Proposing a systems vision of knowledge management in emergency care

This paper makes a case for taking a systems view of knowledge management within health-care provision, concentrating on the emergency care process in the UK National Health Service. It draws upon research in two casestudy organizations (a hospital and an ambulance service). The case-study organizations appear to be approaching knowledge (and information) management in a somewhat fragmented way. They are trying to think more holistically, but (perhaps) because of the ways their organizations and their work are structured, they cannot ‘see’ the whole of the care process. The paper explores the complexity of knowledge management in emergency health care and draws the distinction for knowledge management between managing local and operational knowledge, and global and clinical knowledge.

To reveal is to critique:actor-network theory and critical information systems research

It has been suggested that, in order to maintain its relevance, critical research must develop a strong emphasis on empirical work rather than the conceptual emphasis that has typically characterized critical scholarship in management. A critical project of this nature is applicable in the information systems (IS) arena, which has a growing tradition of qualitative inquiry. Despite its relativist ontology, actor–network theory places a strong emphasis on empirical inquiry and this paper argues that actor–network theory, with its careful tracing and recording of heterogeneous networks, is well suited to the generation of detailed and contextual empirical knowledge about IS. The intention in this paper is to explore the relevance of IS research informed by actor–network theory in the pursuit of a broader critical research project as de? ned in earlier work.

Knowledge management in a New Zealand tree farming company:Ambiguity and resistance to the "technology solution"

Purpose - Managers at the company attempt to implement a knowledge management information system in an attempt to avoid loss of expertise while improving control and efficiency. The paper seeks to explore the implications of the technological solution to employees within the company. Design/methodology/approach - The paper reports qualitative research conducted in a single organization. Evidence is presented in the form of interview extracts. Findings - The case section of the paper presents the accounts of organizational participants. The accounts reveal the workers' reactions to the technology-based system and something of their strategies of resistance to the system. These accounts also provide glimpses of the identity construction engaged in by these knowledge workers. The setting for the research is in a knowledge-intensive primary industry. Research was conducted through observation and interviews. Research limitations/implications - The issues identified are explored in a single case-study setting. Future research could look at the relevance of the findings to other settings. Practical implications - The case evidence presented indicates some of the complexity of implementation of information systems in organizations. This could certainly be seen as more evidence of the uncertainty associated with organizational change and of the need for managers not to expect an easy adoption of intrusive IT solutions. Originality/value - This paper adds empirical insight to a largely conceptual literature. © Emerald Group Publishing Limited.

Mapping causal knowledge: how people consider their environment during meetings

Causal mapping can help managers to think through the causal influence between issues, enabling them to base a decision on a more structured consideration. Even in regular meetings, learning and the integration of knowledge from diverse stakeholders can benefit from causal mapping. Four causal mapping meetings with management teams are analysed to assess how managers thought causally about their environment when strategy-making. We found that although managers can use other views to expand their environmental knowledge, some prefer to use familiar information rather than less familiar information. Despite this preference, many managers thought systemically about a raft of related issues. We discuss our findings in the context of regular meetings and offer improvements to the facilitation of group causal mapping.

Using knowledge management to drive performance

Organisations are gathering ever more information, but are less good at analysing it and utilising the resultant knowledge for improved performance. Here Paul Collier, co-author of research on the subject, discusses how finance can help improve matters.

Intelligence agents (knowledge management)

Reports some insights into knowledge management (KM) derived from UK one-day workshops with six businesses, three non-profits and one public sector organization. Lists the four questions posed to participants and discusses the themes which emerged, e.g. the need for a KM strategy to make raw information more useable, KM performance measurement etc. Stresses the need for commitment from a top-level champion and a wide range of employees to make this work and identifies three types of solutions for improving KM strategy: technological (e.g. databases and intranets), people (e.g. motivation, retention, training and networking) and processes (e.g. procedural instructions and balancing formal/informal knowledge sharing methods). Finds that accountants and senior managers do not generally see KM as very important but argues that management accountants are suitable knowledge champions who could develop explicit links between KM and organizational performance.

Making a journey in knowledge management strategy

This paper reports results from an ongoing project examining what managers think about knowledge management in the context of their organisation. This was done in a facilitated computerassisted group workshop environment. Here we compare the outcomes of workshops held for two relatively large UK organisations, one public sector and the other private. Our conclusions are that there are relatively few differences between the perceptions of these two groups of managers, and that these differences stem more from the stage of the knowledge management life cycle that the two organisations have reached, rather than from the difference in context between public and private sector. © iKMS & World Scientific Publishing Co.

Building user commitment to implementing a knowledge management strategy

In the IS literature, commitment is typically considered to involve organizational or managerial support for a system and not that of its users. This paper however reports on a field study involving 16 organizations that attempted to build user involvement in developing a knowledge management strategy by having them design it. Twenty-two IT-supported group workshops (involving 183 users) were run to develop action plans for better knowledge management that users would like to see implemented. Each workshop adopted the same problem structuring technique to assist group members develop a politically feasible action plan to which they were psychologically and emotionally dedicated. In addition to reviewing the problem structuring method, this paper provides qualitative insight into the factors a knowledge management strategy should have to encourage user commitment. © 2004 Elsevier B.V. All rights reserved.

Manufacturing knowledge management strategy

The study sought to understand the components of knowledge management strategy from the perspective of staff in UK manufacturing organizations. To analyse this topic, we took an empirical approach and collaborated with two manufacturing organizations. Our main finding centres on the key components of a knowledge management strategy, and the relationships between it and manufacturing strategy and corporate strategy. Other findings include: the nature of knowledge in manufacturing organizations; the relevance of (in)formal processes; top-down and bottom-up communication; taking ownership for information processes. We also make comments on the development of action plans for better knowledge management. The implications are that, for an integrated approach to knowledge management strategy in manufacturing organizations, involvement across the organization and at all levels is necessary.

eHealth as a challenge to `expert' power: a focus group study of internet use for health information and management

Objective To investigate current use of the internet and eHealth amongst adults. Design Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. Main outcome measures The focus group data were analysed and interpreted using thematic analysis. Results Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. Conclusions Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner–patient relationship and subsequent implications for health management more generally.

People, technology, processes and risk knowledge sharing

The present global economic crisis creates doubts about the good use of accumulated experience and knowledge in managing risk in financial services. Typically, risk management practice does not use knowledge management (KM) to improve and to develop new answers to the threats. A key reason is that it is not clear how to break down the “organizational silos” view of risk management (RM) that is commonly taken. As a result, there has been relatively little work on finding the relationships between RM and KM. We have been doing research for the last couple of years on the identification of relationships between these two disciplines. At ECKM 2007 we presented a general review of the literature(s) and some hypotheses for starting research on KM and its relationship to the perceived value of enterprise risk management. This article presents findings based on our preliminary analyses, concentrating on those factors affecting the perceived quality of risk knowledge sharing. These come from a questionnaire survey of RM employees in organisations in the financial services sector, which yielded 121 responses. We have included five explanatory variables for the perceived quality of risk knowledge sharing. These comprised two variables relating to people (organizational capacity for work coordination and perceived quality of communication among groups), one relating to process (perceived quality of risk control) and two related to technology (web channel functionality and RM information system functionality). Our findings so far are that four of these five variables have a significant positive association with the perceived quality of risk knowledge sharing: contrary to expectations, web channel functionality did not have a significant association. Indeed, in some of our exploratory regression studies its coefficient (although not significant) was negative. In stepwise regression, the variable organizational capacity for work coordination accounted for by far the largest part of the variation in the dependent variable perceived quality of risk knowledge sharing. The “people” variables thus appear to have the greatest influence on the perceived quality of risk knowledge sharing, even in a sector that relies heavily on technology and on quantitative approaches to decision making. We have also found similar results with the dependent variable perceived value of Enterprise Risk Management (ERM) implementation.

Externality effects of information and communication technologies across country Borders

As information and communications technology (ICT) involves both traditional capital and knowledge capital, potential spillovers through various mechanisms can occur. We posit that ICT capital may boost productivity growth, not only in the home country, but also in other countries. In this paper, we provide empirical evidence of such spillovers using panel data on 37 countries from 1996 to 2004. Our results support the existence of ICT spillovers across country borders. Furthermore, we find that developing countries could reap more benefits from ICT spillovers than developed countries. This is particularly important for policy decisions regarding national trade liberalization and economic integration. Developing economies that are more open to foreign trade may have an economic advantage and may develop knowledge-intensive activities, which will lead to economic development in the long run.

Business processes and knowledge management

Knowledge has been a subject of interest and inquiry for thousands of years since at least the time of the ancient Greeks, and no doubt even before that. “What is knowledge” continues to be an important topic of discussion in philosophy. More recently, interest in managing knowledge has grown in step with the perception that increasingly we live in a knowledge-based economy. Drucker (1969) is usually credited as being the first to popularize the knowledge-based economy concept by linking the importance of knowledge with rapid technological change in Drucker (1969). Karl Wiig coined the term knowledge management (hereafter KM) for a NATO seminar in 1986, and its popularity took off following the publication of Nonaka and Takeuchi’s book “The Knowledge Creating Company” (Nonaka & Takeuchi, 1995). Knowledge creation is in fact just one of many activities involved in KM. Others include sharing, retaining, refining, and using knowledge. There are many such lists of activities (Holsapple & Joshi, 2000; Probst, Raub, & Romhardt, 1999; Skyrme, 1999; Wiig, De Hoog, & Van der Spek, 1997). Both academic and practical interest in KM has continued to increase throughout the last decade. In this article, first the different types of knowledge are outlined, then comes a discussion of various routes by which knowledge management can be implemented, advocating a process-based route. An explanation follows of how people, processes, and technology need to fit together for effective KM, and some examples of this route in use are given. Finally, there is a look towards the future.

TRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and outcome of Treatment with warfarin (TREAT)

Background Atrial fibrillation (AF) patients with a high risk of stroke are recommended anticoagulation with warfarin. However, the benefit of warfarin is dependent upon time spent within the target therapeutic range (TTR) of their international normalised ratio (INR) (2.0 to 3.0). AF patients possess limited knowledge of their disease and warfarin treatment and this can impact on INR control. Education can improve patients' understanding of warfarin therapy and factors which affect INR control. Methods/Design Randomised controlled trial of an intensive educational intervention will consist of group sessions (between 2-8 patients) containing standardised information about the risks and benefits associated with OAC therapy, lifestyle interactions and the importance of monitoring and control of their International Normalised Ratio (INR). Information will be presented within an 'expert-patient' focussed DVD, revised educational booklet and patient worksheets. 200 warfarin-naïve patients who are eligible for warfarin will be randomised to either the intervention or usual care groups. All patients must have ECG-documented AF and be eligible for warfarin (according to the NICE AF guidelines). Exclusion criteria include: aged < 18 years old, contraindication(s) to warfarin, history of warfarin USE, valvular heart disease, cognitive impairment, are unable to speak/read English and disease likely to cause death within 12 months. Primary endpoint is time spent in TTR. Secondary endpoints include measures of quality of life (AF-QoL-18), anxiety and depression (HADS), knowledge of AF and anticoagulation, beliefs about medication (BMQ) and illness representations (IPQ-R). Clinical outcomes, including bleeding, stroke and interruption to anticoagulation will be recorded. All outcome measures will be assessed at baseline and 1, 2, 6 and 12 months post-intervention. Discussion More data is needed on the clinical benefit of educational intervention with AF patients receiving warfarin. Trial registration ISRCTN93952605

Data visualisation and exploration with prior knowledge

Visualising data for exploratory analysis is a major challenge in many applications. Visualisation allows scientists to gain insight into the structure and distribution of the data, for example finding common patterns and relationships between samples as well as variables. Typically, visualisation methods like principal component analysis and multi-dimensional scaling are employed. These methods are favoured because of their simplicity, but they cannot cope with missing data and it is difficult to incorporate prior knowledge about properties of the variable space into the analysis; this is particularly important in the high-dimensional, sparse datasets typical in geochemistry. In this paper we show how to utilise a block-structured correlation matrix using a modification of a well known non-linear probabilistic visualisation model, the Generative Topographic Mapping (GTM), which can cope with missing data. The block structure supports direct modelling of strongly correlated variables. We show that including prior structural information it is possible to improve both the data visualisation and the model fit. These benefits are demonstrated on artificial data as well as a real geochemical dataset used for oil exploration, where the proposed modifications improved the missing data imputation results by 3 to 13%.