To date, few tools or techniques exist to help the individual primary care provider make this difficult and complex transformation. One such tool that has arisen is the shared care plan (SCP). As defined in the Taking Action for Learning and Knowledge Management to improve Diabetes Mellitus (TALK/DM) study (a NIDDK funded pilot project to implement SCPs in primary care), the SCP of primary care becomes the product of collaboration between the practice and the patients. The SCP is created by combining knowledge management (KM) techniques and motivational interviewing (MI) health counselling methods to form a new knowledge object. This paper focuses on this aspect of the TALK/DM study and takes a case study approach to explore how one primary care practice is implementing the SCP as knowledge object (both a paper document and an electronic record in the EMR system) in its organisation. This study adds nuance and insight into how knowledge objects such as the SCP can serve as a tool for collaboration in primary care.

Reassessing Software Quality Performance

Software quality has always been described as a poorly developed construct. Several reports and much evidence show clear problems related to software quality. This research empirically tests if ineffective implementation of knowledge management activities would be a reason behind possible existence of defective quality performance in the software industry. The main finding shows that knowledge management would directly affect quality performance in the Egyptian software industry. Statistical correlation is significant between the two constructs; knowledge management and quality performance.

The patient centered medical home: mental models and practice culture driving the transformation process

BACKGROUND

The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized.

OBJECTIVE

To describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project.

DESIGN

Individual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania.

PARTICIPANTS

A total of 118 individual interviews were conducted with clinicians (N = 47), patient educators (N = 4), office administrators (N = 12), medical assistants (N = 26), front office staff (N = 7), nurses (N = 4), care managers (N = 11), social workers (N = 4), and other stakeholders (N = 3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation.

KEY RESULTS

Three central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice-patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care.

CONCLUSIONS

Key factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, self-assessment, and the development of shared decision-making. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of team-based care.

Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

BACKGROUND

Measuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, and reviewing quantitative self-report instruments.

METHODS

DATA SOURCES

We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments; reference lists of systematic reviews; and citations and references of the main report of instruments.

STUDY SELECTION

To determine the scope of the review, we developed and used a conceptual framework designed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). We included papers reporting development or use of an instrument measuring factors relevant to teamwork. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarizing and comparing instruments. Instrument content was categorized using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care.

RESULTS

We identified 192 potentially relevant instruments, 170 of which were analyzed to develop the taxonomy. Eighty-one instruments measured constructs relevant to CQI teams in primary care, with content covering teamwork context (45 instruments measured enabling conditions or attitudes to teamwork), team process (57 instruments measured teamwork behaviors), and team outcomes (59 instruments measured perceptions of the team or its effectiveness). Forty instruments were included for full review, many with a strong theoretical basis. Evidence supporting measurement properties was limited.

CONCLUSIONS

Existing instruments cover many of the factors hypothesized to contribute to QI success. With further testing, use of these instruments measuring team factors in evaluations could aid our understanding of the influence of teamwork on CQI outcomes. Greater consistency in the factors measured and choice of measurement instruments is required to enable synthesis of findings for informing policy and practice.

Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

Background

Continuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, and reviewing quantitative self-report instruments.

Methods

Data sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments, reference lists of systematic reviews, and citations and references of the main report of instruments. Study selection: The scope of the review was determined by a conceptual framework developed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). Papers reporting development or use of an instrument measuring a construct encompassed by the framework were included. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarising and comparing instruments. Instrument content was categorised using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care.

Results

We identified 186 potentially relevant instruments, 152 of which were analysed to develop the taxonomy. Eighty-four instruments measured constructs relevant to primary care, with content measuring CQI implementation and use (19 instruments), organizational context (51 instruments), and individual factors (21 instruments). Forty-one instruments were included for full review. Development methods were often pragmatic, rather than systematic and theory-based, and evidence supporting measurement properties was limited.

Conclusions

Many instruments are available for evaluating CQI, but most require further use and testing to establish their measurement properties. Further development and use of these measures in evaluations should increase the contribution made by individual studies to our understanding of CQI and enhance our ability to synthesise evidence for informing policy and practice.

Knowledge management in health: a systematic literature review

Knowledge has been used as a resource for intelligent and effective action planning in organizations. Interest in research on knowledge management processes has intensified in different areas. A systematic literature review was accomplished, based on the question: what are the contributions of Brazilian and international journal publications on knowledge management in health? The sample totaled 32 items that complied with the inclusion criteria. The results showed that 78% of journals that published on the theme are international, 77% of researchers work in higher education and 65% have a Ph.D. The texts gave rise to five thematic categories, mainly: development of knowledge management systems in health (37.5%), discussion of knowledge management application in health (28.1%) and nurses' function in knowledge management (18.7%).

Improving Outpatient Diabetes Care

More than 20% of patients in the Veterans Health Administration (VHA) have diabetes; therefore, disseminating “best practices” in outpatient diabetes care is paramount. The authors’ goal was to identify such practices and the factors associated with their development. First, a national VHA diabetes registry with 2008 data identified clinical performance based on the percentage of patients with an A1c >9%. Facilities (n = 140) and community-based outpatient clinics (n = 582) were included and stratified into high, mid, and low performers. Semistructured telephone interviews (31) and site visits (5) were conducted. Low performers cited lack of teamwork between physicians and nurses and inadequate time to prepare. Better performing sites reported supportive clinical teams sharing work, time for non-face-to-face care, and innovative practices to address local needs. A knowledge management model informed our process. Notable differences between performance levels exist. “Best practices” will be disseminated across the VHA as the VHA Patient-Centered Medical Home model is implemented.

A medical home: value and implications of knowledge management

BACKGROUND

Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution.

PURPOSE

We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives.

METHODOLOGY

Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants.

FINDINGS

Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home.

PRACTICE IMPLICATIONS

Knowledge management differences occur within and between practices and can explain differences in performance. By relying more on social tools rather than costly, high-tech investment, KM leverages primary care's relationship-centered strength, facilitating practice redesign as a medical home.

What can family medicine practices do to facilitate knowledge management?

BACKGROUND

Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics.

PURPOSE

To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM.

METHODOLOGY/APPROACH

We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role).

FINDINGS

Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes of these effects were not substantially changed even when practice members perceived their practice environment as more chaotic.

PRACTICE IMPLICATIONS

Steps to facilitate KM should be considered when evaluating more intensive and costly organizational solutions for enhancing family medicine practice performance.