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Knowledge Management (KM) refers to an organization's use of processes and / or strategies in order to gain a greater understanding of experiences or insights held within it. Processes or strategies might include the identification, creation and dissemination of information that is either held within the individual or within the organization (but unrealised or undiscovered). Like its symbiotic partner Information Management (IM), KM has generated various definitions though none has pinpointed with accuracy KM's exact raison d'etre. Though paradoxically it has been viewed as a recognised discipline since the 1990s (Nonaka, 1991). Instead what have been offered are perspectives and taxonomies of what KM should be (Earl, 2001. Begoña, 2007). Moreover, contributions have been offered from academia, private consultancy firms and practitioners.
Therefore, it is the intention of this essay to look at two differing perspectives of KM and discuss them with relevance to the healthcare sector. The first is from Rob Cross's 1998 article in 'Knowledge Management':
"Knowledge management is the discipline of creating a thriving work and learning environment that fosters the continuous creation, aggregation, use and re-use of both organizational and personal knowledge in the pursuit of new business value". (Cross, 1998)
The second is Wilson's 2002 paper in 'Information Research':
"Knowledge management is an umbrella term for a variety of organisational activities, none of which are concerned with the management of knowledge" (Wilson, 2002).
From the 1980s through to the mid 1990s organizations began a programme of downsizing whereby employees were made redundant; de-layering, where strata of management were reconfigured or removed entirely; and outsourcing where sectors of the organization were closed and then bought back in at a fee from external companies. The product of this was that organizations began to lose the skills, insights and experience that had been built up over time within their employees. Organizations soon realised that they had to either re-employ former employees or hire in former employees who were now working as consultants in order to maintain their competitive advantage (Quintas, 2001). What these organizations had lost was a much valued intangible asset, tacit knowledge or the importance of their employees embedded knowledge and experience was to the value of their businesses.
The emergence of the World Wide Web in the mid 1990s as a technological phenomenon had a profound effect on the emergence of KM as a discipline and as will be argued, could in fact be the catalyst that took IM to KM. From 1995 to 2010 internet usage globally had grown exponentially. Figure 2 indicates that where there were just 16 million internet users in 1995, there are now over 1.6 billion. It goes without saying that with a growth in number of internet users there will be a growth in output.
Coiera (2003) states that information economics can explain how organizations have identified that the intangible assets of the organization, the information held either within the firm or knowledge held within an individual has a market value as an information good.
In this supply and demand curve, demand is created by a population of information consumers and producers.
By reducing the costs of ownership from C to C1, a new equilibrium point emerges and greater amounts of information are taken up, as has been seen with the proliferation of information produced by the internet. Coiera also points out that as with other goods, consumers will seek out 'quality information' and that means that consumers of information will be driven to those producers with a good reputation and brand. There are many examples of the capital value of information within healthcare; consumers will pay for health related information such as in a magazine; consultants will pay a subscription for a periodical or journal; and pharmaceutical companies are prepared to pay GPs for data relating to their prescribing habits (Coiera, 2003).
From the same point in the 1990s there was a sudden surge in interest and publications of KM research and journals (Quintas, 2001. Wilson, 2002). From becoming a scientific discipline in the 1990s concerned with practical application, a more theoretical foundation began to emerge from academics such as Ikujiro Nonaka, Hirotaka Takeuchi, Thomas H. Davenport and Baruch Lev. KM had moved from a discipline to something that mattered within the organization and a new management level was created in the form of the Chief Knowledge Officer (CKO). CKOs were concerned with the practical aspects of their organizations especially the intangible assets held within them. The subsequent interest in more theoretical applications meant that research into the area took off quite considerably. Figure 2 indicates how from this period journal articles on the subject increased exponentially.
Serenko et al (2010) states that between 2002 and 2009 there has been much improved co-operation between academics in co-authoring articles with a corresponding drop in articles by a single author and that there has also been a drop in contributions from practitioners; this could indicate that of late KM studies have reached academic maturity. Wilson (2002) also argues that the growth in KM related literature slowed dramatically around this time and that might be the reason why he postulates KM as more of a fad. Moreover, the proliferation of information technology and systems meant that various services, products and consultancy offerings were using the KM heading in their offerings without consideration about the semantics of whether those products or services were about information or knowledge; thus the dimensions may have become blurred and confused.
Over the same period organizations undertook various initiatives in order to improve access to their employee's expertise. This is where Cross's 1998 article above found voice. Xerox had attempted to nurture a more learning environment in order to create and capture knowledge and use that in innovative ways; or it was action oriented. It placed little emphasis on the assets of the firm or forms of intellectual capital as previous practitioners had done before (Skandia, 1996). Moreover, as will be discussed later, Cross's definition and Xerox's initiative has implications for healthcare and health practitioners. (All about the learning environment and clinical governance)
Quintas (2002) states that in psychiatry alone there can be 5,500 papers published annually. Some of these papers will have some clinical relevance which adds to the body of knowledge and it is a challenge for practitioners to keep up with such a deluge or pace. Davenport (1994) points out that managers, whether they be in healthcare or the private sector, gain much of their own information (and thus knowledge) from telephone or face-to-face conversations. Other sources of information are from journals or articles (documentation) and only a small proportion from their information systems. Spender (1996) argues that without identifying the characteristics of knowledge that make it a separate entity to information then there is little use in introducing the concept of knowledge into management discourse. This leads us to the notion that from a point in the 1990s to the present day, the volume of information has perhaps exceeded the limits of what today's technology or information systems can offer us in terms of knowledge. Put another way, there now has to be a form of technology that can capture and harness the knowledge to take us forward, to move us along from IM to KM. In the meantime, organizations are using more process led initiatives to identify, create and disseminate knowledge such as rewards, storytelling, expert directories, knowledge mapping, best practice transfer, knowledge fairs, after action reviews and knowledge requests, whereby insights from expert individual(s) are offered on an ad hoc basis (Snowden, 2002). Or, we are doing it manually!
Bellinger et al (1999) offer a diagrammatical example of where we are with supporting technologies and the relationships between data, information and knowledge.
In this example data is input and aggregated by analysis and data management, perhaps within relational databases. This in turn forms the reports and allows some form of information management. However, should an individual become familiar with not just the managed information and what they might see 'at the coal face', patterns emerge and the individual gains understanding and knowledge. The problem as it stands at the moment is how from a technological perspective to how harness that knowledge back through the loop and capture it.
Various frameworks exist in order to distinguish between the dimensions of knowledge. Alavi & Leidner (2001) proposed a distinction between tacit and explicit knowledge. The former being the knowledge held within the individual that they are not consciously aware they hold. For example, they might complete a given task but they do not consciously go through each step by step. Alternatively, any knowledge that the individual can easily communicate to another individual and that is held quite consciously is explicit knowledge. Serenko & Bontis (2004) argue that this notion is self-contradictory due to the need to translate knowledge into information before it can be made explicit.
Alternatively, Bray (2005) offers a framework around collaborative environments with a distinction between innovation and the 'exploratory creation of new knowledge' versus the 'exploitation of established knowledge. This framework proposes knowledge creation and transfer by way of 'communities of practice' or social networking tools.
The implications for healthcare are that like any profession, it requires a specialist body of skills and knowledge in order to complete the task to a high standard. A distinction has been offered by Sensky (2002) regarding knowledge within healthcare. These relate to catalogue, process and cultural knowledge; catalogue knowledge is the basic knowledge, as basic as a list that a particular service might have on either another service or some external agency that complements the service offered in some way; process knowledge is formed from clinical governance guidelines, hospital or service protocols and any applied care pathways; the last distinction is cultural knowledge and it is formed by how the organization or team applies the catalogue and process knowledge. Sensky argues that by deconstructing knowledge into its component parts allows an organization to identity training needs.
Wright (2005) proposed the term personal knowledge management first in 1999. He was referring to personal knowledge at an individual level. The most basic example of this would be evidence based practice. Historically, practice in healthcare was based on the knowledge and wisdom of the GP or physician and was generated over time by past experience and knowledge regarding a particular presenting problem. The issue with this approach is that the GP or physician, though well regarded in the community, may well have unknown gaps in their knowledge that they have no idea they had. Of course this not ideal situation carries extremely high risks to the patient. Therefore evidence based practice or empirically-supported treatment relies more on interventions where systematic empirical treatments have been identified to have significant effectiveness in treating conditions. There are steps involved in evidence based practice