The Knowledge
Management Paradox: Bridging Knowledge and Pedagogy for Clinical Care
Khalid Samara, Dilip
Patel, Shushma Patel, London
South Bank University
ABSTRACT:
Knowledge management and learning are both evolving practices enhancing individual‘s learning and understanding through provision of information. Knowledge management systems (KMS) are normally characterised as technologies to provide and access information. However, the pedagogical approaches used are more important than the procedural features of the technology. The paper proposes a knowledge based pedagogical framework (KBP) to highlight the involvement of knowledge management (KM) in healthcare organisations. In the healthcare there are yet unanswered questions concerning the part that knowledge plays in decision-making and key challenges to integrate patient’s value, evidence and choice into a KM system. This paper advocates that this could be due to lack of pedagogical practices on assessing the value of knowledge, comprehension and learning applications. The purpose of this study is to gain insight on integrating learning tools and pedagogical practices to discover and manage knowledge systematically within the framework of KM. This blending will help to enrich and address the current KM issues through supporting knowledge activities and by manipulating unstructured, heterogeneous knowledge sources. The framework proposes to enhance rapid and accurate identification of tacit and explicit knowledge between learners to identify KM and pedagogical approaches for the purpose of exploiting and supporting the healthcare knowledge community.
Keywords: Knowledge Management, Pedagogy, e-learning, Healthcare, Tacit and Explicit Knowledge
1. Introduction
This paper explores some key theories and understandings around how KM
systems are made in healthcare. The evolution of KM
and of the professional world has integrated knowledge and information
technology. This integration calls for pedagogical practices centred on the practitioner to appreciate the ways in which
KM and e-learning agents can be blended to
become proactive, interactive, adaptive
and cognitive. However, the challenge is how to create the
learning environment that is normally an absent practice (Kay &
Dyson, 2006). What’s more the autonomous and implicit nature of the
practitioner and the organisation incorporating the
use of knowledge management practices may prove to be challenging (Sheaff & Pilgrim, 2006). As advances in medicine occur
more regularly, the knowledge that practitioners possess may easily
become obsolete, and practitioners with more experience may
paradoxically be less likely to provide adequate care (Choudhry
et al., 2005).
Though codified knowledge is explicit by definition, when knowledge becomes codified the potential of this rich knowledge source may require further learning. However, what this paper examines is the problematic nature of tacit knowledge with respect to both detecting and representing it, that tacit knowledge is one of the main causes of disruption in the knowledge learning cycle (Purves & Robinson, 2004). Practitioners manage this unique learning paradox with various levels of personal skills, yielding a broad variety of information based on a multitude of information, such as clinical guidelines, evaluation reports and efficiency studies, which are highly scattered among deferent systems and services. Therefore, pedagogical decision requires greater attention to tame the increasing frequency of changes to the organisational operations, the applications used, and knowledge-culture of the growing range of unstructured heterogeneous knowledge sources.
Though KM is not without challenges it has pioneered the ways in which intelligent businesses have mounted and disseminated information. Knowledge management provide the framework infrastructure for supporting quality of practice through human learning and organisational tools. However, the current information systems present two basic problems; firstly they are able to process only a small portion of the whole organisations knowledge; secondly they use heterogeneous models and techniques for representing knowledge and manipulating them (Gualtieri & Ruffolo, 2005). To demonstrate these concerns this paper presents a case description and framework to describe how unstructured and structured information can be represented and processed by applying pedagogical practices.
The framework facilitates the fusion of unstructured heterogeneous knowledge sources and illustrates the linkages among management (societal) actions, environmental conditions, pedagogical and technological actions (societal-technical). Thus, this frame will provide the basis for developing and testing to explain the current knowledge management conditions. It focuses on three areas: encapsulates and refines individual needs, a tool for a generic learning system and a framework for the design and evaluation of potential learning tools. Also three types of tacit knowledge are discussed: the rules of thumb that support the decision-making, the collective actions of people and the conventions of tacit knowledge.
2. Knowledge
& Learning
This paper argues that while knowledge is growing and changing faster than ever before the practitioner is becoming less responsive and adapted to those changes. In exploring these issues, more needs to be drawn on learning theory and combine these with knowledge transfer. The development and transfer of explicit knowledge implies that it is possible to short circuit the learning cycle (Newell, 2005). Knowledge transfer entails that each individual or organisational unit require not to learn from the foundation level but can rather learn from the experiences of others (Newell, 2005). What’s more as the knowledge structure of the practitioner is mainly tacit, and the cognitive workload of the practitioner increases so does the need to transfer knowledge into explicit sources crucial as a whole to the experiential dynamics of the organisation. These sources are the supporting motivation, which connect the need to support the fusion of heterogeneous knowledge sources and the unstructured multifaceted conditions in clinical care, which makes this intervention desirable. Whenever possible, knowledge should be complemented with evidence from knowledge sources such as clinical evaluations, efficiency studies, and requirement assessments, internal and external policies. Evidence base encourages learning and provides knowledge distribution, knowledge generation and regeneration.
However, the knowledge base that currently exists to support healthcare is not adequate for the challenges met by evidence-based policy and guidelines, which are predominantly found in clinical decision-making (Kawamoto et al., 2005; Gilgun, 2005; Heneghan, 2005). The belief is that evidence based guideline is found consistent and tested information, however, how are decisions made in the absence of codified knowledge and what is the role of critical knowledge sources such as evidence-based guidelines. What’s more if the rules of thumb are the main source of knowledge then clearly the case of guidelines procedure become redundant and eventually falls into disuse. The answer should not be diluted so as to say that tacit knowledge can or will replace evidence-based guidelines or vice versa, in fact, one cannot work without the other. The incorporation of pedagogical activity and individual perceptive actions toward the design of e-learning tools is an absent link. This integration focuses on the practitioner to realize the ways in which their knowledge and e-learning can be blended to enhance the role of tacit knowledge. Also its integration with various types of knowledge may amount to an example of knowledge creation. Although KM solutions can be directed towards the practitioner-patient interaction, they are in tune with neither the complexity of the experience, nor the actions that make up expert practice, nor the narrative structures that support thought and reflection (Purves & Robinson, 2004).
For example, e-learning, provide real-time sharing and editing, discussion forums, brainstorming and idea generation an environment produced by collaborative learning and presenting pedagogical contents to practitioners. In a collaborative learning environment, the group is an active body; therefore, the system may contain information that refers to it as a whole, in time the practitioner become their own tutor or the trainer where the aid of another person is no longer required. The emphasis at this point is to build a robust learning environment to tackle the richness required for drawing on the individual’s skills and experience in improvising a response to the initial challenge.
This concept of discipline is based on the assumption that what individuals learn, impacts their learning and actions in the later stages. Figure.1 presents a tool in that knowledge and understanding are not acquired passively but in an active manner through personal experience and experiential actions. This tool can be used to establish clear entry points and rationale for applying the range of action learning. For example the hospital manager is acting as a facilitator and moderator and starts by identifying the existing problems with the practitioner and organisation. This tool shows how action learning process is a recurring one, starting at the top and moving round systematically, giving each member the opportunity to present a problem, the challenges that need to be confronted, and the systems both technical and social to facilitate transfer. To apply the proposed model below the paper will later present an implementation plan based on an existing case description.
3.
A Knowledge Based Pedagogical Framework
Figure 1: KBP Framework
3.1. Tool Development And Framework Evaluation
Existing Problems: Start to present problems, challenges and concerns an issue that concerns the organisation (to improve the challenges faced by staff and organisation) In the case with health organisations improvements in patients experience can only be achieved if the workforce is well educated and that education is constantly restored. In identifying pedagogical activities needs both promoting change and impeding change.
Key Pedagogical Process: Before starting an action learning process the hospital/organisation needs to measure the accuracy of the existing problem and what different elements have to be learned, and what the organisation have to share in the realm of action learning and KM. Identify appropriate e-learning tools are in place to achieve maximum knowledge sharing.
Management Issues: Should be targeted at people (i.e. health executives, hospital managers) with the power to make decisions and change things (seeing the bigger picture). In other words, identify if power used in a negative or potentially destructive manner within the system. How is power distributed across the system? How do the key players within the community exercise their power and what are the external influences. Identify any requirements from practitioners, nurses, duty staff etc. Is the knowledge base adequate and distributed effectively across the system? Identify any inadequate learning and training resources and apply action learning when needed. Involve external players in decision-making and change processes. Discover appropriate e-learning agents, for representing knowledge and people. Identify if the potential e-learning tool is adequate for the ongoing learning environment and if features provide knowledge contribution. Provide training and promote the implementation of a virtual learning environment developed to support teaching and learning.
Identify Future Problems: Should be targeted at people with the power to make decisions and change things. Begin to examine learning deficiencies or challenges, identify future drawbacks and address them to external bodies, tackle future training needs and generate hypotheses determining whether a problem exists; create an risk analysis of the problem; identify information needed to understand the problem. Identify the barriers and risks of the formation of knowledge and take action, (societal) barriers, environmental barriers, pedagogical barriers and technological barriers (societal-technical). If problem persists then add and return to Level 1 to correct the challenges faced. However no further level of action can be taken until problem is defined and shared.
Staff’s View: The view of the
staff is central to the pedagogical and knowledge conversion
(Those practitioners, hospital managers, nurses) identify isolated or those
restrictors. Aim those where better knowledge sharing will have the most
influence. Identify those who have problems with understanding or using
e-learning facilities. Review problems and opportunities, by means of
interviews and/or workshops.
Tacit in Action: The actions,
modified, monitored and reflect on positive actions, thus allow expression of
tacit knowledge that might otherwise be difficult to share. Actions need to be
monitored and repeated where the aid of another person is eventually no
longer required.
Staff’s Knowledge Base: Identify relevant and quality knowledge sources and play to what is already in people's minds. Provide facilities to store knowledge in a repository and map to create relationships and relevance of contents. The idea of creating a knowledge storage facility is central also to the pedagogical activities for the purpose of reuse, dissemination and training.
4. The Knowledge Management Paradox And
E-Learning
It is acknowledged that the new knowledge based global economy face complex
challenges such as they require new paradigms of learning, computer literacy,
critical thinking, information analysis and how to manage the accumulation of
heterogeneous knowledge sources. This paper argues that to adapt to the specificities of heterogeneous knowledge sources the
health organisation requires the blending of
pedagogical and KM approached to create a distributed knowledge system.
These challenges are also hindered by the absence of knowledge base in strengthening and identifying the complexity of knowledge creation. The heterogeneity of these knowledge sources needs to be determined in order to present a reliable and consistent method of fusion. The fusion of knowledge sources allows greater knowledge base for retrieval and collection of knowledge as well as exploiting key sources. However one of the key barriers of managing heterogeneous knowledge sources in hospitals is the multifaceted dynamics of the organisation. Thus, the clustering of unmanageable knowledge sources impedes information discovery and retrieval in a dynamic, open environment. The complex knowledge sources need to be understood in context nonetheless, the tacit knowledge builds greater problems as apposed to what KM provides, such as knowledge gained through learning, collaboration and methodical technological framework.
It is also widely accepted that e-learning environment provide learners with opportunities for activities, which are valuable for knowledge construction and supports the fusion of heterogeneous knowledge sources. The e-learning environment assists in this, by leveraging knowledge sources and acts also as a repository so that the learner may collaborate and identify other knowledge sources.
Figure 2: Connecting Pedagogy
& KM for Supporting Knowledge Sources
Figure 2 presents how a relationship of pedagogical approaches/KM and heterogeneous knowledge sources provide a means to manage and tame various electronic learning tools and discover, access and retrieve information from surveys or clinical guidelines and external sources. In order for the health organisation to make effective use of the various e-learning tools, expert systems and groupware, or even intranets they would need added pedagogical approaches to understand the role of KM or technology driven KM systems. Through the various levels of transition individual knowledge is made more explicit by a process of enforcing the learning of KM and acknowledging applications of knowledge such as decision-making, planning and problem solving. Hence, this paper advocates that KM is a by-product of e-learning tools and collaborative environments although needs to be transformed into an appropriate representation of a knowledge based community. The necessity to develop organisational learning infrastructure through which knowledge can be created and diffused is an important dynamic toward the goal of creating an effective KM system.
5. Case Illustrating The Problem Of KM And Learning
5.1. Case Description
Learning and innovation was the beginning of a policy of clinical governance and modernisation. The policy focuses on multi-disciplinary responsibility of colleagues working together in a clinical area to manage risk, implement evidence-based policies, and learn from their mistakes (Sheaff & Pilgrim 2006). In this policy, they set out some objectives and concerns about developing learning organisations in the new National Health Service (NHS).
In 2002 the
From another perspective, the research gap suggests three possible explanations: deficiencies in dissemination, resistance or rejection by practitioners, and cognitive and value mismatch (Purves & Robinson, 2004). In particular the Trust suffered from incorporating a robust running of learning environment to adhere to correct clinical procedures and holistic knowledge base to determine quality information.
5.2. Review And
Analysis Of Case
It is reported that five years prior to1997 the actual incident occurred, at Furness General Hospital NHS Trust, the department of health presented an incident guideline however, prior to and since this incident no updates have been made to tackle for developing clear goals and plans. There are a number of reasons why the guideline was not properly updated:
1. A clear indication of poor knowledge transfer for integrating distributed knowledge sources, which would lay the basis for better evidence base guideline
2. The uncertainty in the health legislation for systematic analysis of evidence used for assessments relating to clinical and health policy in areas of outbreaks
3. The complexity of the incident and poor knowledge base was likely to lead into ineffective management and communication
4. Derelict in achieving a robust learning environment
5. Health organisations view that technology, innovation and competition are strictly made only for business environments leading to neglect in the success of KM, learning tools, information systems and technology
6. Poor communication with external bodies i.e. General Practitioner, Primary Care Trust (PCT) and Local Government.
There are claims that after the incident, new ‘guidelines’ has been written-up and presented to other NHS hospitals, however knowledge transfer has yet not been successful. Thus, a proper KM in this incident cannot be singled out and a policy guideline requires commitment to a concept in which health KM generates through a knowledge integrative and didactic perspective. In contrast identifying these forces needs both promoting change and impeding change, and so what are those barriers preventing change from happening. There is a greater reliance on knowledge process and little in presenting knowledge creation, knowledge as force display.
6. A Generic Implementation Of A KBP Framework
Table 1, is a further representation of the KBP framework (Figure 1) seven stages constituting a frame for analysing the hospital knowledge requirements of a KBP process. The first two are incorporated of present and future perspectives of problems as they do not add value by themselves and therefore is tackled through integration. Using the above literature as a starting point, one can identify common themes or constructs to deliver more rounded information.
Level
1 & 4 Level
2 Level 3 Level 5 & 6 Level 7 Existing
& Future Problems Key
Pedagogical Process Management & Organisational Issues Staffs View & Tacit in
Actions Staffs Knowledge Base Existing
problems identified: (1) Knowledge Base (2) Heterogeneous decision making
systems (3)
Tackle the rule of thumb decision-making process (4) Cognitive overload Hospital
challenges faced with outdated knowledge sources – need to review
and take action External
deficiencies Identified need to address them to clinical staff, senior
officers, GP’s, council, auditors, health and safety executive Training
deficiencies identified: Need for future information on training
opportunities Dilemmas
in designing a long term learning organisation Problems
in changing hospital structure and knowledge culture required to ensure
continues learning Knowledge
creation also includes know-how this may entail expert labour and standardisation
of knowledge creation (take expert advise and distribute
information) The
following barriers restricting the hospitals common knowledge creation: Problems
in switching technologies these Implications preventing highly specialised technologies that can leverage knowledge
easily Problems
identifying individual as an asset Dilemmas
identifying knowledge as an asset - Apply pedagogical Analysis Policies and
Management - Learning barriers
identified: Clinical staff responsible for the legionnaires should
receive action learning - Ensure appropriate ICT
systems are in place - Promote a virtual learning
environment to be proactive, interactive, adaptive and cognitive - Apply virtual tools to
increase promote, store and map clinical information -
Expert systems and groupware, or
even intranets should be included to aid in important decision making - Gather experience on
positive and negative features resulted from KM and Pedagogical
activities - Identify poor leadership - Review a radical change of
practice which has caused problems to exchange ideas - A need for hierarchical
structure: for Clinical decision making - Identify poor leadership - Act on advice and concerns
raised - Are decisions about change
made rapidly and by the people with the most knowledge of the issue - A need for robust risk
management - Produce policy and make
sure it is being, adhered to - Communicate authority,
competence and knowledge to manage, and control the necessary requirements - Effective communications
include face-to-face and collaborative mechanisms - Produce effective
educational learning methods to reinforce evidence based policy and not
heavily rely on institution or intimate acquaintances - Effective Health Management
of the hospital depends on non-active participation of the entire
clinical staff - Managerial systems:
Deficiency in the internal/external communication policies - Management and staff need
a sound knowledge of the management and control of infection in general
as well as the specifics of hospital infection control -Insure that clinical management structure the
information and resources around users needs by applying the technology
to target -Individualise information and
resource access, development of ‘intelligent agents’ or
search engines -Identify those who have problems with understanding
or using e-learning facilities. -To take next step of action: review problems and
opportunities, by means of interviews and/or workshops – record and
self-reflect - Awareness of knowledge
creation - Awareness of the various
applications of knowledge - Distribution and sharing
of knowledge - Awareness of outdated knowledge - Identify poor leadership - A lack of information
identified: for relevant and quality information to store as a knowledge
base - Identifying and
facilitating learning as a knowledge base -Identify a sufficient knowledge repository - Assess and reuse knowledge - Be prepared for emergent learning opportunities - Break knowledge based barriers by identifying other
clinical knowledge sources and relate them to yours - Change knowledge based climate towards a knowledge
based community - Be prepared for evidence based guidelines - Identify poor leadership - Encourage experts to be prepared for learning
opportunities - Map and
relate key knowledge sources
Table 1: A Generic Implementation Of A Knowledge Based Pedagogical Framework
7. Conclusion
It has been widely recognised that active and timely pedagogical approaches is needed in both public health and strategic management of healthcare to support the integration of KM and technologies. However, the actual core of the KM challenge is to blend knowledge across groups for which IT can play a key role (Alavi & Leidner 2001). However, this paper argues that this paradox can be dramatically alleviated if the role of experiential learning becomes part of the KM environment. Pedagogical activity is necessary for building collaborative environments and KM can facilitate in accelerating this by integrating tools and knowledge distribution. This integration could also effectively assist in discovering complex and emerging patterns of heterogeneous knowledge sources.
This paper presented a framework for standardising
pedagogical activities and knowledge
distribution, to provide learners awareness of a long-term effective knowledge
based health community. The KBP framework is about conceptualising
how a health organisation can develop superior
strategy by understanding the knowledge flow in a complex network of
relationships for knowledge creation and innovation. The implementation and
evaluation of the case description is shown to be an important aspect of analysing how a pedagogical environment can accelerate
knowledge distribution, discovery and creation.
Health organisations need to
promote knowledge sharing processes among health workers through the establishment
of standardised policies and procedures and the
implementation of indispensable learning and technology infrastructures.
8. References
Alavi, M. & Leidner,
D. E., 2001, Review: Knowledge Management and Knowledge Management Systems:
Conceptual Foundations and research issues, MIS Quarterly, Vol. 25 (1) pp. 107-136
Choudhry; K.N, Fletcher R.H. & Soumerai, S.B., 2005, Systematic Review: The Relationship
between Clinical Experience and Quality of Healthcare, Ann Intern Med, Vol. 142 (4) pp. 260-273
Gilgun, J.F.,
2005, The Four Cornerstones of Evidence Based Practice in Social Work, Research
on Social Work Practice, vol.15 (1) pp.3-9
Gualteri, A. & Ruffolo,
M., 2005 An Ontology-Based Framework for Representing Organisational Knowledge, In: Proceedings of I-Know 05,
Heneghan, C.,
2005, The Doctor’s Advice and Sleepless Nights: what can you find in 5
minutes, British Medical Journal, Evidence-Based Medicine, vol.10,
pp.37-38
Joseph C., 2002, New outbreak of legionnaires’
disease in the
Kay, R. & Dyson, L.E., 2006, learning to Collaborate and Collaborating to Learn: An Experiential Approach to Teaching Collaborative Systems, Journal of Theoretical and Applied Electronic Commerce Research, Vol.1 (2) pp.36-44
Kawamoto, K., Houlihan, C.A., Balas, E.A. & Lobach, D.F., 2005, Improving Clinical Practice Using Clinical Decision Support Systems, British Medical Journal, vol.330, pp.1-8
Newell, S., 2005, Knowledge Transfer and Learning: Problems of Knowledge Transfer Associated With Trying to Short-Circuit The Learning Cycle, Journal of Information Systems and Technology Management, Vol. 2, (3) pp. 275-290
Purves, I. & Robinson, P., 2004, Knowledge Management for Health: What ’Tools’ Can Improve the Performance of Workgroups, Clinicians and Patients? Medinfo, pp. 678–682
Sheaff, R. & Pilgrim, D., 2006, Can Learning Organisations in The Newer NHS, Implementation Science Vol.1 (27) pp.1-11
Smith, A.F, Wild, C. & Law, J.,
2005, ‘The Barrow-in-Furness legionnaires’
outbreak: qualitative study of the hospital response and the role of the major
incident plan, British Medical Journal, British Association for Accident and
Emergency Medicine, Vol.22, pp.251-255
Contact the Authors:
Professor Dilip Patel, Professor Shushma Patel, Khalid Samara, Faculty of Business,
Computing & Information Management, Centre For
Information Management and E-Business, Room 330,