A KM perspective on implementing an electronic patient record within an NHS hospital

The Electronic Patient Record (EPR) is being developed by many hospitals in the UK and across the globe. We class an EPR system as a type of Knowledge Management System (KMS), in that it is a technological tool developed to support the process of knowledge management (KM). Healthcare organisations aim to use these systems to provide a vehicle for more informed and improved clinical decision making thereby delivering reduced errors and risks, enhanced quality and consequently offering enhanced patient safety. Finding an effective way for a healthcare organisation to practically implement these systems is essential. In this study we use the concept of the business process approach to KM as a theoretical lens to analyse and explore how a large NHS teaching hospital developed, executed and practically implemented an EPR system. This theory advocates the importance of taking into account all organizational activities - the business processes - in considering any KM initiatives. Approaching KM through business processes allows for a more holistic view of the requirements across a process: emphasis is placed on how particular activities are performed, how they are structured and what knowledge demanded and not just supplied across each process. This falls in line with the increased emphasis in healthcare on patient-centred approaches to care delivery. We have found in previous research that hospitals are happy with the delivery of patient care being referred to as their 'business'. A qualitative study was conducted over a two and half year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non- participant observation of meetings and documentary data. We believe that the inclusion of patients within the study may well be the first time this has been done in examining the implementation of a KMS. The theoretical propositions strategy was used as the overarching approach for data analysis. Here Initial theoretical research themes and propositions were used to help shape and organise the case study analysis. This paper will present preliminary findings about the hospital's business strategy and its links to the KMS strategy and process.

Ownership identity, strategy and performance:business group affiliates versus independent firms in India

We consider whether the impact of entrepreneurial orientation on business performance is moderated by the company affiliation with business groups. Within business groups, we explore the trade-off between inter-firm insurance that enables risk-taking, and inefficient resource allocation. Risk-taking in group affiliated firms leads to higher performance, compared to independent firms, but the impact of proactivity is attenuated. Utilizing Indian data, we show that risk-taking may undermine rather than improve business performance, but this effect is not present in business groups. Proactivity enhances performance, but less so in business groups. Firms can also enhance performance by technological knowledge acquisition, but these effects are not significantly different for various ownership categories.

An investigation into the use of knowledge representation in computer-integrated manufacturing

In a certain automobile factory, batch-painting of the body types in colours is controlled by an allocation system. This tries to balance production with orders, whilst making optimally-sized batches of colours. Sequences of cars entering painting cannot be optimised for easy selection of colour and batch size. `Over-production' is not allowed, in order to reduce buffer stocks of unsold vehicles. Paint quality is degraded by random effects. This thesis describes a toolkit which supports IKBS in an object-centred formalism. The intended domain of use for the toolkit is flexible manufacturing. A sizeable application program was developed, using the toolkit, to test the validity of the IKBS approach in solving the real manufacturing problem above, for which an existing conventional program was already being used. A detailed statistical analysis of the operating circumstances of the program was made to evaluate the likely need for the more flexible type of program for which the toolkit was intended. The IKBS program captures the many disparate and conflicting constraints in the scheduling knowledge and emulates the behaviour of the program installed in the factory. In the factory system, many possible, newly-discovered, heuristics would be awkward to represent and it would be impossible to make many new extensions. The representation scheme is capable of admitting changes to the knowledge, relying on the inherent encapsulating properties of object-centres programming to protect and isolate data. The object-centred scheme is supported by an enhancement of the `C' programming language and runs under BSD 4.2 UNIX. The structuring technique, using objects, provides a mechanism for separating control of expression of rule-based knowledge from the knowledge itself and allowing explicit `contexts', within which appropriate expression of knowledge can be done. Facilities are provided for acquisition of knowledge in a consistent manner.

Are we on the same page? Knowledge boundaries and transactive memory system development in cross-functional teams

One of the key challenges that organizations face when trying to integrate knowledge across different functions is the need to overcome knowledge boundaries between team members. In cross-functional teams, these boundaries, associated with different knowledge backgrounds of people from various disciplines, create communication problems, necessitating team members to engage in complex cognitive processes when integrating knowledge toward a joint outcome. This research investigates the impact of syntactic, semantic, and pragmatic knowledge boundaries on a team’s ability to develop a transactive memory system (TMS)—a collective memory system for knowledge coordination in groups. Results from our survey show that syntactic and pragmatic knowledge boundaries negatively affect TMS development. These findings extend TMS theory beyond the information-processing view, which treats knowledge as an object that can be stored and retrieved, to the interpretive and practice-based views of knowledge, which recognize that knowledge (in particular specialized knowledge) is localized, situated, and embedded in practice.