ReviewKnowledge mobilisation in healthcare: A critical review of health sector and generic management literature
Highlights
► Knowledge mobilisation literature 2000–2008 crossing health (public sector) and generic management is critically reviewed. ► Communities of Practice theorem has been imported into health; power perspectives have been exported by using health sites. ► Resource Based View of the firm is well-developed in general management but absent from the public sector literature. ► Epistemology is a common preoccupation, with a simple-to-complex vector of development. ► Vocabulary differs, featuring ‘knowledge’ in generic management literature and ‘evidence’ or ‘research’ within healthcare.
Section snippets
Introduction and background
There is a well established literature on implementing clinical evidence into practice, but less consideration of how management and organisational knowledge gets into practice in healthcare organisations. We here focus on the literatures on knowledge management and knowledge mobilisation (the latter term is preferred as it is looser, signalling unplanned outcomes or possible resistance). These literatures have expanded both in relation to healthcare organisations and the broader generic
Methods: a phased literature review 2000–2008
We structured the review by selecting 29 academic journals (Phase 1), using the UK Association of Business Schools and Web of Science rankings as a guide to identifying ‘high quality’ journals, and then snowballing to earlier references. Within this phase, the generic management literature (20 journals) was reviewed first and then the healthcare literature (9 health and social science journals). It was later supplemented by a search of electronic databases (Phase 2) to capture practitioner/grey
Mapping the terrain through induction
Each paper was assigned to a single ‘leading’ domain, even though material frequently had a cross-cutting element. The social practice perspective of Orlikowski (2002) and Brown and Duguid (2001), for example, was located in Communities of Practice, but was integral to understanding Types of Knowledge and Knowing. The inductive approach allowed for the handling of early ambiguity, since the papers did not form themselves neatly into either-or compartments. We avoided a dualist ‘this but not
What did we find?
We first of all describe the content of the literatures searched, setting the twelve domains within four broad groupings. Inter-relationships between these domains, together with their dominant academic discipline (e.g. social psychology underpins the organisational learning stream) and mode of enquiry (e.g. ethnography is dominant within the cultural stream), are summarised in Table 1. The matrix shows the frequency with which papers were coded to each domain in the management journal search (M
Taxonomies and philosophical enquiry
A major question is: ‘what is knowledge and how do we know what we know?’ The starting point among authors in The Nature of Knowledge and Knowing domain is a hierarchy of data-information-knowledge, depicted as a continuum in which “data require minimal human judgement, whereas knowledge requires a maximum judgement” (see Tsoukas & Vladimorou, 2001, p. 976). A distinction between tacit and explicit knowledge is attributed to Polanyi (1962) and developed by Nonaka (1994). Orlikowski (2002) moves
Theoretical positions
The Resource Based View of the Firm comes from industrial economics and strategic management. The firm produces value, exploiting knowledge as an intangible asset. The organisation or firm gains competitive advantage by protecting and mobilising its core resources (Penrose, 1959, Barney, 1991, Wernerfelt, 1984). Subsequent debates attempt to integrate relational and resource-based views of knowledge, e.g. by linking trust and performance in strategic alliances (Connell & Voola, 2007). Teece,
Disciplinary fields
Information Science/Information Technology (IS/IT) literature is more action than theory-driven. Its attraction to codified knowledge and application lends itself to ‘toolkits’ and formalised implementation frameworks. IS/IT papers retrieved are of two types. One group is empirical, surveying or testing technical solutions, but the (small) second group takes a philosophical view, debating the personalised and the codified (Hansen, Nohria & Tierney, 1999). Personalised approaches are supported
Flows, processes and structure
The remaining four domains collectively make up the largest grouping, describing the structures and dynamic processes of knowledge mobilisation.
The Knowledge Transfer domain takes a functionalist approach, in which knowledge is commodified as an asset that can be ‘moved around’ to augment organisational performance. Transfer is alternatively described as diffusion, sharing, and may be related to adoption of innovation. Newell, Swan, and Galliers (2000) studied Business Process Reengineering as
Time-line trajectories: from simple rules to complex processes
The review concentrated on the 2000–2008 period, with a backward glance through snowballed references. IS/IT was the initial core of the knowledge management movement. Easterby-Smith, Crossman, and Nicolini (2000) noted that 70% of publications on KM pre 2000 were written by information specialists focussing on technical issues such as database design. They anticipated, correctly, that debate would shift towards the human dimension since social factors were impairing IS/IT implementation. We
Comparative analysis: cross-overs and gaps
Is there cross-over between the generic management and healthcare literatures or do they inhabit distinct epistemic Communities of Practice? We consider four categories in turn.
- (a)
Cross-Over from Generic to Health Management occurred when Bate and Robert (2002) introduced Communities of Practice theory. CoP shifted attention away from macro systems towards the micro level of practitioner communities. The concept fits easily with the multi professional groups of doctors, nurses and indeed managers
Three theoretically informed statements to structure future enquiry
We here explore implications of our review for future enquiry, asking where are the main gaps in the current literature and how might it fruitfully develop. We place suggested future work within a clear social science positioning.
Firstly, and as noted, RBV ideas do not feature in current health literature. RBV theory brings in important ideas from industrial economics (Penrose, 1959) and strategic management (Teece et al., 1997), distinctively focussing on themes of productivity, performance
Concluding discussion
The knowledge mobilisation perspective has emerged as an important strand in UK health policy in response to an identified ‘second translation gap’ (Treasury, 2006) whereby new knowledge does not readily translate into practice across the clinical field. Understanding this gap requires a grounding in relevant social science literature(s) and cannot just be explored through a technicist knowledge management literature. Our review of these expanding and diffuse literatures identified many–and
Acknowledgement
The authors acknowledge the support of the UK National Institute of Health Research Service Delivery and Organisation Programme. The views expressed are those of the authors and not necessarily those of the NIHR SDO or the Department of Health.
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