Implementation of guidelines on delirium in a General Hospital: a before-after study of their impact on caregivers' knowledge and clinical skills

INTRODUCTION: Delirium is a highly prevalent disorder, with serious consequences for the hospitalised patient. Nevertheless, it remains under-diagnosed and under-treated. We developed evidence-based clinical practice guidelines (CPGs) focusing on prevention, screening, diagnosis, and treatment of delirium in a general hospital. This article presents the implementation process of these CPGs and a before-after study assessing their impact on healthcare professionals' knowledge and on clinical practice. METHODS: CPGs on delirium were first implemented in two wards (Neurology and Neurosurgery) of the Lausanne university hospital. Interactive one-hour educational sessions for small groups of nurses and physicians were organised. Participants received a summary of the guidelines and completed a multiple choice questionnaire, assessing putative changes in knowledge, before and three months after the educational session. Other indicators such as "diagnosis of delirium" reported in the discharge letters, and mean duration of patients' hospital stay before and after implementation were compared. RESULTS: Eighty percent of the nurses and physicians from the Neurology and Neurosurgery wards attended the educational sessions. Both nurses and physicians significantly improved their knowledge after the implementation (+9 percentage-points). Other indicators were not modified by the intervention. CONCLUSION: A single interactive intervention improved both nurses' and physicians' knowledge on delirium. Sustained and repeated interventions are probably needed to demonstrate changes in clinical practice.

Absorptive capacity and the effect of social integration mechanisms in knowledge utilization

Tiedosta on tullut määräävä tekijä yrityksensuorituskyvylle. Yritykset hankkivat aktiivisesti uutta tietoa ulkoisesta ympäristöstään ja tallentavat sitä tietokantoihinsa. Uusi tieto on innovaatioiden ja uusien ideoiden peruselementti. Uudet ideat pitää myös kaupallistaa, jotta niiden avulla voidaan hankkia kilpailuetua. Absorptiivisen kapasiteetin malli yhdistää tiedon prosessointiin liittyvät kyvykkyydet, jotka vaikuttavat yrityksen kykyyn hyödyntää tietoa tehokkaasti. Ennen kuin tietoa voidaan käyttää uusien tuotteiden ja palveluiden luomiseen, täytyy sitä jakaa yrityksessä ja muuttaa se yrityksen toimintaa palvelevaksi. Aiemmissa tutkimuksissa innovaatiot ovat vahvasti liitetty yrityksen kykyyn uudistua. Tämä pro gradu -tutkielma tutkii sosiaalisten integraatiomekanismien vaikutusta potentiaalisen absorptiivisen kapasiteetin muuttamiseen toteutuneeksi absorptiiviseksi kapasiteetiksi. Yksilöiden ja osastojen välisen yhteistyön sekä luottamuksen vaikutus tiedon sisäistämiseen tutkittiin. Tutkielma pohjautuu monikansallisessa yrityksessä keväällä 2006 suoritettuun uudistumiskyky-tutkimukseen. Tutkielma keskittyy yrityksen kykyyn uudistua uuden tiedon ja innovaatioiden avulla. Tutkielma on kvantitatiivinen tapaustutkimus. Tutkielmassa tehtyjen havaintojen mukaan sosiaaliset integraatiomekanismit ovat tärkeitä uuden tiedon hyödyntämisessä. Tiedon eksplisiittyyden havaitaan vaikuttavan tiedon muuttamiseen yritykselle hyödylliseksi resurssiksi.

On the innovation capacity of technologyrelated knowledge-intensive business services. A case study of the technology and engineering consulting (TEC) sector in Singapore

Even though the research on innovation in services has expanded remarkably especially during the past two decades, there is still a need to increase understanding on the special characteristics of service innovation. In addition to studying innovation in service companies and industries, research has also recently focused more on services in innovation, as especially the significance of so-called knowledge intensive business services (KIBS) for the competitive edge of their clients, othercompanies, regions and even nations has been proved in several previous studies. This study focuses on studying technology-based KIBS firms, and technology andengineering consulting (TEC) sector in particular. These firms have multiple roles in innovation systems, and thus, there is also a need for in-depth studies that increase knowledge about the types and dimensions of service innovations as well as underlying mechanisms and procedures which make the innovations successful. The main aim of this study is to generate new knowledge in the fragmented research field of service innovation management by recognizing the different typesof innovations in TEC services and some of the enablers of and barriers to innovation capacity in the field, especially from the knowledge management perspective. The study also aims to shed light on some of the existing routines and new constructions needed for enhancing service innovation and knowledge processing activities in KIBS companies of the TEC sector. The main samples of data in this research include literature reviews and public data sources, and a qualitative research approach with exploratory case studies conducted with the help of the interviews at technology consulting companies in Singapore in 2006. These complement the qualitative interview data gathered previously in Finland during a larger research project in the years 2004-2005. The data is also supplemented by a survey conducted in Singapore. The respondents for the survey by Tan (2007) were technology consulting companies who operate in the Singapore region. The purpose ofthe quantitative part of the study was to validate and further examine specificaspects such as the influence of knowledge management activities on innovativeness and different types of service innovations, in which the technology consultancies are involved. Singapore is known as a South-east Asian knowledge hub and is thus a significant research area where several multinational knowledge-intensive service firms operate. Typically, the service innovations identified in the studied TEC firms were formed by several dimensions of innovations. In addition to technological aspects, innovations were, for instance, related to new client interfaces and service delivery processes. The main enablers of and barriers to innovation seem to be partly similar in Singaporean firms as compared to the earlier study of Finnish TEC firms. Empirical studies also brought forth the significance of various sources of knowledge and knowledge processing activities as themain driving forces of service innovation in technology-related KIBS firms. A framework was also developed to study the effect of knowledge processing capabilities as well as some moderators on the innovativeness of TEC firms. Especially efficient knowledge acquisition and environmental dynamism seem to influence the innovativeness of TEC firms positively. The results of the study also contributeto the present service innovation literature by focusing more on 'innovation within KIBs' rather than 'innovation through KIBS', which has been the typical viewpoint stressed in the previous literature. Additionally, the study provides several possibilities for further research.

Competitor Information andCompetitive Knowledge Management in a Large Industrial Organization

Thisthesis supplements the systematic approach to competitive intelligence and competitor analysis by introducing an information-processing perspective on management of the competitive environment and competitors therein. The cognitive questions connected to the intelligence process and also the means that organizational actors use in sharing information are discussed. The ultimate aim has been to deepen knowledge of the different intraorganizational processes that are used in acorporate organization to manage and exploit the vast amount of competitor information that is received from the environment. Competitor information and competitive knowledge management is examined as a process, where organizational actorsidentify and perceive the competitive environment by using cognitive simplification, make interpretations resulting in learning and finally utilize competitor information and competitive knowledge in their work processes. The sharing of competitive information and competitive knowledge is facilitated by intraorganizational networks that evolve as a means of developing a shared, organizational level knowledge structure and ensuring that the right information is in the right place at the right time. This thesis approaches competitor information and competitive knowledge management both theoretically and empirically. Based on the conceptual framework developed by theoretical elaboration, further understanding of the studied phenomena is sought by an empirical study. The empirical research was carried out in a multinationally operating forest industry company. This thesis makes some preliminary suggestions of improving the competitive intelligence process. It is concluded that managing competitor information and competitive knowledge is not simply a question of managing information flow or improving sophistication of competitor analysis, but the crucial question to be solved is rather, how to improve the cognitive capabilities connected to identifying and making interpretations of the competitive environment and how to increase learning. It is claimed that competitive intelligence can not be treated like an organizational function or assigned solely to a specialized intelligence unit.

Information sharing in R&D collaboration - Context-dependency and means of governance

Tiedon jakaminen ja kommunikointi ovat tärkeitä toimintoja verkostoituneiden yritysten välillä ja ne käsitetäänkin yhteistyösuhteen yhtenä menestystekijänä ja kulmakivenä. Tiedon jakamiseen liittyviä haasteita ovat mm. yrityksen liiketoiminnalle kriittisen tiedon vuotaminen ja liiketoiminnan vaatima tiedon reaaliaikaisuus ja riittävä määrä. Tuotekehitysyhteistyössä haasteellista on tiedon jäsentymättömyys ja sitä kautta lisääntyvä tiedon jakamisen tarve, minkä lisäksi jaettava tieto on usein monimutkaista ja yksityiskohtaista. Lisäksi tuotteiden elinkaaret lyhenevät, ja ulkoistaminen ja yhteistyö ovat yhä kasvavia trendejä liiketoiminnassa. Yhdessä nämä tekijät johtavat siihen, että tiedon jakaminen on haastavaa eritoten verkostoituneiden yritysten välillä. Tässä tutkimuksessa tiedon jakamisen haasteisiin pyrittiin vastaamaan ottamalla lähtökohdaksi tiedon jakamisen tilanneriippuvuuden ymmärtäminen. Työssä vastattiin kahteen pääkysymykseen: Mikä on tiedon jakamisen tilanneriippuvuus ja miten sitä voidaan hallita? Tilanneriippuvuudella tarkoitetaan työssä niitä tekijöitä, jotka vaikuttavat siihen, miten yritys jakaa tietoa tuotekehityskumppaneidensa kanssa. Tiedon jakamisella puolestaan tarkoitetaan yrityksestä toiselle siirrettävää tietoa, jota tarvitaan tuotekehitysprojektin aikana. Työn empiirinen aineisto on kerätty laadullisella tutkimusotteella case- eli tapaustutkimuksena yhdessä telekommunikaatioalan yrityksessä jasen eri liiketoimintayksiköissä. Tutkimusjoukko käsitti 19 tuotekehitys- ja toimittajanhallintatehtävissä toimivaa johtajaa tai päällikköä. Työ nojaa pääasiassa hankintojen johtamisen tutkimuskenttään ja tilanneriippuvuuden selvittämiseksi paneuduttiin erityisesti verkostojen tutkimukseen. Työssä kuvattiin tiedon jakaminen yhtenä verkoston toimintona ja yhteistyöhön liittyvättiedon jakamisen hyödyt, haasteet ja riskit identifioitiin. Tämän lisäksi työssä kehitettiin verkoston tutkimismalleja ja yhdistettiin eri tasoilla tapahtuvaa verkoston tutkimusta. Työssä esitettiin malli verkoston toimintojen tutkimiseksija todettiin, että verkostotutkimusta pitäisi tehdä verkosto, ketju, yrityssuhde- ja yritystasolla. Malliin on myös hyvä yhdistää tuote- ja tehtäväkohtaiset ominaispiirteet. Kirjallisuuskatsauksen perusteella huomattiin, että tiedon jakamista on aiemmin tarkasteltu lähinnä tuote- ja yrityssuhteiden tasolla. Väitöskirjassa esitettiin lisää merkittäviä tekijöitä, jotka vaikuttavat tiedon jakamiseen. Näitä olivat mm. tuotekehitystehtävän luonne, teknologia-alueen kypsyys ja toimittajan kyvykkyys. Tiedon jakamisen luonnetta tarkasteltaessa erotettiin operatiivinen, projektin hallintaan ja tuotekehitykseen liittyvä tieto sekä yleinen, toimittajan hallintaan liittyvä strateginen tieto. Tulosten mukaan erityisesti tuotekehityksen määrittelyvaihe ja tapaamiset kasvotusten korostuivat yhteistyössä. Empirian avulla tutkittiin myös niitä tekijöitä, joilla tiedon jakamista voidaan hallita tilanneriippuvuuteen perustuen, koska aiemmin tiedon jakamisen hallintakeinoja tai menestystekijöitä ei ole liitetty suoranaisesti eri olosuhteisiin. Nämä hallintakeinot jaettiin yhteistyötason- ja tuotekehitysprojektitason tekijöihin. Yksi työn keskeisistä tuloksista on se, että huolimatta tiedon jakamisen haasteista, monet niistä voidaan eliminoida tunnistamalla vallitsevat olosuhteet ja panostamalla tiedon jakamisen hallintakeinoihin. Työn manageriaalinen hyöty koskee erityisesti yrityksiä, jotka suunnittelevat ja tekevät tuotekehitysyhteistyötä yrityskumppaniensa kanssa. Työssä esitellään keinoja tämän haasteellisen tehtäväkentän hallintaan ja todetaan, että yritysten pitäisikin kiinnittää entistä enemmän huomiota tiedon jakamisen ja kommunikaation hallintaan jo tuotekehitysyhteistyötä suunniteltaessa.

Dynamics of Appropriability - Finding a Balance between Efficiency and Strength in the Appropriability Regime

Building and sustaining competitive advantage through the creation of market imperfections is challenging in a constantly changing business environment - particularly since the sources of such advantages are increasingly knowledge-based. Facilitated by improved networks and communication, knowledge spills over to competitors more easily than before,thus creating an appropriability problem: the inability of an innovating firm to utilize its innovations commercially. Consequently, as the importance of intellectual assets increases, their protection also calls for new approaches. Companies have various means of protection at their disposal, and by taking advantage of them they can make intangibles more non-transferable and prevent, or at leastdelay, imitation of their most crucial intellectual assets. However, creating barriers against imitation has another side to it, and the transfer of knowledge in situations requiring knowledge sharing may be unintentionally obstructed. Theaim of this thesis is to increase understanding of how firms can balance knowledge protection and sharing so as to benefit most from their knowledge assets. Thus, knowledge protection is approached through an examination of the appropriability regime of a firm, i.e., the combination of available and effective means ofprotecting innovations, their profitability, and the increased rents due to R&D. A further aim is to provide a broader understanding of the formation and structure of the appropriability regime. The study consists of two parts. The first part introduces the research topic and the overall results of the study, and the second part consists of six complementary research publications covering various appropriability issues. The thesis contributes to the existing literature in several ways. Although there is a wide range of prior research on appropriability issues, a lot of it is restricted either to the study of individual appropriability mechanisms, or to comparing certain features of them. These approaches are combined, and the relevant theoretical concepts are clarified and developed. In addition, the thesis provides empirical evidence of the formation of the appropriability regime, which is consequently presented as an adaptive process. Thus, a framework is provided that better corresponds to the complex reality of the current business environment.

The role of trust and its evolution in distributed teams in a multinational organisation

Tutkimuksen päätavoitteena on ollut selvittää miten kansallinen ja organisaatiokulttuuri, niihin liittyvät normit ja arvot edesauttavat tai vaikeuttavat luottamuksen kehittymistä monikulttuurisissa tiimeissä maailmanlaajuisessa organisaatiossa. Tutkimuksen avulla haluttiin myös selvittää miten luottamus kehittyy hajautetuissa monikansallisissa tiimeissä WorldCom Internationalissa. Empiirinen tutkimusmenetelmä perustuu kvalitatiivisiin teemahaastatteluihin, jotka tehtiin WorldComin työntekijöille. Tutkimuksessa havaittiin, ettei yhteisten sosiaalisten normien merkitys luottamuksen syntymiselle ole niin merkittävä, koska WorldComin yhtenäiset toimintatavat sekä hallitseva amerikkalaisen emoyhtiön "kotikulttuuri" muodostavat yhtenäiset toimintalinjat tiimeissä. Tietokonevälitteisen kommunikoinnin jatkuva käyttö on edesauttanut työntekijöiden ns. sosiaalisen älyn kehittymistä, sillä henkilökohtaisen tapaamisen puuttuminen kehittää vastaavasti taitoja aistia ja tulkita sähköpostien tai puhelinneuvotteluiden aikana välittyviä vastapuolen "näkymättömiä" vihjeitä.

The Key Features of Knowledge and Knowledge Management in Product Development Process

Tutkimusongelmana oli kuinka tiedon johtamisella voidaan edesauttaa tuotekehitysprosessia. Mitkä ovat ne avaintekijät tietoympäristössä kuin myös itse tiedossa, joilla on merkitystä erityisesti tuotekehitysprosessin arvon muodostumiseen ja prosessien kehittämiseen? Tutkimus on laadullinen Case-tutkimus. Tutkimusongelmat on ensin selvitetty kirjallisuuden avulla, jonka jälkeen teoreettinen viitekehys on rakennettu tutkimaan rajattua ongelma-aluetta case-yrityksestä. Empiirisen tutkimuksen materiaali koostuu pääasiallisesti henkilökohtaisten teemahaastattelujen aineistosta. Tulokset merkittävimmistä tiedon hyväksikäytön haittatekijöistä, kuten myös parannusehdotukset on lajiteltu teoreettisessa viitekehyksessä esitettyjen oletustekijöiden mukaan. Haastatteluissa saadut vastaukset tukevat kirjallisuudesta ja alan ammattilaiselta saatua käsitystä tärkeimmistä vaikuttavista tekijöistä. Tärkeimmät toimenpiteet ja aloitteet joilla parannettaisiin tiedon muodostumista, koskivat ennnen kaikkea työnteon ulkoisia olosuhteita, eikä niinkään tiedon muodostumisen prosessia itseään. Merkittävimpiä haittatekijöitä olivat kultturiin, fyysiseen ja henkiseen tilaan ja henkilöstöresursseihin liittyvät ongelmat. Ratkaisuja ongelmiin odotettiin saatavan lähinnä tietotekniikan, henkilöstöresurssien ja itse tiedon muokkaamisen avulla. Tuotekehitysprosessin ydin tietovirtojen ja –pääomien luokittelu ja tulkitseminen tiedon muodostusta kuvaavan Learning Spiralin avulla antoi lähinnä teoreettisia viitteitä siitä millaisia keinoja on olemassa tiedon lisäämiseen ja jakamiseen eri tietotyypeittäin. Tulosten perusteella caseyrityksessä pitäisi kiinnittää erityistä huomiota tiedon dokumentointiin ja jakamiseen erityisesti sen tiedon osalta, joka on organisaatiossa vain harvalla ja/tai luonteeltaan hyvin tacitia.

The use of future-oriented knowledge in regional innovation processes: Research on knowledge generation, transfer and conversion

The importance of the regional level in research has risen in the last few decades and a vast literature in the fields of, for instance, evolutionary and institutional economics, network theories, innovations and learning systems, as well as sociology, has focused on regional level questions. Recently the policy makers and regional actors have also began to pay increasing attention to the knowledge economy and its needs, in general, and the connectivity and support structures of regional clusters in particular. Nowadays knowledge is generally considered as the most important source of competitive advantage, but even the most specialised forms of knowledge are becoming a short-lived resource for example due to the accelerating pace of technological change. This emphasizes the need of foresight activities in national, regional and organizational levels and the integration of foresight and innovation activities. In regional setting this development sets great challenges especially in those regions having no university and thus usually very limited resources for research activities. Also the research problem of this dissertation is related to the need to better incorporate the information produced by foresight process to facilitate and to be used in regional practice-based innovation processes. This dissertation is a constructive case study the case being Lahti region and a network facilitating innovation policy adopted in that region. Dissertation consists of a summary and five articles and during the research process a construct or a conceptual model for solving this real life problem has been developed. It is also being implemented as part of the network facilitating innovation policy in the Lahti region.

Supporting the Management of the Knowledge Flow from the Customers in CRM through a VCE

Knowledge flow from the customers is an important resource for a company and therefore it should engage its customers in knowledge co-creation. Through providing a virtual customer environment (VCE) as knowledge creation and sharing platform a company can obtain this type of knowledge, which is important for strategic purposes. In the VCE the members of the virtual customer community (VCC) create and share knowledge individually and collectively in diverse roles, utilizing many interaction facilities. Creating a functional VCE is not either easy or quick task and a company needs to analyze various issues carefully. Providing such a VCE in which customers want to share their experiences and insights is however worth of considering, since it brings many benefits for the company. In this research the main benefit is stated as the supportative role of the VCE in the better management of the knowledge flow from the customers.

Web 2.0+ educación: colaboración y recursos abiertos

Con la llegada de la web 2.0, ha sido posible para todos los usuarios participar y colaborar en la construcción del conocimiento, además de servir al dominio público gracias al intercambio libre y legal de los contenidos y a su reutilización. Además los recursos educativos abiertos, son un concepto reciente en lo que respecta a la organización del mundo de intercambio de variedad de materiales y herramientas educacionales, e instituciones como la UNESCO están interesadas en el desarrollo de estos, para ser utilizados en una escala tan amplia y global como sea posible. Sin embargo los REA están teniendo algunas dificultades para alcanzar su eficacia, ya que hay algunas diferencias cruciales en la organización y en la interacción de estas redes abiertas. Este artículo intenta realizar un análisis del intercambio libre y legal de los contenidos y su reutilización utilizadas como apoyo para el aprendizaje en diferentes espacios en línea, aprovechando las posibilidades tecnológicas que permiten conformar nuevas estructuras de socialización-colaboración en línea.

Knowledge Management in China and in Finland- A cross country comparison

Nowadays, knowledge management (KM) is important for the success of individuals, organizations, and countries. While comparative study approach of knowledge management is a good way to enlarge peoples‘ understandings of KM, how these processes and practices are different across countries is an interesting research topic. The goal of this study is to conduct a cross-country KM comparison between China and Finland. More specifically, the current status of Chinese and Finnish KM will be studied, and then comparisons will be made in three dimensions: knowledge processes, knowledge management practices, and performance and perceptions of KM. A cross-country KM survey was conducted through a well-designed questionnaire. At the end of the study, current Chinese and Finnish KM findings are presented respectively, and a comparison of KM between the two countries is done. From the comparison, it was found that China and Finland have statistically significant differences in several knowledge processes and KM practices. Some detailed information from the comparison is also illustrated. This research partly filled the theoretical gap in understanding contemporary Chinese KM. The KM comparison between China and Finland provides useful information to KM researchers and practitioners.

Developing the measurement and management of knowledge: applying the constructive research approach in a knowledge intensive service environment

Intellectual assets have attained continuous attention in the academic field, as they are vital sources of competitive advantage and organizational performance in the contemporary knowledge intensive business environment. Intellectual capital measurement is quite thoroughly addressed in the accounting literature. However, the purpose of the measurement is to support the management of intellectual assets, but the reciprocal relationship between measurement and management has not been comprehensively considered in the literature. The theoretical motivation for this study rose from this paradox, as in order to maximise the effectiveness of knowledge management the two initiatives need to be closely integrated. The research approach of this interventionist case study is constructive. The objective is to develop the case organization’s knowledge management and intellectual capital measurement in a way that they would be closely integrated and the measurement would support the management of intellectual assets. The case analysis provides valuable practical considerations about the integration and related issues as the case company is a knowledge intensive organization in which the know-how of the employees is the central competitive asset and therefore, the management and measurement of knowledge are essential for its future success. The results suggest that the case organization is confronting challenges in managing knowledge. In order to appropriately manage knowledge processes and control the related risks, support from intellectual capital measurement is required. However, challenges in measuring intellectual capital, especially knowledge, could be recognized in the organization. By reflecting the knowledge management situation and the constructed strategy map, a new intellectual measurement system was developed for the case organization. The construction of the system as well as its indicators can be perceived to contribute to the literature, emphasizing of the importance of properly considering the organization’s knowledge situation in developing an intellectual capital measurement system.

Intra-organizational knowledge transfer in a Finnish multinational company

The ability of a multinational company to effectively transfer knowledge from one unit to another can create a great source of competitive advantage and is crucial for long-term success. However, in their attempts to disseminate existent knowledge across national boundaries, organizations encounter several obstacles. Especially challenging is the transfer of tacit knowledge, the most valuable kind, as it is embedded in the minds and the behavior of people. The purpose of this study is to identify the main factors and challenges to be considered in intra-organizational knowledge transfer and consequently develop a framework that could be utilized to improve the process. The research is of qualitative nature and it adopts an exploratory approach. The study was further conducted as an intensive single-case study through studying a Finnish multinational company, and the researcher adopted a role as a participant observant in the research setting. Other data collection methods include semi-structured interviews and an online survey. The research findings show that knowledge transfer is currently challenging within the international sales organization of the case company. The majority of knowledge is currently concentrated in the company headquarters, and it is not always systematically distributed to the regional offices abroad. The main factor affecting knowledge transfer seems to be the organizational culture, which does not support or encourage knowledge sharing. The company is struggling in having a common place for information and employees that lack proper social networks have difficulties accessing relevant knowledge. Some recommended improvement suggestions include the institutionalization of knowledge transfer by turning it into an articulated organizational goal, and the implementation of a reward system that includes soft factors, such as teamwork and knowledge sharing behavior. Furthermore, the organizational culture should be more open and supportive in order to reinforce trust. Individuals in regional offices should be given better support by offering them dedicated mentors and increasing the amount of expatriation. Finally, knowledge should actively be codified and stored in commonly shared platforms where it is easily accessible by all employees.